B Fruitfull

Acid Reflux causes and Treatment

Treatment of localised and locally advanced esophageal cancer

Treatment of localised and locally advanced esophageal cancer


[Music] First we will discuss the treatment for localized
esophageal cancer. Earlier stages of esophageal cancer are carcinoma
in situ (Tis) and T1a. Endoscopic mucosal resection is the technique
which is used for treatment of Tis and T1a disease. This procedure is performed through an endoscope,
in which first a fluid is injected the lesion, and then lesion is removed from surrounding
structures. As you can see in the figure, only the superficial
cancerous portion is removed, while the remaining tissue remains unaffected. Esophagectomy or removal of esophagus is also
an option for early stage disease, but is practiced less commonly. As you can see in the figure, in esophagectomy,
most of the esophagus is removed. And the stomach is pulled up to be joined
to the remaining part of the esophagus. Now we come to the treatment for T1b disease,
or the disease that infiltrates into the submucosa, without the involvement of lymph nodes. For T1b disease without lymph nodes involvement,
esophagectomy is the preferred treatment. Now, we will discuss the treatment for T2
or T3 disease. That is, the disease which has infiltrated
into muscularis propria or serosa. And for the treatment for esophageal cancer,
which has spread to the regional lymph nodes. In these cases, sugery alone may not be sufficient
for the treatment, so different combination of surgery, radiotherapy and chemotherapy
are used. Cancerbro, how it is decided what combination
of modalities to be used? It is decided by oncologist on an individual
basis, depending upon the exact stage of the disease, the comborbidities and the performance
status of the patient. Now we come to the treatment for T4 disease,
in which the disease extends to involve the adjacent structures. In this figure, the disease has extended to
involve the heart or pericardium. And here, the cancer has spread to the great
vessels of the heart. Here, it invades the lungs or pleora. And here, the cancer has infiltrated into
the diaphragm. And here it has spread to the trachea. In some cases of T4 disease, surgery may not
be possible, so a combinaton of chemotherapy and radiation therapy may be used. And if it is possible, then surgical resection
of the tumor, with or without chemotherapy and radiation therapy is done. In T4 disease also, the decision to do surgery
or not, and to give chemotherapy or radiotherapy is taken by the oncologist on an individual
patient basis after assessing the exact stage of the disease and understanding the comorbidities
and the performance status of the patient.

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