Approximately 16,000 new cases of esophageal cancer are diagnosed each year. Most people are symptomatic at the time of diagnosis, and symptoms include difficulty swallowing, weight loss, pain on swallowing or inability to pass liquids or solid food. The most common type of esophageal cancer is known as adenocarcinoma, which usually arises in the lower esophagus near the stomach and is caused by gastroesophageal reflux disease (GERD). GERD is a condition that exposes the esophagus to high levels of acid produced by the stomach and causes significant inflammation and changes (Barrett's Esophagus, dysplasia) that can lead to cancer in the esophagus. The second most common type of esophageal cancer is known as squamous cell carcinoma, which is mostly related to smoking and/or alcohol use.
The diagnosis of esophageal cancer is usually made once symptoms occur. An esophagoscope (special tube with small video camera attached to the tip) is passed into the esophagus and used to perform a biopsy in order to make a definitive diagnosis.
Tumor staging is a method to determine how advanced esophageal cancer may be. This includes a staging system (TNM) that specifically describes (T) the thickness of the tumor, (N) lymph node status and (M) spread to other areas of the body. Ascertaining the tumor stage, the surgeon can determine the treatment plan by addressing the following questions:
In our practice, we obtain accurate results for staging by performing a minimally-invasive esophageal cancer staging procedure known as Endoscopic Ultrasound (EUS). Additional staging techniques required for esophageal cancer staging include a PET/CT scan.
Surgery, or esophageal resection, is recommended in those patients who have early stage esophageal cancer; the procedure is performed before or after chemotherapy and radiation, depending on the tumor stage. We perform three different procedures for esophageal resection: Transhiatal Esophagectomy, Transthoracic Esophagectomy (Ivor-Lewis), and Three-Incision Esophagectomy (McKeown). We are currently involved in a nationwide clinical trial sponsored by a major oncology group (ECOG-E2205) that is designed to determine the effects of chemotherapy and radiation before and after surgery for the treatment of esophageal cancer using novel targeted anti-cancer drugs.
Palliation. Patients who are not considered fit for surgical resection due to health issues or advanced disease may be candidates for procedures that may improve, or palliate, their symptoms. We perform esophageal dilation and stenting for people who may develop obstruction caused by esophageal cancer and are unable to pass liquid or solid food. Different types of stents are used to maintain patency of the esophagus in order to preserve the ability to continue oral feeds so that patients can avoid placement of feeding tubes to maintain adequate nutrition.
A stent is a tube inserted into the esophagus or airway that prevents obstruction caused by a tumor. We have extensive experience with the insertion of different types of stents that are effective in improving a patient's quality of life by enhancing their ability to eat or breathe. Some patients require removable stents during chemotherapy or radiation before definitive surgery in order to help them do well during their pre-operative treatment. Other patients require permanent stents in the esophagus or airway system for definitive treatment if surgery is not an option.
Achalasia is a benign motor disorder of the esophagus that can result in difficulty swallowing liquid and solid food. Although some forms of treatment for achalasia include Botox injection or balloon dilation, the most effective method of treatment or "gold standard" is surgery. Laparoscopic Modified Heller Myotomy is a minimally-invasive procedure that corrects the abnormal part of the esophagus found in patients with achalasia. The procedure is performed through small incisions in the abdomen using a laparoscopic approach. Hospital stay after surgery is usually two days, and patients return home eating soft food then are quickly advanced to a regular diet.
GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD) AND DIAPHRAGMATIC HERNIAS
Gastroesophageal reflux disease (GERD) causes heartburn and is the result of acid produced in the stomach that ascends into the esophagus causing irritation that can lead to esophageal cancer. Most people with GERD obtain significant relief of their symptoms of heartburn with medications that reduce acid production by the stomach (proton pump inhibitors). However, there are people who continue to have symptoms despite use of medications. These people may be candidates for a minimally invasive procedure that helps maintain a physical barrier between the stomach and esophagus to prevent reflux of acid out of the stomach by creating a wrap of the stomach around the esophagus known as a laparoscopic Nissen fundoplication.
For patients with paraesophageal hernias, prior anti-reflux surgery and chronic diaphragmatic hernias, we offer laparoscopic, thoracoscopic and open procedures as indicated.
ESOPHAGEAL (ZENKER'S) DIVERTICULUM AND DYSMOTILITY
An esophageal diverticulum is formed by an outpouching of the esophagus. They can occur at different levels of the esophagus. Zenker's diverticulum are found at the base of the neck and may be related to spasm of the adjacent muscle sphincter (cricopharnygeus).
We offer a minimally-invasive treatment option using endoscopic transpharyngeal cricopharngeal mytomy for symptomatic patients with Zenker's Diverticulm.
Esophageal strictures can be caused by congenital webs, longstanding acid reflux or injury from ingestion of caustic substances or prior surgery. We offer endoscopic dilation, stents and surgery as indicated.