Oesophageal Cancer Treatment by Stage

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After a person is diagnosed with oesophageal cancer, doctors will try to determine its stage. The cancer stage describes the severity of cancer and the appropriate treatment.

Determining the Stage

The most common way to stage oesophageal cancer is tumour, node, and metastasis (TNM) staging. Tumour (T) describes the area of cancer; Node (N) describes whether the cancer has spread to the nearby lymph nodes; and Metastasis (M) describes whether the cancer has spread to distant lymph nodes and other body parts like the lungs or liver.

Available Treatment Options

Treatment of oesophageal cancer depends on the cancer type, where the cancer has spread, and the patient’s existing health conditions. Treatment may include:

  • Surgery Oesophagectomy refers to a surgery to remove some or most parts of the oesophagus. Stage 1 cancer is usually treated with endoscopic treatment or surgery alone.
  • Chemotherapy – This uses anti-cancer drugs to kill cancer cells. Usually, you do not need chemotherapy for stage 1 oesophageal cancer. You may receive this treatment before surgery if you have stage 2 or 3 cancer.
  • Radiotherapy – Radiotherapy or radiation therapy aims to shrink cancerous tumours and destroy cancer cells through high-energy radiation beams. It can be done before or after surgery or together with chemotherapy.
  • Targeted drug therapy – Newer drugs have been developed to target the changes in cells that cause cancer. These drugs sometimes work when standard chemotherapy drugs do not. This therapy can also be used as a treatment in combination with chemotherapy.
  • Symptom Control (Supportive) therapy -This is a treatment to prevent and relieve the symptoms of oesophageal cancer. Its primary purpose is to improve the quality of life of a cancer patient regardless of stage.

Cancer Stage and Treatment

The patient’s overall health and cancer stage will determine the type of treatment(s).

Stage 0 means there are severely abnormal cells in the inner lining of the oesophagus. The main treatment involves removing them through an endoscopic treatment called endoscopic mucosal resection. It involves putting a thin wire called a snare through the endoscope to remove the abnormal area of the tissue. (An endoscope is a thin, tube-like instrument with a light and a lens for viewing the internal parts of the body). If endoscopic treatment cannot fully remove the abnormal areas, it can be combined with other treatments like light therapy and heat treatment.

Stage 1 usually means that cancer has not spread beyond the thick muscle in the oesophageal wall. Most patients with very early stage 1 cancer can be treated with the same endoscopic treatment (endoscopic mucosal resection). But if they are healthy enough, they can undergo oesophagectomy (surgery) to remove the part of the oesophagus that contains cancer. After surgery, if not all of the tumour was removed, chemotherapy and radiation therapy (chemoradiation) may be given simultaneously.

Stage 2 means the cancer may have spread as far as the outer layer covering of the oesophagus. It may have spread to 1-2 nearby lymph nodes.

Stage 3 means that the cancer may have spread beyond the covering and into nearby tissue (covering of the lungs, outer covering of the heart, or the diaphragm). It may also have spread to nearby lymph nodes. Treatment for stages 2 and 3 is usually chemoradiation followed by surgery.

Stage 4 means that the cancer is advanced. Treatment for this stage aims at controlling the cancer and maintaining a good quality of life. Treatments include chemotherapy, targeted drug therapy, radiation therapy, and symptom control therapy. Chemotherapy and targeted drug therapy help patients feel better and live longer, while radiation therapy and symptom control therapy are used to relieve pain or difficulty swallowing.

Tips to Reduce Risk of Oesophageal Cancer

The risk of developing oesophageal cancer can be reduced by following these tips:

Eat a proper diet and maintain an ideal weight. Following a healthy eating pattern and maintaining a healthy weight are important. Obesity has been linked to oesophageal cancer, so eating a diet rich in fruits and vegetables and engaging in frequent physical activity are recommended.

Quit smoking and reduce alcohol intake. Alcohol and tobacco are two significant risk factors for oesophageal cancer. While these factors increase cancer risk individually, consuming both alcohol and tobacco can increase risk even more. Avoid smoking and reduce your alcohol consumption to limit your risk of this disease.

Get treatment for reflux. Treating acid reflux (gastroesophageal reflux disease) may help prevent oesophageal cancer. Reflux is often treated with lifestyle and diet changes as well as drugs. If these treatments do not work, surgery is an option.

It would be best to seek professional advice from your doctor if you have any of the mentioned factors. Inquire what strategies would work best in managing obesity, quitting smoking, reducing alcohol intake, and treating acid reflux.

Conclusion

There are various treatments for oesophageal cancer. Treatment options may be combined depending on the patient’s overall health and cancer stage. Hence, it is crusial to have an honest and open discussion with your doctor to make an informed decision on a treatment plan.

References

  • https://www.singhealth.com.sg/patient-care/conditions-treatments/esophageal-cancer
  • https://www.healthhub.sg/a-z/diseases-and-conditions/526/esophageal-cancer
  • https://www.parkwaycancercentre.com/sg/learn-about-cancer/types-of-cancer/cancer-details/esophageal-cancer
  • https://www.cancer.org/treatment/understanding-your-diagnosis/staging.html
  • https://www.cancerresearchuk.org/about-cancer/oesophageal-cancer/stages-types-and-grades/tnm-staging#:~:text=for%20oesophageal%20cancer-,TNM%20staging%20for%20oesophageal%20cancer,way%20to%20stage%20oesophageal%20cancer.
  • https://www.cancer.org/cancer/esophagus-cancer/treating/surgery.html
  • https://www.cancerresearchuk.org/about-cancer/oesophageal-cancer/treatment/chemotherapy/chemotherapy-treatment#:~:text=Common%20chemotherapy%20drugs%20for%20oesophageal,or%203%20of%20these%20drugs.
  • https://www.cancer.org/treatment/understanding-your-diagnosis/staging.html
  • https://www.hopkinsmedicine.org/health/conditions-and-diseases/esophageal-cancer/esophageal-cancer-treatment
  • https://www.cancerresearchuk.org/about-cancer/oesophageal-cancer/stages-types-and-grades/

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Upper Gastrointestinal, Weight Loss & General Surgeon
Dr. Lim Khong Hee graduated from the National University of Singapore in 1992. He obtained his postgraduate degree in 1998 and was a Clinical Fellow (HMDP) in Upper Gastrointestinal and Laparoscopic Surgery at the renowned Princess Alexandra Hospital (Brisbane) in 2002.
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