Treatment

The choice of therapy or combination of therapies used to treat esophageal cancer depends upon the stage of the disease, the age and physical condition of the patient and other factors. The five principal types of treatment are:

• Surgery
  • Esophagectomy
    This treatment is frequently used for early-stage esophageal cancer. The diseased portion of the esophagus and any effected lymph nodes are removed and the remaining portion of the esophagus is reconnected to the stomach. When the removed section is too long to permit reconnection, a section of the large intestine may be grafted in between the stomach and the remaining esophagus.

  • Esophagogastrectomy
    When esophageal cancer has spread to the stomach, an esophagogastrectomy, in which the diseased part of the esophagus, the upper part of the stomach and nearby lymph nodes are removed. The remaining part of the stomach is pulled up and reattached to the esophagus. A section of large intestine may be grafted between the stomach and esophagus if necessary.

• Radiation Therapy
  Radiation may used either before surgery or in combination with chemotherapy as the primary treatment. Radiation therapy for esophageal is primarily done with a series of external beam treatments, but brachytherapy, in which pellets of radioactive material are implanted near the tumor is sometimes used.
  • Intensity-Modulated Radiation Therapy
    Thompson was one of the first facilities in the world to treat patients with intensity modulated radiation therapy. Since 1998 more than 1,000 patients have received IMRT treatment at Thompson. In IMRT the multileaf collimator reshapes the treatment field between individual doses of radiation for maximum dosage to the tumor with minimum damage to surrounding healthy tissue.

  • TomoTherapy
    Thompson was the first facility in the world to treat head and neck cancers with TomoTherapy.

    This advanced technology's exact tumor mapping; image-registration patient positioning system; and helical-pattern, intensity-modulated, collimator-controlled radiation beam allow maximum doses to be focused on the area to be treated with minimum damage to surrounding tissue.

  • HDR brachytherapy
    In high-dose-rate brachytherapy radioactive pellets are implanted into the tumor. The benefits of the technology are significant. Treatment time is reduced, affected areas receive a maximum dose and surrounding healthy tissue is spared.

    Thompson at Methodist pioneered high-dose-rate brachytherapy in 1998, and has done more than 700 procedures with this technology. The HDR brachytherapy team here is the most experienced in the area.

    Thompson's Downtown facility has the area's first dedicated brachytherapy suite. The patient's scan is made and all preparation for treatment is done right in the HDR brachytherapy suite. Since the patient doesn't have to be transported from a separate CT room to the treatment area, the placement of the radioactive pellets is more precise. And with a dedicated suite, treatment can always be scheduled exactly when needed.

• Chemotherapy
  Chemotherapy is used to shrink tumors before surgery and in combination with radiation therapy as the principal treatment when surgery or photodynamic therapy are not good options.

• Photodynamic Therapy
  Photodynamic therapy is used to treat early-stage esophageal cancer. The Laser Center at Thompson is a world teaching center for this technique, which uses a light-activated drug, and laser light to destroy abnormal cells. The PDT balloon needed to deliver an effective, controlled dose of laser light to the area of interest was developed at the Thompson Laser Center, and many physicians and others who participated in the study leading to FDA approval of the procedure were trained at this facility.

• Electrocoagulation
  Electrocoagulation kills esophageal cancer cells with electricity.