Esophageal cancer treatment in 869 Oncology and Thoracic surgery clinics worldwide

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869 clinics specializing in Oncology and Thoracic surgery providing treatment of Esophageal cancer Esophageal cancer is a malignancy that develops in the esophagus, the tube connecting the throat to the stomach. It can cause difficulty swallowing, weight loss, and other symptoms. Early detection is crucial for better outcomes.
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disease worldwide.

Africa · 14
Americas · 183
Asia · 265
Europe · 370
Oceania · 37
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Africa · 14 Americas · 183 Asia · 265 Europe · 370 Oceania · 37
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Prices for popular procedures:
  1. Video-assisted thoracic surgery (VATS)
    $58,980
  2. Total esophagectomy
    $58,980
  3. Esophagogastrectomy
    $54,579
  4. Esophagocoloplasty
    ≈ $13,141
  5. Esophageal dilation
    ≈ $3,842
  6. Esophageal stenting
    ≈ $11,275
  7. Jejunostomy
    ≈ $13,001
  8. External beam radiotherapy (EBRT)
    by request
  9. LINAC based stereotactic radiosurgery
    by request
photo
Seoul, South Korea
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology, Dentistry
The hospital is fully devoted to elevating its medical service quality by introducing state-of-the-art equipment and systems such as Robot surgery, Linear Accelerator, 3.0T MRI, read more
Prices for popular procedures:
  1. Esophagocoloplasty
    ≈ $949
  2. Esophageal dilation
    ≈ $236
  3. Esophageal stenting
    ≈ $616
  4. Thoracoplasty including sternoplasty
    ≈ $1,495
  5. Diagnostic thoracoscopy
    ≈ $597
  6. Repair of diaphragmatic hernia
    ≈ $413
  7. Rectum anterior resection
    $588
  8. Conization
    ≈ $614
  9. Open hysterectomy
    $325
photo
Colombo, Sri Lanka
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
Languages: English
It is located in Sri Jayewardenepura, the capital of Sri Lanka, on nearly 30 acres of beautifully landscaped garden with serene nature. This state of read more
Prices for popular procedures:
  1. Video-assisted thoracic surgery (VATS)
    $2,007
  2. Total esophagectomy
    $3,843
  3. Esophagogastrectomy
    ≈ $18,952
  4. Esophagocoloplasty
    ≈ $1,609
  5. Esophageal dilation
    ≈ $438
  6. Esophageal stenting
    ≈ $1,354
  7. Jejunostomy
    $985
  8. Thoracoplasty including sternoplasty
    ≈ $3,288
  9. Diagnostic thoracoscopy
    $924
photo
Almaty, Kazakhstan
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology, Dentistry
Languages: English, Russian
At the Almaty SEMA Hospital Clinic, you can get a full range of medical services provided by our leading specialists. Whether you need a small read more
Prices for popular procedures:
  1. Total esophagectomy
    ≈ $5,268
  2. Esophagogastrectomy
    ≈ $8,317
  3. Esophagocoloplasty
    ≈ $1,845
  4. Esophageal dilation
    ≈ $528
  5. Esophageal stenting
    ≈ $1,465
  6. Jejunostomy
    ≈ $1,601
  7. Radiation therapy
    by request
  8. LINAC based stereotactic radiosurgery
    by request
  9. Chemotherapy for stomach cancer
    by request
photo
Lajeado, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Orthopedic surgery, Oncology
Bruno Born Hospital is a philanthropic institution, with more than 80 years. It is registered with the National, State and Municipal Councils of Social Assistance read more
Prices for popular procedures:
  1. Total esophagectomy
    ≈ $5,268
  2. Esophagogastrectomy
    ≈ $8,317
  3. Esophagocoloplasty
    ≈ $1,845
  4. Esophageal dilation
    ≈ $528
  5. Esophageal stenting
    ≈ $1,465
  6. Jejunostomy
    ≈ $1,601
  7. Radiation therapy
    by request
  8. Chemotherapy for stomach cancer
    by request
  9. Thoracoplasty including sternoplasty
    ≈ $2,713
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ Hospital São Camilo Pompeia has followed, over the years, the growth of the population and the scientific and technological advances aimed at medical and read more
Prices for popular procedures:
  1. Total esophagectomy
    ≈ $5,268
  2. Esophagogastrectomy
    ≈ $8,317
  3. Esophagocoloplasty
    ≈ $1,845
  4. Esophageal dilation
    ≈ $528
  5. Esophageal stenting
    ≈ $1,465
  6. Jejunostomy
    ≈ $1,601
  7. Chemotherapy for stomach cancer
    by request
  8. Thoracoplasty including sternoplasty
    ≈ $2,713
  9. Diagnostic thoracoscopy
    ≈ $1,147
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
Integrated into the São Camilo de São Paulo Hospitals Network in March 1979, the Santana Unit has an agile and modern structure implemented to offer read more
Prices for popular procedures:
  1. Chemotherapy for stomach cancer
    by request
  2. Thoracoplasty including sternoplasty
    ≈ $2,713
  3. Diagnostic thoracoscopy
    ≈ $1,147
  4. Repair of diaphragmatic hernia
    ≈ $2,681
  5. Thoracentesis
    ≈ $325
  6. Open chest surgery
    ≈ $4,432
  7. Chest wall deformity correction
    ≈ $2,527
  8. Surgical removal of lung cyst (including hydatid cyst)
    ≈ $3,397
  9. Trachea and air passages surgery
    ≈ $5,952
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
A member of the Network since 2000, Hospital São Camilo Ipiranga has an emergency room for patients aged 12 years and over, an Intensive Care read more
Prices for popular procedures:
  1. Total esophagectomy
    ≈ $5,268
  2. Esophagogastrectomy
    ≈ $8,317
  3. Esophagocoloplasty
    ≈ $1,845
  4. Esophageal dilation
    ≈ $528
  5. Esophageal stenting
    ≈ $1,465
  6. Jejunostomy
    ≈ $1,601
  7. Radiation therapy
    by request
  8. LINAC based stereotactic radiosurgery
    by request
  9. Brachytherapy
    by request
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
Founded in 1968, the Mooca unit is known for being a highly complex Oncological Treatment Center and for having a renowned Clinical Research Center. In read more
Prices for popular procedures:
  1. Video-assisted thoracic surgery (VATS)
    ≈ $4,549
  2. Total esophagectomy
    ≈ $5,268
  3. Esophagogastrectomy
    ≈ $8,317
  4. Esophagocoloplasty
    ≈ $1,845
  5. Esophageal dilation
    ≈ $528
  6. Esophageal stenting
    ≈ $1,465
  7. Jejunostomy
    ≈ $1,601
  8. Radiation therapy
    by request
  9. Chemotherapy for stomach cancer
    by request
photo
Rio de Janeiro, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Quinta D'Or Hospital opened in September 2001 and is located opposite Quinta da Boa Vista, in Rio de Janeiro. It emerged from the renovation read more
Prices for popular procedures:
  1. Targeted therapy
    by request
  2. Chemotherapy for stomach cancer
    by request
  3. Chemotherapy for melanoma
    by request
  4. Chemotherapy for endometrial cancer
    by request
  5. Chemotherapy for gallbladder cancer
    by request
  6. Chemotherapy for colorectal cancer
    by request
  7. Chemotherapy for bone cancer
    by request
  8. Chemotherapy for eye cancer
    by request
  9. Chemotherapy for myeloma
    by request
photo
Belo Horizonte, Brazil
Specializations: Oncology
Founded in 1999, Oncocentro was born with the purpose of offering an integral, welcoming and interdisciplinary service. Over the years, it has become a reference read more
Prices for popular procedures:
  1. Chemotherapy for stomach cancer
    by request
  2. Thoracoplasty including sternoplasty
    ≈ $2,713
  3. Diagnostic thoracoscopy
    ≈ $1,147
  4. Repair of diaphragmatic hernia
    ≈ $2,681
  5. Parotidectomy
    ≈ $1,332
  6. Thoracentesis
    ≈ $325
  7. Open chest surgery
    ≈ $4,432
  8. Chest wall deformity correction
    ≈ $2,527
  9. Cervical lymphadenectomy
    ≈ $2,014
photo
Belo Horizonte, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Lifecenter Hospital stands out among the most sophisticated and renowned health institutions in Minas Gerais. Its activities cover urgent and emergency medical care, surgeries, read more
Prices for popular procedures:
  1. Total esophagectomy
    ≈ $5,268
  2. Esophagogastrectomy
    ≈ $8,317
  3. Esophagocoloplasty
    ≈ $1,845
  4. Esophageal dilation
    ≈ $528
  5. Esophageal stenting
    ≈ $1,465
  6. Jejunostomy
    ≈ $1,601
  7. Targeted therapy
    by request
  8. Chemotherapy for stomach cancer
    by request
  9. Thoracoplasty including sternoplasty
    ≈ $2,713
photo
Salvador, Brazil
Specializations: Vascular surgery, Thoracic surgery, Neurosurgery, Oncology
Founded 30 years ago, the Oncology Nucleus of Bahia (NOB) joined the Oncoclínicas Group in 2014. The clinic offers comprehensive and individualized care to cancer read more
Prices for popular procedures:
  1. Total esophagectomy
    ≈ $24,600
  2. Esophagogastrectomy
    ≈ $60,506
  3. Esophagocoloplasty
    ≈ $3,163
  4. Esophageal dilation
    ≈ $816
  5. Esophageal stenting
    ≈ $2,301
  6. Jejunostomy
    ≈ $2,953
  7. Chemotherapy for stomach cancer
    by request
  8. Thoracoplasty including sternoplasty
    ≈ $5,702
  9. Diagnostic thoracoscopy
    ≈ $2,308
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
We invite you to visit one of the largest health institutions in the country… A sanatorium with history, but looking to the future. The Doctor read more
Prices for popular procedures:
  1. Chemotherapy for stomach cancer
    by request
  2. Thoracoplasty including sternoplasty
    ≈ $5,702
  3. Diagnostic thoracoscopy
    ≈ $2,308
  4. Repair of diaphragmatic hernia
    ≈ $1,426
  5. Radical prostatectomy
    ≈ $8,699
  6. Transurethral resection of the prostate (TURP)
    ≈ $4,261
  7. Conization
    ≈ $1,995
  8. Open hysterectomy
    ≈ $3,664
  9. Radical nephrectomy
    ≈ $9,537
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The British Hospital of Buenos Aires is a non-profit civil association that aims to provide the community with highly complex health care, train medical professionals read more
Prices for popular procedures:
  1. Total esophagectomy
    ≈ $5,268
  2. Esophagogastrectomy
    ≈ $8,317
  3. Esophagocoloplasty
    ≈ $1,845
  4. Esophageal dilation
    ≈ $528
  5. Esophageal stenting
    ≈ $1,465
  6. Jejunostomy
    ≈ $1,601
  7. Chemotherapy for stomach cancer
    by request
  8. Hemicolectomy
    ≈ $3,335
  9. Rectum anterior resection
    ≈ $3,204
photo
Serra, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Orthopedic surgery, Oncology
Founded in 2001, Vitória Apart Hospital is a center of excellence in high complexity medicine in Espírito Santo, prepared to take care of people's health read more
Prices for popular procedures:
  1. Chemotherapy for stomach cancer
    by request
  2. Thoracoplasty including sternoplasty
    ≈ $5,702
  3. Diagnostic thoracoscopy
    ≈ $2,308
  4. Repair of diaphragmatic hernia
    ≈ $1,426
  5. Radical prostatectomy
    ≈ $8,699
  6. Transurethral resection of the prostate (TURP)
    ≈ $4,261
  7. Conization
    ≈ $1,995
  8. Open hysterectomy
    ≈ $3,664
  9. Radical nephrectomy
    ≈ $9,537
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Hospital de Clínicas José de San Martín is the flagship teaching hospital in our country. Dependent on the University of Buenos Aires, read more
Prices for popular procedures:
  1. Radiation therapy
    by request
  2. LINAC based stereotactic radiosurgery
    by request
  3. Chemotherapy for stomach cancer
    by request
  4. Childhood vascular tumor treatment
    ≈ $736
  5. Coronary artery bypass graft (CABG)
    ≈ $18,212
  6. Laminectomy
    ≈ $8,501
  7. Peripheral artery angioplasty and stent placement
    ≈ $5,532
  8. Arteriovenous (AV) fistula surgery
    ≈ $2,085
  9. Endovascular thrombectomy
    ≈ $3,694
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Hospital "Prof. Dr. Juan P. Garrahan" is the pediatric center of reference in public health, free and highly complex in Argentina. Since its inauguration, read more
Prices for popular procedures:
  1. Radiation therapy
    by request
  2. Chemotherapy for stomach cancer
    by request
  3. Heart valve replacement
    ≈ $25,978
  4. Heart valve repair
    ≈ $22,420
  5. Aortic valve replacement (AVR)
    ≈ $25,227
  6. Mitral valve replacement (MVR)
    ≈ $19,353
  7. Transcatheter aortic valve replacement (TAVR)
    ≈ $34,466
  8. Varicose veins treatment
    ≈ $4,593
  9. Brain aneurysm repair
    ≈ $11,974
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Orthopedic surgery, Oncology
On July 24, 1896, the Pirovano Hospital (which was to be called Belgrano Hospital) opened its doors to ensure the assistance of an original population read more
Prices for popular procedures:
  1. Radiation therapy
    by request
  2. Chemotherapy for stomach cancer
    by request
  3. Thoracoplasty including sternoplasty
    ≈ $5,702
  4. Diagnostic thoracoscopy
    ≈ $2,308
  5. Repair of diaphragmatic hernia
    ≈ $1,426
  6. Radical prostatectomy
    ≈ $8,699
  7. Transurethral resection of the prostate (TURP)
    ≈ $4,261
  8. Conization
    ≈ $1,995
  9. Open hysterectomy
    ≈ $3,664
photo
Rosario, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
More than 100 years ago, on June 24, 1912, the Spanish Hospital was inaugurated in Rosario, driven by the demand for health care from Spanish read more
Prices for popular procedures:
  1. Video-assisted thoracic surgery (VATS)
    ≈ $12,344
  2. Radiation therapy
    by request
  3. Thoracoplasty including sternoplasty
    ≈ $5,702
  4. Diagnostic thoracoscopy
    ≈ $2,308
  5. Repair of diaphragmatic hernia
    ≈ $1,426
  6. Radical prostatectomy
    ≈ $8,699
  7. Transurethral resection of the prostate (TURP)
    ≈ $4,261
  8. Conization
    ≈ $1,995
  9. Open hysterectomy
    ≈ $3,664
photo
Córdoba, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
We are a benchmark health care network in Argentina and we are committed to offering the world excellent medicine. Our Hospital is among the main read more

Clinics grouping by rating

Clinic with the highest rating of 5 — Berkana clinic in Moscow, Russia and 4 more, clinic with the most reviews number of 35757 — Aster CMI hospital in Bengaluru, India.

With rating 4.0 and over — 297 clinics .

Countries with the highest number of clinics treating the diseases:

Esophageal cancer:

Related procedures:

Esophageal cancer: Overview and Treatment

Overview

Esophageal cancer (EC) is the seventh most commonly diagnosed malignancy worldwide and the sixth most common cause of cancer-related death. [1] Due to the aggressive nature of EC, the 5-year overall survival rate is 30–40%. [2] However, esophageal cancer is quite treatable.

Where does esophageal cancer start?

The esophagus is a part of the digestive system. It is the 25 cm long fibromuscular tube that passes food and liquid from the throat to the stomach. [3]

The esophageal wall is a four-layer structure with a mucosa, submucosa, muscularis propria, and adventitia. [4]

The origin of malignant tumors comes from the cells of the inner layer - the mucosa, which consists of 2 main types of cells:

  • the glandular cells that produce mucus. They give rise to adenocarcinoma.
  • the squamous epithelial cells lining the esophagus. They give rise to squamous cell carcinoma.[4] [5]

Adenocarcinoma and squamous cell carcinoma occur more often. A third, rarer type of esophageal cancer is small cell carcinoma. It begins in neuroendocrine cells, which release hormones into the bloodstream in response to nerve signals.

Other types of esophageal cancer, such as small-cell neuroendocrine cancers, lymphomas, and sarcoma, are rare and comprise less than 1% of esophageal cancers.[5] [6]

Risk factors

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. The following factors may raise the risk of developing esophageal cancer: [5]

  • Age between 45 and 70;
  • Gender. Men are 3 to 4 times more likely to develop esophageal cancer than women;
  • Race. Black people are twice as likely as white people to develop the squamous cell type of esophageal cancer;
  • Tobacco. Using any form of tobacco, such as cigarettes, cigars, pipes, chewing tobacco, and snuff raises the risk of esophageal cancer;
  • Alcohol. Heavy drinking over a long period increases the risk of squamous cell carcinoma of the esophagus, especially when combined with tobacco use;
  • Gastroesophageal reflux disease (GERD) is a condition in which stomach acid repeatedly flows back up into the esophagus;
  • Barrett’s esophagus is a condition in which the flat pink lining of the esophagus becomes damaged by acid reflux, which causes the lining to thicken and become red. Damage to the lining of the esophagus causes the squamous cells in the esophagus lining to turn into glandular tissue. People with Barrett's esophagus are more likely to develop adenocarcinoma of the esophagus.
  • A diet with low fiber;
  • Obesity. Patients with obesity have an increased risk of GERD. Also, adipose tissue cells secrete inflammatory factors that adversely affect the condition of the mucous layer of the esophagus;
  • Lye. Accidental ingestion of the lye that can be found in some cleaning products, such as drain cleaners;
  • Achalasia. Achalasia is a condition when the lower muscular ring of the esophagus does not relax during the swallowing.

Symptoms

Esophageal cancer may not cause symptoms early on; it usually happens when the disease is advanced. These symptoms of esophageal cancer are associated with tumor growth, mechanical obstruction in the esophagus, or destruction of surrounding tissues and organs. [4] [5]

Symptoms of esophageal cancer include:

  • swallowing problems (dysphagia)
  • pain in your throat or the middle of your chest, especially when swallowing
  • choking, nausea, and vomiting
  • heartburn or acid reflux
  • symptoms of indigestion, such as excessive burping
  • a cough that is not getting better
  • a hoarse voice
  • bad breath
  • black stool or coughing up blood (although these are uncommon)
  • loss of appetite or unexplained weight loss
  • feeling tired or having no energy
  • feeling sick

Diagnosis

The primary techniques used to diagnose suspected esophageal cancer include:[6] [7]

  • A barium swallow or contrast esophagram is an imaging test that examines the upper gastrointestinal tract, specifically the esophagus, throat, and back of the mouth. A barium swallow can help diagnose structural or functional issues. Barium is a dry powder that is mixed with water to create a drinkable contrast material that must be taken orally, after which a series of X-rays are taken;
  • Esophagogastroscopy. The doctor passes an endoscope, a thin, lighted tube, into the esophagus to examine it. Endoscopic ultrasound uses sound waves to provide more information about the extent of tumor involvement in nearby tissues.
  • Biopsy: during the endoscopy, the doctor can take tissue samples from suspicious esophagus areas, followed by histological examination under a microscope. Doctors also examine the tumor sample for the presence of proteins that can be affected by targeted drugs.

Other tests, including computed tomography (CT) scans, positron emission tomography (PET) scan, thoracoscopy, and laparoscopy, may be performed to determine if the cancer has spread, or metastasized, outside of the esophagus. This process is called "staging" and is necessary for planning treatment.

Staging

There are different ways of staging esophageal cancer. TNM and number staging systems are most commonly used in clinical practice. [4]

TNM staging system evaluates:

T - the size of the primary tumor

N - involvement of lymph nodes in the tumor

M - presence of metastases.

The number staging system includes five stages, which are:

0 - high-grade dysplasia: abnormal cells (not yet cancer) are found only in the layer of cells that line the esophagus;

I - cancer cells are found only in the layer of cells that line the esophagus.

II - the cancer has reached the muscle layer or the outer wall of the esophagus. In addition, the cancer may have spread to 1 to 2 nearby lymph nodes.

III - the cancer has reached deeper into the inner muscle layer or the connective tissue wall. It may have spread beyond the esophagus into surrounding organs and/or has spread to more local lymph nodes.

IV - the most advanced stage, where cancer has spread to distant organs and/or lymph nodes far from the esophagus.

Treatment

Esophageal cancer is quite a treatable type of cancer. Treatment for esophageal cancer typically includes a combination of surgery, radiation therapy, and chemotherapy.

The choice of treatment regimen depends on several factors, such as:

histological type of cancer

size and tumor location

presence of metastases

patient's health

Surgery

Surgery is the most effective treatment for early-stage esophageal cancer.

If the tumor hasn't spread deeply into the tissue, ablation techniques can be used. These include laser therapy, photodynamic therapy (PDT), radiofrequency ablation, argon plasma ablation (APC), and cryoablation. These methods can be combined with endoscopic resection.

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are good options for lesions that do not penetrate the mucosal layer (T1a) or the lesions that develop only within the epithelium and lamina propria. Endoscopic methods are safe and have a minimal number of complications. These methods are characterized by a short recovery time. [3]

An esophagectomy is the most effective treatment for patients without invasion to adjacent organs or distant metastasis. It involves removing some or most of the esophagus. Depending on the tumor's location and clinic equipment, an esophagectomy can be open or minimally invasive. [4] During an open esophagectomy, the surgeon removes all or part of the esophagus through an incision in the neck, chest, abdomen, or a combination of these areas. The esophagus is then reconstructed using another organ, such as the stomach or the small or large intestine. Minimally invasive esophagectomy includes laparoscopy or robot-assisted techniques. Sometimes, a combination of these approaches may be used. When possible, these procedures are performed through several small incisions, leading to less pain and quicker recovery compared to traditional surgery. [4] [5]

An esophagogastrectomy is used when cancer occurs in the middle or lower part of the esophagus, or it has grown into the stomach. In such cases, removing the top part of the stomach and a part of the esophagus is necessary. An esophagogastrectomy is always accompanied by the need to reconstruct the removed part of the esophagus using part of the intestine. [5]

Lymphadenectomy or lymph node removal is often done during an esophagectomy. Removing the lymph nodes from around the esophagus and examining them for tumor metastases is important. The number of lymph nodes the surgeon removes varies. [4]

The main postoperative issue is restoring nutrition. A gastrostomy tube, surgically placed through the abdominal wall into the stomach, helps the patient continue feeding. This tube can remain in place until the end of therapy.[6]

Radiotherapy

Two types of radiation therapy are used for esophageal cancer: external beam radiation therapy (EBRT) and brachytherapy. Brachytherapy is a type of internal radiation therapy in which a source of radiation is placed in or near the tumor. External beam radiation therapy is used in combination with chemotherapy. This option reduces the radiation dose and intensity of its adverse effects.

Radiotherapy alone is not standard for esophageal cancer due to its high toxicity and limited effectiveness. However, it can be used to control symptoms in advanced esophageal cancer that has spread or in combination with chemotherapy (chemoradiotherapy).

Radiation therapy can be carried out before surgery to reduce tumor size and surgery volume. In advanced stages, when cancer is unresectable, chemoradiotherapy on its own can be the primary treatment. [7]

Systemic therapy

Systemic therapy includes chemotherapy, targeted therapy, and immunotherapy.

Chemotherapy kills fast-growing cells throughout the body, including cancer cells and some normal cells. When chemotherapies are combined, it is called multi-agent or combination chemotherapy. Chemotherapy might be given before surgery (neoadjuvant chemotherapy) and/or after surgery (adjuvant chemotherapy). Long-term multicenter trials confirm the effectiveness of neoadjuvant chemoradiation for patients with squamous cell carcinoma.

Targeted therapy focuses on specific or unique features of cancer cells. It examines how cancer cells grow, divide, and move in the body. These drugs stop or inhibit the action of molecules that help cancer cells grow and/or survive. They are often selected based on next-generation sequencing (NGS) and immunohistochemistry (IHC) results, which are performed on tumor biopsy samples. Several targeted therapies have shown promise in pairing with radiation in preclinical and clinical studies, including epidermal growth factor receptor (EGFR) inhibitors, receptor tyrosine kinase (RTK) inhibitors, cell cycle checkpoint inhibitors (Wee1, Chk1/2), and vascular endothelial growth factor (VEGF) inhibitors, among others.

Immunotherapy can be given alone or with other types of treatment. Immunotherapy is a systemic treatment that tries to reactivate your own immune system against cancer. Immunotherapy may also improve outcomes in the neoadjuvant setting when combined with chemoradiation.[11]

Complications of Treatment

Despite its high effectiveness, the treatment of esophageal cancer is very aggressive and can lead to various complications.

The most common are:

- Functional gastric emptying disorder is defined as delayed gastric emptying in the absence of mechanical obstruction of the stomach;

- Reflux esophagitis is associated with the backflow of acid from the stomach into the esophagus.

- Pulmonary complications

- Chylothorax is a condition where lymphatic fluid, called chyle, accumulates in the pleural cavity, the space between the lungs and the chest wall. It is more often caused by damage to the thoracic duct during surgery.

- Anastomotic or thoracogastric fistula develops due to failure of the suture at the site of resection of the esophagus;

- Anastomotic stenosis or esophageal stenosis, in most cases, is caused by poor healing of the mucous membrane;

- Severe diarrhea: esophageal cancer treatment may also lead to severe diarrhea by causing gastrointestinal dysfunction;

- Radiation damage to the mucous membrane of the oral cavity and esophagus leads to ulceration and severe pain.

Prognosis

Survival depends on several factors, primarily the stage of the disease. Patients with very early-stage disease have a better survival chance. Among those who receive treatment, 40% will survive one year or more, 15% will survive up to five years, and 10% will survive ten years or more. [9]

People with a low body mass index and severe nutritional deficiencies are at risk for developing severe complications of therapy and its interruption. [9]

References

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3. Bajwa SA, Toro F, Kasi A. Physiology, Esophagus. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.

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7. D'Journo XB, Thomas PA. Current management of esophageal cancer. J Thorac Dis. 2014 May;6 Suppl 2(Suppl 2):S253-64.

8. Bolger, J.C., Donohoe, C.L., Lowery, M. et al. Advances in the curative management of oesophageal cancer. Br J Cancer 126, 706–717 (2022).

9. Tustumi F, Kimura CM, Takeda FR, Uema RH, Salum RA, Ribeiro-Junior U, Cecconello I. Prognostic factors and survival analysis in esophageal carcinoma. Arq Bras Cir Dig. 2016 Jul-Sep;29(3):138-141

10. Vitzthum LK, Hui C, Pollom EL, et al. Trimodality Versus Bimodality Therapy in Patients With Locally Advanced Esophageal Carcinoma: Commentary on the American Society of Clinical Oncology Practice Guidelines. Pract Radiat Oncol 2021;11:429-33.

11. Kelly RJ, Ajani JA, Kuzdzal J, et al. Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer. N Engl J Med 2021;384:1191-203.

  • Alejandro Santos, M.D.
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