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ESOPHAGAL CANCER TREATMENT IN TURKEY

Esophageal cancer is a disease in which malignant (cancerous) cells form in the tissues of the esophagus.

The esophagus is a hollow, muscular tube that transports food and fluid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucosa, muscle, and connective tissue. Esophageal cancer begins on the inside of the esophagus and spreads outward through other layers as it grows.

Рак пищевода

The esophagus and stomach are part of the upper gastrointestinal (digestive) system.

The two most common forms of esophageal cancer are named for the type of cells that become cancerous:

  • Squamous cell carcinoma:  cancer that forms in the thin, flat cells that line the inside of the esophagus. This cancer most often occurs in the upper and middle part of the esophagus, but can occur anywhere in the esophagus. It is also called epidermoid carcinoma.

  • Adenocarcinoma: Cancer that begins in glandular cells. The glandular cells of the lining of the esophagus produce and secrete fluids such as mucus. Adenocarcinomas usually form in the lower esophagus, near the stomach.

1.  Risks of developing esophageal cancer

Smoking, alcohol abuse, and Barrett's esophagus can increase the risk of esophageal cancer.

Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; the absence of risk factors does not mean that you will not get cancer. Talk to your doctor if you think you are at risk. Risk factors include the following:

  • Tobacco use.

  • Drinking strong alcohol.

  • Barrett's esophagus: A condition in which the cells lining the lower part of the esophagus are altered or replaced by abnormal cells, which can lead to esophageal cancer. Gastric reflux (heartburn) is the most common cause of Barrett's esophagus.

  • Elderly age.

2. Symptoms

Signs and symptoms of esophageal cancer include weight loss and painful or difficult swallowing.

These and other signs and symptoms can be caused by esophageal cancer or other conditions. Check with your doctor if you have any of the following:

  • Painful or difficult swallowing.

  • Weight loss.

  • Chest pain.

  • Hoarseness and cough.

  • Indigestion and heartburn.

  • Lump under the skin.

3. Diagnostics

Tests that examine the esophagus are used to diagnose cancer of the esophagus.

The following tests and procedures can be used:

  • Physical examination and health history: Examining the body to check for general signs of health, including checking for signs of illness, such as tumors or anything else that seems unusual. A history of the patient's health habits, as well as past illnesses and treatments will also be recorded.

  • Chest X-ray:  X-ray of organs and bones inside the chest. X-rays are a type of energy beam that can pass through the body onto film, creating an image of areas within the body.

  • Esophagoscopy: A procedure to examine the esophagus for abnormal areas. An esophagoscope is inserted through the mouth or nose through the pharynx into the esophagus. An esophagoscope is a thin, tube-shaped instrument with a light and a viewing lens. He may also have an instrument for taking tissue samples, which are checked under a microscope for signs of cancer. When the esophagus and stomach are examined, it is called an upper endoscopy.

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Эзофагоскопия

Esophagoscopy. A thin, illuminated tube is inserted through the mouth into the esophagus to look for abnormal areas.

  • Biopsy: Removal of cells or tissues so that a pathologist can examine them under a microscope to check for signs of cancer. A biopsy is usually done during an esophagoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but can lead to cancer.

After cancer of the esophagus has been diagnosed, tests are done to find out if the cancer cells have spread in the esophagus or to other parts of the body.

The process used to determine if cancer cells have spread in the esophagus or to other parts of the body is called staging. The information gathered during the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. During the preparation process, the following tests and procedures can be used:

  • Endoscopic ultrasound (EUS)  : A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. For esophageal cancer, the endoscope is inserted through the mouth. An endoscope is a thin tubular instrument with a light and a viewing lens. A probe at the end of an endoscope is used to reflect high-energy sound waves (ultrasound) from internal tissues or organs and create an echo. The echo forms a picture of body tissue called a sonogram. A biopsy may also be done. This procedure is also called endosonography.

  • CT (computed tomography): A procedure in which a series of detailed pictures of the interior of the body, such as the chest, abdomen, and pelvis, are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to make organs and tissues more visible. This procedure is also called computed tomography, computed tomography, or computed axial tomography.

  • PET scan (positron emission tomography): a procedure to look for malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Cancer cells appear brighter because they are more active and consume more glucose than normal cells. PET scans and computed tomography can be performed at the same time. This is called a PET-CT scan.

  • MRI (Magnetic Resonance Imaging): A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (MRI).

  • Thoracoscopy:  a surgical procedure to examine the internal organs of the chest for abnormal areas. An incision (incision) is made between two ribs and a stethoscope is inserted into the chest. The thoracoscope is a thin, tubular, illuminated instrument with a viewing lens. He may also have an instrument to remove samples of tissue or lymph nodes, which are checked under a microscope for signs of cancer. In some cases, this procedure can be used to remove part of the esophagus or lung.

  • Laparoscopy: A surgical procedure to examine the internal organs of the abdomen for signs of illness. Small incisions (incisions) are made in the abdominal wall, and a laparoscope (a thin, illuminated tube) is inserted into one of the incisions. Other instruments can be inserted through the same or a different incision to perform procedures such as removing organs or taking tissue samples to check under a microscope for signs of disease.

  • Ultrasound examination: A procedure in which high energy sound waves (ultrasound) are reflected from internal tissues or organs, such as the neck, and create an echo. The echo forms a picture of body tissue called a sonogram. The picture can be printed to view later.

4. Several factors affect prognosis (chance of recovery) and treatment options.

V  forecast  and the treatment option depends on the following conditions:

  • The stage of the cancer (whether it affects part of the esophagus, includes the entire esophagus, or has spread to other places in the body).

  • Is it possible to completely remove the tumor with surgery?

  • The general health of the patient.

5. Stages of esophageal cancer

The grade of the tumor is also used to describe the cancer and the treatment plan.

The tumor class describes how abnormal cancer cells look under a microscope and how quickly the tumor can grow and spread. Grades 1 through 3 are used to describe esophageal cancer:

  • Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.

  • Grade 2 cancer cells look more abnormal under a microscope and grow and spread faster than grade 1 cancer cells.

  • Grade 3 cancer cells look more abnormal under a microscope and grow and spread faster than grade 1 and 2 cancer cells.

 

In squamous cell carcinoma of the esophagus, the following stages are used:

 

Stage 0 (high-grade dysplasia)

 

In stage 0, cancer has formed in the inner lining of the esophageal wall. Stage 0 is also called high-grade dysplasia.

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0 стадия рака пищевода

Squamous cell carcinoma of the esophagus stage 0. Cancer has formed in the lining of the esophagus.

Squamous cell carcinoma of the esophagus, stage I

Stage I  divided into stages IA and IB, depending on where it spread  cancer  ...

Плоскоклеточный рак пищевода 1 стадии

Stage IA squamous cell carcinoma of the esophagus. The cancer has spread to the mucosal layer or the thin muscle layer of the esophagus wall. Cancer cells are grade 1 or unknown. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.

Stage IB:  the cancer has spread:

  • into the mucosal layer, thin muscle layer or submucous layer of the esophagus wall. Cancer cells of any grade or grade are unknown; or

  • into the thick muscle layer of the esophagus wall. Cancer cells are classified as grade 1.

Плоскоклеточный рак пищевода стадии IB.

Squamous cell carcinoma of the esophagus stage IB. The cancer has spread to the mucosal layer, thin muscle layer, or submucosal layer of the esophageal wall. Cancer cells of any grade or grade are unknown; OR the cancer has spread to the thick muscle layer of the esophageal wall. Cancer cells are classified as grade 1. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.

Stage II squamous cell carcinoma of the esophagus

Stage II is divided into stages IIA and IIB, depending on where the cancer has spread.

  • Stage IIA:  the cancer has spread:

    • into the thick muscle layer of the esophagus wall. Cancer cells are grade 2 or 3, or grade unknown; or

Рак пищевода 2 стадия

Stage IIA squamous cell carcinoma of the esophagus (1). The cancer has spread to the thick muscle layer of the esophagus wall. Cancer cells are grade 2 or 3, or the grade is unknown. Grade 2 and 3 cancer cells look more abnormal under the microscope and grow and spread faster than grade 1 cancer cells.

  • into the connective tissue layer of the esophagus wall. The tumor is located in the lower part of the esophagus; or

Плоскоклеточный рак пищевода IIA стадии

Stage IIA squamous cell carcinoma of the esophagus (2). The cancer has spread to the connective tissue layer of the esophagus wall. The tumor is located in the lower esophagus.

  • into the connective tissue layer of the esophagus wall. Cancer cells are classified as grade 1. The tumor is located in the upper or middle esophagus.

INCREASE

Плоскоклеточный рак пищеводы

Stage IIA squamous cell carcinoma of the esophagus (3). The cancer has spread to the connective tissue layer of the esophagus wall. Cancer cells are classified as grade 1. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells. The tumor is located in the upper or middle esophagus.

Stage IIB : The cancer has spread:

  • into the connective tissue layer of the esophagus wall. Cancer cells are grade 2 or 3. The tumor is in the upper or middle esophagus; or

Плоскоклеточный рак пищеводы 2В стадии

Stage IIB squamous cell carcinoma of the esophagus (1). The cancer has spread to the connective tissue layer of the esophagus wall. Cancer cells of 2 or 3 degrees. Grade 2 and 3 cancer cells look more abnormal under a microscope and grow and spread faster than grade 1 cancer cells. The tumor is located in the upper or middle esophagus.

  • into the connective tissue layer of the esophagus wall. The extent of the cancer cells is unknown, or it is not known where the tumor formed in the esophagus; or

Плоскоклеточный рак пищевода стадии IIB

Stage IIB squamous cell carcinoma of the esophagus (2). The cancer has spread to the connective tissue layer of the esophagus wall. The extent of the cancer cells is unknown, or it is not known where the tumor formed in the esophagus.

  • into the mucosal layer, thin muscle layer or submucous layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Плоскоклеточный рак пищевода стадии IIB (3).

Stage IIB squamous cell carcinoma of the esophagus (3). The cancer has spread to the mucosal layer, thin muscle layer, or submucosal layer of the esophageal wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Stage III squamous cell carcinoma of the esophagus

Stage III is divided into stages IIIA and IIIB, depending on where the cancer has spread.

Stage IIIA: Cancer has spread:

  • into the mucosal layer, thin muscle layer or submucous layer of the esophagus wall. Cancer is found in 3–6 lymph nodes near the tumor; or

  • into the thick muscle layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Плоскоклеточный рак пищевода 3 стадии

Stage IIIA squamous cell carcinoma of the esophagus. The cancer has spread to the mucosal layer, thin muscle layer, or submucosal layer of the esophageal wall. Cancer is found in 3–6 lymph nodes near the tumor; OR the cancer has spread to the thick muscle layer of the esophageal wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Stage IIIB:  the cancer has spread:

  • into a thick muscle layer or a layer of connective tissue of the esophagus wall. Cancer is found in 1-6 lymph nodes near the tumor; or

Стадия 3В плоскоклеточного рака пищевода

Stage IIIB squamous cell carcinoma of the esophagus (1). The cancer has spread to the thick muscle layer or connective tissue layer of the esophagus wall. Cancer is found in 1-6 lymph nodes near the tumor.

  • into the diaphragm,  unpaired vein  pleura, sac around the heart, or peritoneum.  Cancer can be found in 0–2 lymph nodes near the tumor.

Плоскоклеточный рак пищевода 3В

Stage IIIB squamous cell carcinoma of the esophagus (2). The cancer has spread to (a) the diaphragm, (b) the incomplete vein, (c) the pleura, (d) the sac around the heart, or the peritoneum (not shown). Cancer can be found in 0–2 lymph nodes near the tumor.

Stage IV squamous cell carcinoma of the esophagus

Stage IV is divided into stages IVA and IVB, depending on where the cancer has spread.

 

Stage IVA: The cancer has spread:

  • into the diaphragm, loose vein, pleura, sac around the heart, or peritoneum. Cancer is found in 3–6 lymph nodes near the tumor; or

Плоскоклеточный рак пищевода 4А

Squamous cell carcinoma of the esophagus stage IVA (1). The cancer has spread to (a) the diaphragm, (b) the incomplete vein, (c) the pleura, (d) the sac around the heart, or the peritoneum (not shown). Cancer is found in 3-6 lymph nodes near the tumor.

  • into nearby structures such as the aorta, airways, or spine. Cancer can be found in 0-6 lymph nodes near the tumor; or

Плоскоклеточный рак пищевода 4А

Stage IVA squamous cell carcinoma of the esophagus (2). The cancer has spread to nearby structures such as the airway, aorta, or spine. Cancer can be found in 0-6 lymph nodes near the tumor.

  • up to 7 or more lymph nodes near the tumor.

Плоскоклеточный рак пищевода 4А

Stage IVA squamous cell carcinoma of the esophagus (3). The cancer has spread to 7 or more lymph nodes near the tumor.

  • up to 7 or more lymph nodes near the tumor.

Плоскоклеточный рак пищевода 4В

Stage IVB: Cancer has spread to other parts of the body, such as the liver or lungs.

For adenocarcinoma of the esophagus, the following stages are used:

Stage 0 (high-grade dysplasia)

In stage 0, cancer has formed in the inner lining of the esophageal wall. Stage 0 is also called high-grade dysplasia.

Аденокарцинома пищевода 0 стадии

Stage IVB: Cancer has spread to other parts of the body, such as the liver or lungs.

Stage 0 esophageal adenocarcinoma. Cancer has formed in the lining of the esophagus.

Stage I esophageal adenocarcinoma

Stage I is divided into stages IA, IB, and IC, depending on where the cancer has spread.

  • Stage IA:  the cancer has spread to the lining or thin muscle layer of the esophagus wall. Cancer cells are grade 1 or unknown.

Аденокарцинома пищевода IA стадии. Рак распространился на слой слизистой оболочки или тонкий мышечный слой стенки пищевода. Раковые клетки относятся к 1 степени или неизвестны. Раковые клетки 1 степени больше похожи на нормальные клетки под микроскопом и растут и распространяются медленнее, чем раковые клетки 2 и 3 степени.

Stage IA adenocarcinoma of the esophagus. The cancer has spread to the mucosal layer or the thin muscle layer of the esophagus wall. Cancer cells are grade 1 or unknown. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.

Stage IB:  the cancer has spread:

  • into the mucosal layer or thin muscle layer of the esophagus wall.  Cancer cells -  2 degrees;  or

  • into the submucosal layer of the esophagus wall. Cancer cells are either grade 1 or 2, or the grade is unknown.

Аденокарцинома пищевода стадии IB. Рак распространился на слой слизистой оболочки или тонкий мышечный слой стенки пищевода. Раковые клетки 2 степени. Раковые клетки 2-й степени выглядят более ненормально под микроскопом, растут и распространяются быстрее, чем раковые клетки 1-й степени; ИЛИ рак распространился на подслизистый слой стенки пищевода. Раковые клетки относятся к 1 или 2 степени, или степень неизвестна.

Adenocarcinoma of the esophagus stage IB. The cancer has spread to the mucosal layer or the thin muscle layer of the esophagus wall. Cancer cells of the 2nd degree. Grade 2 cancer cells look more abnormal under the microscope and grow and spread faster than grade 1 cancer cells; OR the cancer has spread to the submucosa of the esophageal wall. Cancer cells are either grade 1 or 2, or the grade is unknown.

IC stage:  The cancer has spread:

  • into the mucosal layer, thin muscle layer or submucous layer of the esophagus wall.  Cancer cells -  3 degrees;  or

  • into the thick muscle layer of the esophagus wall. Cancer cells are either grade 1 or 2.

Аденокарцинома пищевода IC стадии. Рак распространился на слой слизистой оболочки, тонкий мышечный слой или подслизистый слой стенки пищевода. Раковые клетки относятся к 3 степени. Раковые клетки 3-й степени выглядят более ненормально под микроскопом, растут и распространяются быстрее, чем раковые клетки 1 и 2 степени; ИЛИ рак распространился на толстый мышечный слой стенки пищевода. Раковые клетки относятся к 1 или 2 степени.

Stage IC adenocarcinoma of the esophagus. The cancer has spread to the mucosal layer, thin muscle layer, or submucosal layer of the esophageal wall. Cancer cells are classified as grade 3. Grade 3 cancer cells look more abnormal under a microscope and grow and spread faster than grade 1 and 2 cancer cells; OR the cancer has spread to the thick muscle layer of the esophageal wall. Cancer cells are either grade 1 or 2.

Stage II esophageal adenocarcinoma

Stage II is divided into stages IIA and IIB, depending on where the cancer has spread.

  • Stage IIA:  the cancer has spread to the thick muscle layer of the esophagus wall. Cancer cells are grade 3 or unknown.

Аденокарцинома пищевода IIA стадии. Рак распространился на толстый мышечный слой стенки пищевода. Раковые клетки имеют степень 3 или степень неизвестна. Раковые клетки 3 степени выглядят более ненормально под микроскопом, растут и распространяются быстрее, чем раковые клетки 1 и 2 степени.

Stage IIA esophageal adenocarcinoma. The cancer has spread to the thick muscle layer of the esophagus wall. Cancer cells are grade 3 or unknown. Grade 3 cancer cells look more abnormal under a microscope and grow and spread faster than grade 1 and 2 cancer cells.

Stage IIB:  the cancer has spread:

  • into the connective tissue layer of the esophagus wall;  or

  • into the mucosal layer, thin muscle layer or submucous layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Аденокарцинома пищевода IIB стадии. Рак распространился на соединительнотканный слой стенки пищевода; ИЛИ рак распространился на слой слизистой оболочки, тонкий мышечный слой или подслизистый слой стенки пищевода. Рак обнаруживается в 1-2 лимфатических узлах рядом с опухолью.

Stage IIB esophageal adenocarcinoma. The cancer has spread to the connective tissue layer of the esophagus wall; OR the cancer has spread to the mucosal layer, thin muscle layer, or submucosal layer of the esophageal wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Stage III esophageal adenocarcinoma

Stage III is divided into stages IIIA and IIIB, depending on where the cancer has spread.

  • Stage IIIA:  The cancer has spread:

    • into the mucosal layer, thin muscle layer or submucous layer of the esophagus wall. Cancer is found in 3–6 lymph nodes near the tumor; or

    • into the thick muscle layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Аденокарцинома пищевода IIIA стадии. Рак распространился на слой слизистой оболочки, тонкий мышечный слой или подслизистый слой стенки пищевода. Рак обнаруживается в 3–6 лимфатических узлах рядом с опухолью; ИЛИ рак распространился на толстый мышечный слой стенки пищевода. Рак обнаруживается в 1-2 лимфатических узлах рядом с опухолью.

Stage IIIA esophageal adenocarcinoma. The cancer has spread to the mucosal layer, thin muscle layer, or submucosal layer of the esophageal wall. Cancer is found in 3–6 lymph nodes near the tumor; OR the cancer has spread to the thick muscle layer of the esophageal wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

From tadia IIIB:  the cancer has spread:

  • into the thick muscle layer of the esophagus wall.  Cancer is found in 3–6 lymph nodes near the tumor;  or

  • into the connective tissue layer of the esophagus wall. Cancer is found in 1-6 lymph nodes near the tumor; or

Аденокарцинома пищевода IIIB стадии (1). Рак распространился на толстый мышечный слой стенки пищевода. Рак обнаруживается в 3–6 лимфатических узлах рядом с опухолью; ИЛИ рак распространился на соединительнотканный слой стенки пищевода. Рак обнаруживается в 1-6 лимфатических узлах рядом с опухолью.

Stage IIIB esophageal adenocarcinoma (1). The cancer has spread to the thick muscle layer of the esophagus wall. Cancer is found in 3–6 lymph nodes near the tumor; OR the cancer has spread to the connective tissue layer of the esophageal wall. Cancer is found in 1-6 lymph nodes near the tumor.

  • into the diaphragm,  unpaired vein  pleura, sac around the heart, or peritoneum.  Cancer can be found in 0–2 lymph nodes near the tumor.

Аденокарцинома пищевода IIIB стадии (2). Рак распространился на (а) диафрагму, (б) неполную вену, (в) плевру, (г) мешок вокруг сердца или брюшину (не показано). Рак может быть обнаружен в 0–2 лимфатических узлах рядом с опухолью.

Stage IIIB esophageal adenocarcinoma (2). The cancer has spread to (a) the diaphragm, (b) the incomplete vein, (c) the pleura, (d) the sac around the heart, or the peritoneum (not shown). Cancer can be found in 0–2 lymph nodes near the tumor.

Stage IV esophageal adenocarcinoma

Stage IV is divided into stages IVA and IVB, depending on where the cancer has spread.

Stage IVA: The cancer has spread:

  • into the diaphragm, azygos vein, pleura, sac around the heart, or peritoneum. Cancer is found in 3–6 lymph nodes near the tumor; or

Аденокарцинома пищевода IVA стадии (1). Рак распространился на (а) диафрагму, (б) неполную вену, (в) плевру, (г) мешок вокруг сердца или брюшину (не показано). Рак обнаруживается в 3-6 лимфатических узлах рядом с опухолью.

Stage IVA esophageal adenocarcinoma (1). The cancer has spread to (a) the diaphragm, (b) the incomplete vein, (c) the pleura, (d) the sac around the heart, or the peritoneum (not shown). Cancer is found in 3-6 lymph nodes near the tumor.

  • into nearby structures such as the aorta, airways, or spine.  Cancer can be found in 0-6 lymph nodes near the tumor; or

Аденокарцинома пищевода IVA стадии (2). Рак распространился на близлежащие структуры, такие как дыхательные пути, аорту или позвоночник. Рак может быть обнаружен в 0-6 лимфатических узлах рядом с опухолью.

Stage IVA esophageal adenocarcinoma (2). The cancer has spread to nearby structures such as the airway, aorta, or spine. Cancer can be found in 0-6 lymph nodes near the tumor.

  • up to 7 or more lymph nodes near the tumor.

Аденокарцинома пищевода IVA стадии (3). Рак распространился на 7 или более лимфатических узлов рядом с опухолью.

Stage IVA esophageal adenocarcinoma (3). The cancer has spread to 7 or more lymph nodes near the tumor.

  • Stage IVB:  the cancer has spread to other parts of the body, such as the liver or lungs.

Аденокарцинома пищевода IVB стадии. Рак распространился на другие части тела, например, на печень или легкие.

Stage IVB esophageal adenocarcinoma. The cancer has spread to other parts of the body, such as the liver or lungs.

Esophageal cancer may recur (come back) after treatment.

Cancer can return to the esophagus or to other parts of the body.

6. Overview of treatment options

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There are different types of treatment for patients with esophageal cancer.

Various treatments are available for patients with esophageal cancer. Some treatments are standard (currently used) and some are in clinical trials. A treatment clinical trial is a scientific study designed to help improve existing treatments or provide information about new treatments for cancer patients. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. Patients may want to take part in a clinical trial. Some clinical trials are only open to patients who have not yet started treatment.

Patients have special nutritional needs during esophageal cancer treatment.

Many people with esophageal cancer find it difficult to eat because they have trouble swallowing. The esophagus can be narrowed by a tumor or as a side effect of treatment. Some patients can receive nutrients directly into a vein. Others may need a feeding tube (a flexible plastic tube that is inserted through the nose or mouth into the stomach) until they can eat on their own.

Six types of standard treatments are used:

 

1. Operation

Surgery is the most common treatment for esophageal cancer. Part of the esophagus may be removed during an operation called an esophagectomy.

Эзофагэктомия. Часть пищевода удаляется, желудок подтягивается и присоединяется к оставшемуся пищеводу.

Esophagectomy. Part of the esophagus is removed, the stomach is pulled up and attached to the remaining esophagus.

The doctor will connect the remaining healthy part of the esophagus to the stomach so that the patient can swallow. A plastic tube or part of the intestine can be used to connect. Lymph nodes near the esophagus can also be removed and viewed under a microscope to see if they contain cancer. If the esophagus is partially blocked by a tumor, an expandable metal stent (tube) can be placed inside the esophagus to keep it open.

Пищеводный стент. Устройство (стент) помещается в пищевод, чтобы он оставался открытым, чтобы пища и жидкости могли проходить в желудок.

Esophageal stent. A device (stent) is placed in the esophagus to keep it open so that food and fluids can pass into the stomach.

Small early-stage cancer and high-grade esophageal dysplasia can be removed with endoscopic resection. An endoscope (a thin, tubular instrument with light and viewing lenses) is inserted through a small incision (incision) in the skin or through an opening in the body, such as the mouth. An instrument attached to the endoscope is used to remove tissue.

 

2. Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy:

  • External beam therapy  uses a device outside the body to direct radiation to an area of the body affected by cancer.

  • Internal beam therapy  uses a radioactive substance sealed in needles, seeds, wires, or catheters that are inserted directly into or near the tumor.

 

How radiation therapy is given depends on the type and stage of cancer treatment. External and internal radiation therapy is used to treat esophageal cancer.

A plastic tube can be inserted into the esophagus to keep it open during radiation therapy. This is called intubation and dilation.

 

3. Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is injected directly into the cerebrospinal fluid, organ or body cavity, such​​ like the abdomen, drugs mainly target cancer cells in these areas (regional chemotherapy). How chemotherapy is given depends on the type and stage of cancer treatment.

 

4. Chemoradiation therapy

Chemoradiation therapy combines chemotherapy and radiation therapy to enhance the effect of both.

 

5. Laser therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.

 

6. Electrocoagulation

Electrocoagulation is the use of electric current to kill cancer cells.

Another type of treatment is widely used in Turkey:

Targeted therapy  is a type of treatment that uses drugs or other substances to identify and destroy certain cancer cells. Targeted therapy usually does less damage to normal cells than chemotherapy or radiation therapy. Monoclonal antibody therapy is a type of targeted therapy used to treat esophageal cancer.

Monoclonal antibodies are proteins of the immune system created in the laboratory for the treatment of many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that can promote cancer cell growth. The antibodies are then able to kill cancer cells, block their growth, or prevent them from spreading. Monoclonal antibodies are given by infusion. They can be used alone or to carry drugs, toxins, or radioactive materials directly to cancer cells. Trastuzumab is a monoclonal antibody that has been studied in esophageal cancer. It can be prescribed to block the action of the growth factor protein HER2, which sends growth signals to esophageal cancer cells.

Additional tests may be required.

Some of the tests that were done for  diagnostics  cancer or definition  stages  cancer can be repeated. Some tests will be repeated to see how effective the treatment is. Decisions to continue, change, or stop treatment may be based on the results of these tests.

Some tests will continue from time to time after treatment ends. The results of these tests can show if your  condition  or cancer  relapsed  (returned). These tests are sometimes called  control  or control examinations.

Treatment of stage 0 (high-grade dysplasia)

Stage 0 treatment may include the following:

  • Surgery.

  • Endoscopic resection.

 

Stage I esophageal cancer treatment

Treatment for stage I squamous cell carcinoma or adenocarcinoma may include the following:

  • Chemoradiation therapy followed by surgery.

  • Operation only.

 

Stage II esophageal cancer treatment

 

Treatment for stage II squamous cell carcinoma or adenocarcinoma may include the following:

  • Chemoradiation therapy followed by surgery.

  • Operation only.

  • Chemotherapy followed by surgery.

  • Chemoradiotherapy only.

 

Stage III esophageal cancer treatment

 

Treatment for stage III squamous cell carcinoma or adenocarcinoma may include the following:

  • Chemoradiation therapy followed by surgery.

  • Chemotherapy followed by surgery.

  • Chemoradiotherapy only.

Stage IV esophageal cancer treatment

 

Treatment for squamous cell carcinoma of the esophagus or stage IV adenocarcinoma may include the following:

  • Chemoradiation therapy followed by surgery.

  • Chemotherapy.

  • Laser surgery or electrocautery as palliative therapy to relieve symptoms and improve quality of life.

  • Esophageal stent as palliative therapy to relieve symptoms and improve quality of life.

  • External or internal radiation therapy as palliative therapy to relieve symptoms and improve quality of life.

  • Clinical trials of chemotherapy.

  • Clinical trials of targeted therapy in combination with chemotherapy.

 

Treatment of recurrent esophageal cancer

 

Treatment for recurrent esophageal cancer may include the following:

  • Using any standard therapies as palliative care to relieve symptoms and improve quality of life.

  • Clinical trials.

COST OF TREATMENT AND DIAGNOSTICS IN TURKEY

 

  • Brachytherapy for adenocarcinoma on request

  • Prostatectomy with Da Vinci robot for adenocarcinoma from $ 12,000

  • Chemotherapy for breast cancer from $ 1200

  • Cyberknife for adenocarcinoma from $ 4400

  • Focused ultrasound ablation (HIFU) for adenocarcinoma from $ 11,000

  • Intraperitoneal chemotherapy HIPEC for adenocarcinoma from $ 20,000

  • Lung cancer surgery from $ 10,300

  • Biopsy for Esophageal Cancer from $ 450

  • CT (computed tomography) for esophageal cancer from $ 50

  • PET-CT for Esophageal cancer from $ 500

  • Chemotherapy for breast cancer from $ 1200

  • Esophagectomy for Esophageal Cancer from $ 8000

  • Radiation therapy for rectal cancer  on request

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