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The incidence of esophageal cancer is increasing more rapidly than any other gastrointestinal malignancy in the western world. This trend has been attributed to an increase in gastroesophageal reflux (heartburn), which is considered a risk factor for the development of esophageal cancer, particularly when reflux symptoms have been present for more than 10 years. The first symptom to suggest esophageal malignancy is dysphagia, or difficulty swallowing.
Diagnosing Esophageal Cancer
An upper GI barium X-ray may suggest the presence of esophageal cancer, but the diagnosis is confirmed by an upper GI endoscopy and biopsy of the tumor. Further diagnostic tests are then performed to determine the "stage" of the tumor - whether it is confined to the esophagus or involves regional lymph nodes and/or other sites. These tests include a CAT scan of the chest and upper abdomen, endoesophageal ultrasound, and occasionally, a PET scan.
Treatment Options for Esophageal Cancer
If the tumor is determined to be in an early stage (does not invade through the wall of the esophagus, does not involve the lymph nodes, or there is no distant spread) then surgical resection of the esophagus is considered. Unfortunately, many patients present with more advanced disease-when the tumor has already invaded the muscular layer of the esophagus and involves regional lymph nodes. Under these circumstances, multimodality therapy is usually recommended, involving a combination of preoperative chemotherapy and radiation therapy followed by surgical resection.
The type of surgical resection depends upon whether the tumor is located in the upper third, middle third, or lower third of the esophagus. The procedure may entail removing the entire esophagus or two-thirds of the esophagus and a portion of the stomach. Improvements in postoperative management have decreased the risks of surgical resection of an esophageal tumor. Institutions like Lahey Clinic that perform a large volume of these procedures generally produce superior patient outcomes.
Further Information
For additional information on the surgical treatment of esophageal cancer at Lahey, please contact the Department of Cardiovascular and Thoracic Surgery at 781-744-8570.
