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Esophageal Cancer
Esophagus is a food pipe connecting mouth,pharynx to stomach.
What are symptoms of esophagus cancer?
- Difficulty in swallowing food
- Progressive increase in swallowing problem initially for solids, then semisolid, then liquid also
- Weight loss
- Backache
- Cough
- Change in voice
What should one do if there is above problem?
If persistent problem >2-3 weeks, please consult gastroenterologist or oncologist.
What tests are done to evaluate these patients?
They require
- Endoscopy with biopsy
- Contrast CT scan chest and abdomen to assess surrounding organ involvement and extent of spread
What treatment is needed for ca esophagus?
- Treatment wise esophagus is divided into 3 parts-Upper 3’rd, middle 3’rd, lower 3'rd
- If non metastatic (loacalised) upper 3’rd need chemoradiotherapy
- Middle & lower 3’rd require either surgery or radical radiotherapy
Which is better - surgery or radiotherapy?
Surgery has better quality of life than radiation and better chance of cure. If disease recur after radiation, salvage surgery is extremely difficult, hence fit patient surgery is always first choice. Radiation generally reserved for patient who are medically unfit for surgery.
What are types of surgery?
Two types of surgery
- Transthoracic (through chest)
- Transhiatal (through abdomen)
What is neoadjuvant therapy?
Chemo/radiotherapy given prior to surgery in locally advanced tumors to downstage disease. It increases chances of total removal, and decreases recurrence chances.
What are methods of surgery?
- Open Method
- Thoracoscopy/Laparoscopy (VATS/LAP)
What is done in VATS?
VATS is Video Assisted Thoracic Surgery
In it, esophagus freed from surrounding from surrounding attachment and removing lymph nodes. Then patient is made supine, and laparoscopically stomach is mobilized removing local lymph nodes to make stomach tube. This stomach tube is pulled in neck and joined to upper esophagus part.
What is THE?
- THE (transhiatal esophagectomy) is mobilizing esophagus through abdomen without opening chest
- Some part is done blindly and lymph node are not removed
- Mainly performed for lower esophageal cancer
How safe is this surgery?
This is supramajor surgery. Because of advances in anaesthesia technique and VATS/laparoscopy made this much safer. Chances of death reduced dramatically with above. For fit patients, morbidity is minimal.
What is optimization needed prior to surgery?
Most common complication is chest infection/pneumonitis, because of ventilator requirement. To prevent if chest physiotherapy in form of incentive spirometer exercises are started from beginning of treatment (right from starting neoadjuvant treatment).
Second important is nutritional build up. Neoadjuvant chemo/radiotherapy gives time for both chest optimization and nutritional build up. it is very important for success of surgery.
What are complications of surgery?
Complication with good surgery is minimal.
Known complications are chest infection, bleeding, anastomotic (intestinal joint) leak, stomach tube necrosis, voice change due to nerve handling, thoracic duct leak etc.
What precaution one should take post surgery?
Main thing is decrease in stomach size, hence food capacity decreases. So these patients should take small but frequent feeds.
Other is removal of valve which one way passage from esophagus to stomach which prevent food regurge. Hence these patient should not sleep immediately after food and should always sleep slightly upright (use 2 pillows), this prevent vomiting.