- Esophagus Cancer Treatment According to its Phase
- Zero Phase Treatment
- Treatment Phase I
- Treatment Phases II and III
- Treatment Phase IV
Esophagus Cancer Treatment According to its Phase
In general, the primary treatment of esophageal cancer depends on its phase and invasion of the body. However, other things, as general well-being of a patient, can also impact cancer therapy. Discuss with your doctor the treatment plan suggested by him or her.
Zero Phase Treatment
Actually, the zero phase is not a real cancer. It is characterized by the presence of high-grade dysplasia, which is a kind of initial cancer. There are pathologic cells, which look like cancerous ones. They are found in the inner layer of cells lining the esophagus. They do not invade deep layers of the esophagus. This phase is usually revealed during a routine biopsy in case of Barrett’s esophagus.
Therapy in this case usually involves endoscopic methods, as photo radiation therapy, radiofrequency ablation (RFA) or endoscopic mucosal resection (EMR). Patients should adhere to long-lasting follow-up with periodical upper endoscopy. It is essential to watch pre-cancer cells in the esophagus after endoscopic therapy
There is one more option: the pathologic part of the esophagus can be excised with esophagectomy. This is the main surgical attack. It has one very important advantage: the lifelong follow-up with endoscopy is not needed.
Treatment Phase I
This phase is characterized by the invasion of deep layers of one`s esophagus by the cancer. However, the malignant tumor has not invaded the globate glands or any other organ.
There are T I cancers (belonging to the phase I), when malignant growth invades only a little part of mucosal lining and hasn`t yet grown into the sub-mucous membrane. They can be treated with endoscopic mucosal resection, which is typically followed by endoscopic manipulations to remove the remainder of pathological areas in the esophagus.
However, the majority of patients with cancers of the phase I, whose state of health is enough for a surgical attack, usually have it (esophagectomy). As a rule, chemical therapy and beam-therapy are used afterwards, especially, in the case of the remainder of some cancerous cells.
There are cancers, when malignant growth has invaded the muscularis propia (T2 cancers or tumors). In this case, beam-therapy is often used before a surgical attack. If the malignant growth is less than 2 cm, only surgery can be used. However, if the tumor is near the stomach, chemical therapy in combination with beam-therapy can be applied before the surgical attack. The targeted agent (Herceptin) can be used with chemical therapy if the cancer is HER2 positive and the beam-therapy is not used.
When the malignant growth is located in the top part of the esophagus (in the neck area), chemical therapy is usually recommended as the essential treatment instead a surgical attack. In some cases, it can cure the cancer. Follow-up with endoscopy is strongly recommended afterwards in order to reveal any cancer returning.
Patients with the 1st phase of cancer, who are not able to have a surgical attack due to health concerns or who are against any surgical attack, can have ERM or endoscopic ablation, chemical therapy, beam-therapy or their combination as treatment.
Treatment Phases II and III
Phase II combinates cancers, which have invaded the main muscle layer of the esophagus. It can also invade the connective tissue on the external surface of the esophagus. This phase also involves cancers, which have spread to one or two lymph glands.
Phase III combinates cancers, which have invaded the outer layer or close organs and tissues. The cancers of this phase can also invade close lymph glands.
If the state of health of patients is good enough, chemical therapy in combination with beam-therapy is used, and it is followed by a surgical attack. At the same time, people having adenocarcinoma in the area, where the stomach meets esophagus, are often treated with only chemical therapy and subsequent surgery. The pharmacologic agent trastuzumab can be used as a targeted one for chemical therapy in the case of HER2 positive cancer. Beam-therapy is not used in this case. The surgical attack alone can be applied in case of a small malignant growth.
If a surgical attack is used first, it can be followed by the combination of chemical therapy with beam-therapy. It is especially recommended in case of adenocarcinoma or if some cancerous cells may have been left behind.
In some cases, particularly if cancers are in the upper area of the esophagus, chemical therapy in combination with beam-therapy are the main treatment options without surgery. People, who did not have surgery, should have systematic examinations with endoscopy in order to reveal any sign of remaining cancer. Regrettably, cancerous cells cannot always be visible, though they can be present below the inner cover of the esophagus.
People, who don`t have a surgical attack due to big problems with their health, usually get chemical therapy in combination with beam-therapy as the main treatment.
Treatment Phase IV
In case of the phase IV, the esophageal cancer has invaded distant globate glands or other organs.
All things considered, these types of cancer are hard to become free of. Here, a surgical attack is not the best option. Treatment should keep the cancer under review and relieve its possible symptoms.
Chemical therapy can be used (perhaps, in combination with targeted pharmacologic agent trastuzumab if the cancer is HER2 positive). This can help patients feel better as long as possible. Beam-therapy or other options can be
used to help with pain or trouble swallowing.
In case of a malignant growth at the gastroesophageal junction, treatment option with targeted pharmacologic agent ramucirumab (Cyramza) can be used. It can be applied in combination with chemical therapy.
Some patients prefer not to have therapies with serious bad effects and prefer to receive only treatments that will help keep them comfortable and add to their quality of life.