Treating Early-Stage Esophageal Cancer

Michael Wallace, MD, Mayo Clinic

New Procedure Shown to be Effective in Treating Early-Stage Esophageal Cancer

DEAR MAYO CLINIC:

I've heard there's a new way to treat esophageal cancer that doesn't require removing the esophagus. What does this treatment involve? Does it work as well as the old treatment?

ANSWER:

Cancer of the esophagus, like many other types of cancer, is often curable if caught early. Until recently, though, the only treatment option for people who developed esophageal cancer, even if it was detected early, was esophagectomy -- surgery to remove the esophagus. Now, a new minimally invasive procedure that removes the cancerous cells has been shown to be just as effective as esophagectomy for treating early-stage esophageal cancer.

The esophagus is a long hollow tube that runs from your throat to your stomach. It carries food to the stomach to be digested. Esophageal cancer usually begins in the cells that line the inside of the esophagus. Many people who develop early-stage esophageal cancer are first diagnosed with Barrett's esophagus, a condition in which the cells lining the esophagus change.

Barrett's esophagus is usually a result of repeated exposure to stomach acid and is often diagnosed in people who have long-term gastroesophageal reflux disease (GERD). Esophageal cancer arising from Barrett's esophagus is increasing in frequency faster than any other cancer in the United States. The majority of patients with esophageal cancer have Barrett's esophagus, although, unfortunately, most of them don't know they have it until cancer develops.

When not treated quickly and effectively, esophageal cancer can spread rapidly to other organs. But the traditional treatment for early-stage esophageal cancer -- removal of the esophagus -- is a high-risk surgery that typically involves long-term side effects, such as difficulty swallowing and frequent nausea, vomiting and heartburn. The surgery itself carries a risk of serious complications, too, such as infection, bleeding, leakage of fluid into the tissues surrounding the surgery and, rarely, death.

In a study published in 2009, Mayo Clinic researchers found that early-stage esophageal cancers can be effectively treated with less-invasive, organ-sparing endoscopic therapy. Endoscopy is a procedure done as an outpatient, and under sedation, where a flexible tube is passed by a doctor via the mouth, into the esophagus. The tube has a high definition video camera and operating channels to take biopsies or perform procedures. The researchers compared surgery (esophagectomy) to endoscopic resection of the cancer from the lining of the esophagus.

In the study of 178 patients with early-stage esophageal adenocarcinoma, 132 were treated with endoscopic mucosal resection and 46 were treated surgically with esophagectomy. After following the patients for nine years, the researchers found both groups had a comparable overall mortality rate, making the less-invasive therapy just as effective as surgery for early-stage cancers.

Endoscopic mucosal resection carries a risk of complications, including bleeding, tearing of the esophagus and narrowing of the esophagus. But these are rare and relatively minor compared to the risks associated with esophagectomy. Following the procedure, people who have had endoscopic mucosal resection may need to take smaller bites of food and eat more slowly to avoid food becoming stuck in the esophagus.

After treatment, people who have had endoscopic mucosal resection need regular checkups with their doctors. Follow-up endoscopies are usually required every few months to make sure the cancer doesn't come back. If the cancer recurs, it can often be effectively treated with repeat endoscopic mucosal resection.

This newer minimally invasive procedure is only an option for early-stage cancers. Patients who have more advanced esophageal cancer will likely have to undergo surgery and possibly chemotherapy and radiation. -- Michael Wallace, M.D., Gastroenterology, Mayo Clinic, Jacksonville, Fla.

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