The best cancer care begins with a comprehensive evaluation. At DHRC, the first step in evaluating esophageal cancer is usually an endoscopic examination of the esophagus (esophagoscopy). During this procedure, oncologist guides a thin, lighted tube called an endoscope down the esophagus and into your stomach. The endoscope provides a clear view of the esophagus and allows the oncologist to remove a small sample of tissue (biopsy), which is sent to a pathologist for further study.

In some cases, patient may have a barium X-ray, a test in which a chalky liquid (barium) is used to coat the lining of the esophagus so that the lining shows up clearly on a series of X-rays.

Staging tests

If the patient are diagnosed with esophageal cancer, he will need further tests to determine how deeply the cancer has penetrated into the layers of the esophagus and whether it has spread to the lymph nodes or other organs - a process called staging.

Oncologists at DHRC use state-of-the-art, minimally invasive diagnostic techniques to stage esophageal cancer. Precisely identifying the extent and spread of the disease is a crucial step in selecting the appropriate treatment for each patient. Staging tests used at DHRC include:

• CT scans: The first step in staging esophageal cancer is usually a CT scan, a type of X-ray that produces images of the body in cross sections rather than in the overlapping images produced by conventional X-rays. DHRC offers the most advanced CT technology, which is faster, more sensitive and uses less radiation than do older CT scans.
• Positron Emission Tomography (PET) scan: This test uses a small amount of radioactive glucose to identify rapidly growing cancer cells and detect changes that aren't visible by other methods.
• Endoscopic ultrasound (EUS): During endoscopic ultrasound, a tiny ultrasound probe is placed into the esophagus through an endoscope. The probe produces sound waves that penetrate deep into tissue, detecting how far a tumor may have spread into the esophagus wall. EUS can be technically demanding, and produces the best results when performed by an experienced endoscopist.

Tumour Board Evaluation

All patients who come to DHRC for oncology care start their treatment only after they have been discussed in the Tumor Board and given a Tumor Board Number. In the tumor board all our specialists (Medical Oncologists, Radiation Oncologists, Surgical Oncologists, Oncopathologists, Radiologists and Microbiologists) evaluate and discuss the findings, and chart out the optimal plan of treatment for each patient based on established national and international guidelines and protocols. This treatment plan takes into account the overall health of the patient, the extent (stage) of the cancer and their preferences. The primary treatments for gastric cancer (stomach cancer) include surgery, radiation therapy and chemotherapy.

Oncologists at DHRC see several thousand patient who have esophageal cancer each year. That experience helps them to guide patients toward the most appropriate treatment approach. We take great care to ensure patients understand the benefits and risks associated with each treatment option.

DHRC offers all treatment options for esophageal cancer, including surgery, external beam radiation therapy, Brachytherapy, chemotherapy and targeted therapy.

Tremendous advances have occurred in esophageal cancer treatment over the past decade. DHRC offers an exceptionally comprehensive treatment program that makes full use of the latest therapies.

ENDOSCOPIC THERAPIES

At DHRC, early esophageal cancer is often treated with endoscopic therapies rather than with surgery. Our Surgical Oncologists are among the world's most experienced in the use of these techniques, which preserve the esophagus, cause minimal trauma and have a low risk of complications. Most people need a minimum of three endoscopic treatments, spaced eight to twelve weeks apart, to remove abnormal cells and allow healthy, new cells to grow in their place.

Specialists at all three DHRC offer advanced endoscopic treatments and precisely tailor them to meet the needs of each patient. These therapies include:

• Endoscopic mucosal resection: During EMR, a saline solution is injected under a nodule or lesion in the esophagus. The solution forms a blister that allows oncologists to cut or suction away the lesion, while leaving the rest of the esophagus intact. Patients who undergo this procedure have the same outcomes as people who undergo surgery to remove the entire esophagus.
• Radiofrequency ablation (RFA): In this outpatient procedure, controlled bursts of radiofrequency energy burn away thin layers of abnormal tissue on the surface of the esophagus, leaving healthy tissue intact. Radiofrequency ablation takes about 45 minutes, and patients can usually return to their normal activities the next day, though some patient may experience chest pain and difficulty swallowing for about a week.
• Photodynamic Therapy (PDT): Photodynamic therapy uses a light-sensitive drug and laser light to destroy cancer cells in the esophagus. At the start of treatment, patient were given an intravenous drug called porfimer sodium that makes cancer cells sensitive to light. A few days later, oncologist activates the drug inside the patient's esophagus with a laser light inserted through an endoscope. The laser destroys the targeted cells without harming healthy ones. Photodynamic therapy may also be used to treat cancer that recurs after surgery, radiation or chemotherapy or in conjunction with endoscopic mucosal resection. PDT produces the deepest tissue destruction of any ablative method, but also carries a higher risk of complications.

SURGERY

When cancer is more advanced, surgery to remove the esophagus (esophagectomy) is usually necessary. During the procedure, surgical oncologist remove the damaged portion of the esophagus and sometimes nearby lymph nodes and the upper part of the stomach (fundus).

To re-establish the continuity of the digestive tract, the stomach is formed into a tube and pulled upward to join the remaining portion of the esophagus. DHRC offer both transhiatal esophagectomy, which is performed through the neck and abdomen and is usually effective for cancer higher in the esophagus, and transthoracic esophagectomy, which uses incisions in the abdomen and chest.

When possible, surgical oncologists at DHRC perform esophageal surgery using laparoscopic techniques. Unlike traditional open surgery, which requires long abdominal and chest or neck incisions, minimally invasive esophagectomy uses four or five small incisions that require just a stitch or two to close. This approach causes less trauma to the body, and usually leads to shorter hospital stays, reduced postoperative pain and a faster recovery. Minimally invasive esophagectomy is a complex surgery, but it can produce excellent results in the hands of a skilled surgical oncologist.

COMBINED-MODALITY TREATMENTS

Depending on the extent of the cancer, surgical oncologists may recommend radiation combined with chemotherapy (chemoradiation) before or after surgery. For patients with more advanced disease, chemotherapy and radiation may be the primary treatment.

PALLIATIVE CARE

When cancer is so widespread that treatment options are limited, DHRC offers palliative care to ease symptoms and improve quality of life. In every case, an experienced, integrated team of care providers serves the social, psychological and spiritual needs of patients and their families.

The team may include physicians from a number of fields as well as dietitians, medical social workers, psychologists, pharmacists and pain management specialists. If the patient is facing a serious illness, the primary treatment team will consult with a DHRC palliative care expert who then works with your primary consultants to address the needs of the patient and their family. DHRC is committed to providing every patient with compassionate end-of-life care.