RECTAL CANCER AND OTHER GASTROINTESTINAL CANCERS
Carcinoma of the Esophagus
Carcinoma of the esophagus may be treated either with surgery or with radiation therapy combined with chemotherapy. The combination of radiation therapy and chemotherapy is more effective than radiation therapy alone. The advantage of surgery compared with radiation therapy and chemotherapy is that there is less likely to be a stricture in the esophagus that could cause swallowing problems after successful treatment. The disadvantage is that a major operation is required.
The optimal treatment at this time appears to be the combination of preoperative chemotherapy and irradiation to facilitate tumor regression followed by esophagectomy (surgical removal of the esophagus) and reconstruction, usually with a gastric transposition (suturing the stomach to the hypopharynx in the neck). This provides a good chance of cure with a relatively low risk of serious complications.
Before any treatment is started, the recommended treatment, the reasons it is recommended, the procedures to be carried out, the expected or possible side effects or complications, and the expected benefits are all explained to the patient and family. The patient must give permission for treatment, based on this knowledge ("informed consent"), before treatment is given.
The radiation is given once a day, 5 days a week, for 25 treatments over 5 weeks. The chemotherapy usually consists of two cycles of fluorouracil (5-FU) and cisplatin during the first and fifth weeks of radiation therapy. The surgery is performed one month after the chemotherapy and radiation therapy, and should be performed by a surgeon experienced with esophagectomies so as to reduce the risk of major complications.
