With approximately 17,000 new cases each year, esophageal cancer is the sixth most leading cause of cancer-related deaths in the United States. An increase in the incidence of esophageal cancer in recent years has been attributed to the prevalence of gastroesophageal reflux disease (GERD) among the adult population.
At West Coast Thoracic Surgery, renowned thoracic surgeons Ali Mahtabifard, MD and Clark Fuller, MD have undergone extensive training in the comprehensive management and advanced surgical care of esophageal cancer. Having trained at some of the country’s most prestigious cancer institutions, Dr. Mahtabifard and Dr. Fuller utilize the most current medical knowledge and cutting-edge surgical techniques to treat esophageal cancer with patient specificity and quality of life in mind.
What Causes Esophageal Cancer?
There are two types of esophageal cancer that originate from very different sources: squamous cell carcinoma of the upper and mid esophagus and adenocarcinoma of the lower esophagus. In the past, cancer of the upper and mid esophagus was more common as a result of excessive smoking and alcohol consumption. Today, the majority of individuals diagnosed with esophageal cancer have the adenocarcinoma variety as a direct result of chronic acid reflux (GERD). Adenocarcinoma can develop when untreated or uncontrolled GERD symptoms cause significant damage and genetic changes to cells within the lower esophagus.
Esophageal Cancer Symptoms & Diagnosis
Since the symptoms of esophageal cancer are similar to those of GERD, patients who have experienced years of acid reflux may find it difficult to detect cancer progression in its early stages. Patients, particularly those with a history of chronic acid reflux, should be aware of newly developed or worsening symptoms that may indicate malignant changes within the esophageal lining:
- Difficulty swallowing
- Chest pain or burning
- Difficulty passing food
- Chronic heartburn
An endoscopic tissue biopsy (outpatient) is necessary in order to examine the esophagus and stomach and to confirm the presence of esophageal cancer. This initial diagnosis is usually made by a gastroenterologist. Once a diagnosis of esophageal cancer is established, our surgeons can order a variety of further tests including an endoscopic ultrasound exam (EUS) and/or a PET/CT scan to determine the extent of disease. This initial process of staging the cancer is very important as it helps dictate subsequent treatment. The endoscopic ultrasound determines the depth of invasion into the esophageal wall and whether or not cancer has spread to nearby lymph nodes. The PET/CT scan helps to determine whether the cancer has spread to other parts of the body. By gathering as much information as possible, our surgeons can develop a comprehensive treatment plan tailored to an individual’s specific condition.
Treatment for Esophageal Cancer
Treatment for esophageal cancer is completely dependent on the stage. That is why the aforementioned efforts for proper staging are vitally important. For very early-stage precancerous changes (Barrett’s esophagus), minimally invasive endoscopic techniques may be used to remove the affected esophageal lining while preserving the structure of the esophagus. It is fairly common for patients to need reflux surgery (either TIF or Nissen Fundoplication) following this procedure to protect the esophagus from further acid exposure and damage.
When cancer has spread into the muscular layers of the esophagus, surgical resection of the affected area (esophago-gastrectomy) and nearby lymph nodes is necessary to remove all potential sites of tumor spread and to maximize the chance of curing the disease. Following removal of the esophagus and part of the stomach, the remaining portion of the stomach is used to construct a new gastric tube which can then be attached to the upper esophagus in the neck. In some cases, further treatment post-operatively such as chemotherapy may be recommended in order to reduce the risk of recurrence and improve treatment outcomes.
When the cancer has spread to local lymph nodes or if it is deeper in the esophageal wall, treatment usually begins with a combination of chemotherapy and radiation. More imaging tests are done after the initial treatment and some of those patients will then require esophageal resection.
The various treatment modalities, the specific details and the order of the treatments can be very complex. Our experienced surgeons will make sure to go over all treatment options with you at your comprehensive consultation in order to determine the best course of treatment for each patient.
Esophago-gastrectomy for the treatment of esophageal cancer is a complex procedure that should only be performed by thoracic surgeons with high levels of training and experience. This is a major operation and should only be performed by a team of surgeons that performs these operations routinely. As leading experts in esophageal disease and video-assisted thoracic surgery (VATS), Dr. Fuller and Dr. Mahtabifard perform esophago-gastrectomy using a minimally invasive thoracic approach to reduce the risk of complications and recovery time. In addition, both surgeons perform the operation together to ensure the best results and to make sure that it is done in a timely fashion. Therefore, our patients enjoy the benefit of having two fully trained and experienced thoracic surgeons performing their operation.
After surgery, our surgeons place great importance on post-operative care and routine follow-up and monitoring, as well as long-term management of esophageal and digestive health to improve quality of life and maintain optimal treatment outcomes for our patients.
Contact an Expert Thoracic Surgeon
Ali Mahtabifard, MD and Clark Fuller, MD, directors of West Coast Thoracic Surgery, are renowned thoracic surgeons who specialize in the comprehensive treatment of esophageal cancer and other thoracic malignancies. As leading experts in the field of minimally invasive thoracic surgery, Ali Mahtabifard, MD and Clark Fuller, MD perform a variety of cutting-edge procedures that offer significant benefits over traditional surgical techniques.
To learn more about our treatment approach to esophageal cancer or to schedule a consultation with one of our expert thoracic surgeons, please call 310.854.0909 or fill out our online contact form.
Next, read about achalasia.