Esophageal Cancer: Why Early Diagnosis and Team-Based Care Mean Better Outcomes.

A burning discomfort in the chest after eating is painful and frustrating. Heartburn that gets worse or keeps coming back can sometimes be an early sign of esophageal cancer, one of the most aggressive types. There’s good news: with early detection and a team of experts on your side, surviving—and thriving—after treatment is possible.

The esophagus is the tube that connects the throat to the stomach, passing food and drink along for digestion. Cancer of the esophagus is rare, making up about 1% of cancers in the U.S. 

If you have heartburn that comes back more than twice a week or doesn’t respond to over-the-counter medications, talk with your doctor about esophageal cancer at your next appointment. Also known as gastroesophageal reflux disease (GERD), chronic heartburn can lead to a precancerous condition called Barrett’s Esophagus, so it’s best to get it checked out early. The sooner cancer is found, the better the chances of successful treatment. 

There are two primary types of esophageal cancer that impact different cells. Each has different risk factors and may need different treatments:
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• Squamous cell carcinoma most commonly affects the upper and middle parts of the esophagus. The most important risk factors for this type are smoking tobacco and drinking alcohol. It is most common outside of the U.S.

• Adenocarcinoma is cancer that most commonly begins lower in the esophagus near the stomach. The most common risk factor for adenocarcinoma is acid reflux, or heartburn, when the contents of the stomach move back into the esophagus. This type makes up about 80% of esophageal cancer cases in the U.S.

If your doctor finds you’re at risk, they may recommend regular screening with a process known as endoscopy. During this screening, a gastroenterologist uses a thin, flexible tube with a camera to look for signs of cancer. 

If you’re diagnosed with esophageal cancer, it’s ideal to have a team on your side working for the best outcomes. At MedStar Georgetown Cancer Institute, our collaborative teams of experts work together at the forefront of science to find and treat cancers of the esophagus. 

Diagnosis, staging, and treatment of esophageal cancer.

Most esophageal cancers are found and diagnosed with endoscopy. To diagnose cancer and determine how advanced it is, our teams may use other methods, including:
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• A physical examination and medical and family history

• Biopsy, during we use an endoscope to remove a small sample of esophageal tissue. These cells are examined in the laboratory for signs of cancer.

• Advanced imaging such as CT scan, PET scan, MRI, or endoscopic ultrasound to determine whether and how far the cancer has spread.

These steps guide the best treatment options. Our team of experts tailors a personalized treatment plan based upon the size, location, and stage of your cancer. Our deep experience with effective care and the latest research-backed advancements means you’ll have access to the best treatment. 

At the Institute, we work closely with researchers from Georgetown Lombardi Comprehensive Cancer Center, so our patients always have access to the latest clinical trials and advanced treatments.

For most patients, surgery is an important part of treatment. Our expert surgeons use minimally invasive, robotic-assisted esophagectomy techniques to speed up recovery time and reduce pain while safely removing the tumor and affected portions of the esophagus.  

For instance, we’re one of the few centers that performs esophageal cancer surgery with the Da Vinci 5, the latest technology in integrated robotic-assisted surgery. This remarkable machine enables us to see more clearly and operate more precisely. Instead of large incisions in traditional “open” surgery, this technique involves a few smaller incisions through which surgeon-controlled robotic arms access and remove the tumor.

While some Centers will take a hybrid approach to surgery with a portion of the operation performed open, but my partners and I find that our approach offers the greatest benefit to patients, including:
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• More precision: The small size and flexibility of the robotic instruments makes it easier to remove cancerous tissue without impacting nearby healthy structures.

• Significantly less pain: Patients experience less pain following robotic-assisted surgery, so they need less medication and recover more quickly.

• Lower risk of infection and less blood loss: Small incisions lower infection risk and minimize blood loss.

• Less time in the hospital: Most patients can go home sooner following robotic-assisted surgery.

• Less scarring and shorter recovery: Smaller incisions tend to heal faster, so patients can get back to work and life sooner.

With advanced robotic surgery, we can achieve all these benefits for patients without sacrificing high-quality cancer care. 

Treatment for esophageal cancer also can include:
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• Chemotherapy: Powerful drugs to eliminate cancer cells throughout the body.

• Immunotherapy: Treatments to boost the immune system can help kill cancer cells.

• Radiation therapy: High-energy radiation beams delivered with external and internal techniques to destroy cancer cells.

Related reading: Is Chronic Acid Reflux Just Heartburn? Understand the Risk of Esophageal Cancer.

Team-based care is the best care.

Working collaboratively allows us to provide the best care for our patients. Surgical oncologists like my partners and me, medical oncologists, radiation oncologists, gastroenterologists, and nutritionists care for our patients together.

When we bring this expertise together for our patients, the result is the safest, most effective, and most advanced treatment. 

All our patients also benefit from enhanced recovery protocols, sometimes known as fast-track recovery. These techniques help minimize patients’ time in the hospital and reduce their exposure to opioid medications that can have side effects including addiction.    

To accomplish this, fast track recovery involves:
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• Making sure patients get up and moving right away after surgery to reduce the risk of complications and promote blood flow

• Minimizing drains and tubes to make walking easier

• Using as little fluid as possible during surgery to avoid complications including delayed bowel function and breathing difficulties

• Alternative pain management techniques, such as long-acting nerve blocks and gentler, non-addictive pain relievers

Taken together, these techniques have been shown to keep patients comfortable with fewer opioid medications while improving recovery. Research has shown enhanced recovery programs demonstrate better outcomes for patients, including fewer complications and less time in the hospital.

There are more effective treatments for esophageal cancer than ever before, and finding cancer early gives us the best chance of success. With the right team and technologies on your side, patients with esophageal cancers can live high-quality lives long after treatment.