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Surgery for esophageal cancer can be either palliative or curative, depending on what stage the cancer is in and the patient's overall health.

Curative Surgery

In the early stages of the cancer, curative surgery is normally the first option. Surgery to remove the affected lymph nodes and mucosa and tumors is known as an esophagectomy, which is essentially removal of part or the entire esophagus, depending on the extent of damage.

Esophagectomy is said to provide complete reversal, especially if the lesions are in the early stages. For the early stages of cancer, ablation of the esophageal mucosa using an endoscope is still experimental.

The two types of esophagectomy are

• Trans-hiatal esophagectomy or THE, which is performed on both the abdomen and the neck.
• Trans-thoracic esophagectomy or TTE, which as the name suggests requires the surgeon to open the chest cavity.

Palliative Surgery

In cases where the cancer is in its last stages and/or the patient is inoperable, palliative surgery is performed to ease the discomfort. Endoscopic dilation is a good palliative option for tracheoesophageal fistulas and dysphagia.

Procedure

The type of surgery will depend on the location of the cancer and the extent of its spread. An esophagectomy may result in the removal of the entire or part of the esophagus, nearby tissues, affected lymph nodes, and even part or whole of the stomach.

The procedure for a trans-hiatal esophagectomy is as follows:

• Incisions are made in the abdomen as well as chest.
• The surgeon will remove the affected esophagus and pull up the stomach to join it to the remaining esophagus.
• He/she may use a part of the intestine (large or small) to connect your stomach to the esophagus.
• If the stomach also needs to be removed, the remaining part of the esophagus is connected directly to the small intestine.
• The surgeon may also insert a feeding tube in your small intestine to ensure that you obtain adequate nutrition during the healing process.

In advanced but curable cancers, the 5-year survival rate for esophageal cancer is almost 41%. For patients with stage 3 esophageal cancer, survival can be achieved in 25% to 35% of patients, if an esophagectomy is performed.

Complications

You may experience pain post-surgery, albeit this can be controlled with adequate medication. Complications to watch out for post-surgery include:

• Leakage of food from the new joints
• Pneumonia
• Infections
• Breathing problems
• Bleeding

The occurrence of complications is frequent following esophageal cancer surgery. Hospitalization could be anywhere between 10 to 14 days after surgery.

Recovery

While the focus is now shifting to neoadjuvant or preoperative chemoradiotherapy as a means to improve survival, surgery is still often the first line of treatment in resectable cancer.

In people who have undergone an esophagectomy, lingering health problems may result. In a study published in the Journal of Clinical Oncology, it was found that patients who had undergone esophageal cancer surgery and survived for five years experienced fatigue, breathlessness, eating discomfort, insomnia. Further, those who had experienced complications immediately after surgery had more severe symptoms.

Treatment

Esophageal cancer treatment is determined based on the stage in which the cancer is, and it mostly comprises of one or all of the listed options:

• Surgery
• Chemotherapy
• Radiation

Additional treatment options include:

• Endoscopic dilation, where a stent is placed in the esophagus to keep it dilated.
• Photodynamic therapy, where a drug is first injected in the tumor, the tumor is then exposed to light. The light serves to activate the medicine so as to kill the tumor.

References

• http://www.ssat.com/cgi-bin/esoph.cgi
• http://www.cancer.gov/clinicaltrials/results/summary/2007/esophageal0807
• http://www.nlm.nih.gov/medlineplus/news/fullstory_123828.html
• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001328/

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