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Esophageal Cancer Care at Allegheny Health Network
Occurring in the esophagus - which is a long narrow tube that carries food from your throat to your stomach - Esophageal cancer begins in the cells that line this tube. Fortunately, this type of cancer is rare in the United States. And preventing, detecting, and treating esophageal cancer has never been more effective, or easier for you to receive the care you need.
At the Allegheny Health Network Esophageal and Lung Institute, our highly skilled multidisciplinary team creates unique prevention strategies, early diagnosis and innovative treatments that focus solely on you and your specific health needs.
Bringing together experts from many different specialties to evaluate you condition, we collaborate to quickly diagnose your condition and determine a detailed treatment plan that will give you the best possible outcome.
Our renowned doctors focus on an array of esophageal conditions that could lead to cancer, including gastroesophageal reflux disease (GERD), laryngopharyngeal reflux and Barrett’s esophagus. Treatments include the latest breakthroughs and minimally invasive surgeries that are performed at only a handful of medical centers around the country.
Click on the links below to learn more about cancer symptoms and how Allegheny Health Network diagnoses and treats esophageal cancer. Throughout your treatment, your 24/7 Care Navigator can assist you and provide support should you have any questions or concerns.
Esophageal Cancer Symptoms
In the early stages of esophageal cancer, it’s usually asymptomatic (meaning no symptoms). If the cancer has spread to nearby tissues, you may experience some minor symptoms. Many people tend to ignore these symptoms because they think they’re caused by something harmless, like indigestion. However, if you experience any of the following symptoms on a regular basis, see your doctor:
- Difficulty swallowing
- Pressure or burning in the chest after swallowing
- A feeling that food is stuck in your throat
- Weight loss without trying
- Worsening indigestion or heartburn
- Coughing or hoarseness
As esophageal cancer worsens, symptoms can become more severe, including:
- Difficulty swallowing liquids
- Trouble swallowing saliva
- Frequent choking
- Coughing or vomiting up blood
- Feeling a lump on your neck, collarbone, or under your arm
- Difficulty breathing
If you've been diagnosed with Barrett's esophagus, a precancerous condition that increases your risk of esophageal cancer caused by chronic acid reflux, an Esophageal and Lung Institute physician will discuss with you the signs and symptoms to watch for that may indicate your condition is becoming more serious.
Risk factors include, but are not limited to, obesity, tobacco use, and excessive alcohol use.
Diagnosing Esophageal Cancer
Here at the Cancer Institute, we use sophisticated screening and diagnostic technologies that provide you with a precise and accurate diagnosis. Our doctors, radiologists, and clinicians are highly specialized in the detection and evaluation of Esophageal cancer and use state-of-the-art imaging and diagnostic resources to determine the location, stage and type of cancer, as well as screen, prevent and treat your cancer.
Our advanced diagnostic tests include:
- Sedated traditional endoscopy. This procedure uses a flexible tube with a light and camera to visually inspect your esophagus, stomach, and part of the small intestine. The camera is passed into the digestive tract through your mouth.
- Volumetric laser endomicroscopy. This cross-sectional imaging technique allows the physician to visualize the layers of your esophagus for a more accurate biopsy sampling and tissue grading.
- Biopsy collection. A standard part of an endoscopic procedure, biopsies are very small pieces of tissue that are removed and inspected under a microscope by a specially trained pathologist. These biopsies enable tissue grading and are used to detect Barrett’s esophagus, dysplasia, and cancer.
- Endoscopic mucosal resection. This procedure involves the insertion of flexible tube through your mouth [to view your esophagus) with ultrasound (high-frequency sound waves) to produce images that enable examination of the esophageal wall layers and surrounding lymph nodes.
- PET (positron emission tomography) and CT (computed tomography) scans. These procedures use penetrating waves to produce images. Often used to detect metastatic cancer, a PET scan introduces a radioactive substance through a patient’s vein, which collects in organs and tissues, and is detected by a scanner and converted into 3-D images. CT scans show the structure of and blood flow to and from organs. This test is often used to evaluate response to chemotherapy and radiation.
- Molecular staging of tumors. This procedure is used to identify the unique molecular profiles of a specific tumor in order to best select treatment options.
- Staging laparoscopy. This procedure is used for individuals who do not show metastasis or lymph node involvement via other testing methods in order to select the best course of treatment – immediate surgery or chemotherapy.
Treating Esophageal Cancer
Treatment for cancer is dependent on what stage of the cancer (where it is contained or has spread to surrounding tissues) it is in, whether the tumor can be completely removed by surgery and your overall health. As part of the initial stages of your treatment, a complete physical exam and history will be used. Additionally you may be asked to get a chest x-ray and complete a Barium swallow (also called and upper GI series), which is a liquid that coats the esophagus and allows more accurate x-rays to be taken.
At Allegheny Health Network, our team of doctors and surgeons, and radiation and medical oncologists ensure that you have access to the highest quality of care available, including every possible treatment, procedure and clinical trial best suited for your situation.
Our extensive treatment options include:
Surgeons at the Cancer Institute utilize the latest techniques and technologies, and are among the most experienced in the country. Their expertise ensures that you receive the most comprehensive treatment plan with the best possible outcome.
Our advanced surgical options include:
- Ablation. This procedure uses either electrical current (radiofrequency) or extreme cold (cryo) to burn or freeze a part of a cancerous lesion for removal.
- Endoscopic mucosal resection. This procedure can be used if the cancer is small and only on the surface of your colon. A needle is placed into the colon wall and the surgeon injects a saline solution to form a bubble under the lesion. Using suction, the lesion is removed.
- Sub-mucosal dissection. Similar to EMR, this procedure removes more esophageal tissue.
- Minimally invasive esophagectom. This procedure laparoscopically and thoracosopically (insertion of an endoscope, or tube with a camera) removes a diseased portion of the esophagus and replaces it with a portion of the stomach.
- Palliative care of dysphagia. When esophageal cancer is caught in an advanced stage, surgical removal of the lesion may not be an effective treatment option, so these palliative care options are available.
- Stent placement. Utilized to compress the size of an esophageal tumor, this procedure alleviates swallowing difficulty and opens the lumen of the esophagus to allow for food passage.
- Cryoablation. This procedure may be used in order to reduce the size of an esophageal tumor to alleviate swallowing discomfort.
- Dilation. This treatment may be used when a stricture (narrowing of the esophagus) is present as a result of cancer or after therapy such as radiation.
- Individualized tumor profiling. This procedure allows doctors to identify tumor-specific biomarkers and utilizes a meticulous review of existing research to best select what medical treatments might work best for a specific patient.
Treatment for your cancer may not require surgery. In many cases, Radiation Therapy is used to shrink and destroy cancer cells. Along with your doctor, you can decide what course of treatment will be most beneficial as it relates to your overall diagnosis.
Here at the Cancer Institute we use state-of-the-art technology, including advanced computer software and imaging, to administer high–dose radiation beams directly to a tumor, minimizing your overall exposure.
As the only radiation oncology network accredited in western Pennsylvania by both the American Society for Radiation Oncology and American College of Radiology, you can feel assured knowing you are receiving the highest quality care available. This accreditation means that the Cancer Institute at Allegheny Health Network meets specific guidelines for patient safety, quality control, and efficiency of equipment.
The Cancer Institutes advanced radiation therapies include:
- Adaptive radiation therapy (ART). This therapy uses imaging prior to radiation treatment delivery to analyze if there are significant changes in your anatomy and/or the tumor. If there are changes, the radiation dose is recalculated.
- 4-D CT simulation. This radiation treatment planning procedure involves advanced computed tomography (CT) scans and 4-dimensional (4-D) equipment and software. A 4-D CT simulation allows for the visualization of your internal anatomy and the tumor during breathing. This allows for more precise tumor targeting and less radiation dose to normal tissue, which improves cancer-control rates and lessens side effects.
- Gated delivery. This treatment uses specific equipment and software via a linear accelerator (radiation treatment delivery machine) to monitor patient breathing and tumor movement. During treatment delivery, the radiation beam can be turned on and off based on your breathing cycle, allowing for more precise treatment and less radiation to normal tissues.
- Intensity-modulated radiation therapy (IMRT). This therapy uses sophisticated computer technology to map the precise dimensions and density of cancerous tumors. Afterward, virtual treatment simulations are performed, and with minimal harm to surrounding healthy tissue, the radiation dose's shape and intensity is conformed to the simulation's exact parameters.
- Stereotactic Body Radiotherapy (SBRT). This technique combines the precision of image guidance, the accuracy of IMRT, and motion management (4-D CT and Anzai respiratory gating) to deliver high doses of radiation in less than five treatments. This technique was pioneered at Allegheny Health Network Cancer Institute and has dramatically improved our ability to control tumors.
- Positron Emission Tomography-Computed Tomography (PET-CT). This advanced imaging technique combines the functional activity of PET with the structural anatomy of CT for cancer staging and radiation treatment planning.
- Stereotactic body radiotherapy (SBRT). This advanced radiation technique delivers precise high dose radiation in one to five treatments to lung tumors, limiting potential side effects. It has proven to improve cure rates in a manner previously not achievable by standard conventional radiation therapy. At Allegheny Health Network, we have treated hundreds of patients successfully with this technique.
- I-125 Vicryl mesh brachytherapy. This technique allows the placement of radioactive sources into the surgical cavity at the time of operation. It reduces the amount of lung that needs to be removed and can help patients with poor lung function.
- 3-D conformal external-beam radiation therapy. This form of treatment planning based on computed tomography (CT), magnetic resonance imaging (MRI) and/or positron-emission tomography (PET), allowing for the 3-D reconstruction of tumors and normal tissue. This approach produces an accurate image of the tumor and surrounding organs so radiation oncologists can mold multiple radiation beams to the exact shape and contour of the tumor.
- High-dose rate (HDR) endobronchial and esophageal brachytherapy. This type of internal radiation therapy delivers high doses of radiation from radioactive seeds that are temporarily implanted in your airway or esophagus close to or inside the tumor. This treatment is typically given as an outpatient over numerous days. It ensures the maximum radiation dose is given to cancerous tissues while minimizing exposure to the surrounding healthy tissue.
The department of Medical Oncology specializes in diagnosing and caring for patients with a variety of medicines, including chemotherapy, targeted therapy, immunotherapy, adjuvant and neoadjuvant therapy. Medicines are administered by mouth (oral) or by vein (intravenous) depending upon the treatment plan developed by your primary doctor or medical oncologist.
Throughout your care, your doctor will coordinate your medication needs and your 24/7 Care Navigator may also be a part of this coordinated care effort.
The Cancer Institute’s advanced medical oncology therapies include:
- Chemotherapy. Similar in the same way that antibiotics kill bacteria, chemotherapy kills cancer cells. Because of the potency of these drugs, and their ability to sometimes also damage normal cells, side effects can occur, including hair loss, nausea and lowered blood counts. Fortunately, your body’s normal cells repair themselves much better than cancer cells. Throughout your treatment, we carefully monitor your wellness and determine medication requirements that can reduce side effects and maximize the chemotherapy’s effectiveness.
- Targeted therapy. This therapy is less toxic, and in some cases, more effective than traditional chemotherapy. It works by attacking specific genes within the surrounding blood vessels that help cancer to grow.
- Immunotherapy. This form of biological therapy is designed to help your immune system fight your cancer better. Working to enhance immune system function at the cellular level, immunotherapy utilizes cancer vaccines, genetically engineered human immune stimulatory molecules, and monoclonal antibodies (cloned antibodies from healthy cells used to support the immune system to help it fight cancer).
- Adjuvant therapy. This treatment is given after surgery to reduce the chance of residual microscopic cancer cells remaining in your body. It may include chemotherapy and/or radiation therapy.
- Neoadjuvant therapy. This treatment is given before surgery and may include chemotherapy and/or radiation therapy. It may reduce the amount of tumor remaining at the time of surgery, allowing for a more conservative operation.
As with any cancer therapy or treatment, your medical oncologist or primary care doctor, in conjunction with your 24/7 Care Navigator, will with work with you to determine how best to treat your cancer.