NCCN Guidelines for Patients® | Esophageal Cancer - page 30

NCCN Guidelines for Patients
: Esophageal Cancer
Version 1.2013
Part 4: Overview of cancer treatments
Ablation destroys very small tumors with little harm to
nearby tissue. There is more than one way to ‘ablate’ a
tumor. However, an endoscope is used for all methods
to deliver the treatment. The recommended types of
ablation are:
• Cryoablation – this ablation method kills cancer cells
by freezing them with liquid nitrogen that is sprayed
through an endoscope.
• Radiofrequency ablation – this ablation method kills
cancer cells using heat from electrodes that are
passed through an endoscope.
• Photodynamic therapy – this ablation method kills
cancer cells using a laser that activates a cancer-
killing drug in the tumor that was injected into a
vein days before.
Ablation may cause swelling and mild pain for a few
days. Photodynamic therapy may make your skin
and eyes sensitive to strong light. Like EMR, ablation
sometimes causes bleeding, a tear through the
esophageal wall, or narrowing of the esophagus.
4.2 Surgical treatment
The goal of surgery is to remove all the cancer from the
body. To do so, the tumor is removed along with some
normal-looking tissue around its rim, called the surgical
margin. An esophagectomy removes some or all of the
esophagus along with nearby lymph nodes. How much of
your esophagus will be removed depends on the cancer
stage and where the tumor is in your esophagus. An
esophagogastrectomy removes the lower esophagus,
the top part of the stomach, and nearby lymph nodes.
You will be given instructions on how to prepare for your
surgery. The week before your surgery you may have to
stop taking some medicines. On the day of your surgery,
you should not eat or drink. General anesthesia will
be used. In some people, general anesthesia causes
nausea with vomiting, confusion, muscle aches, itching,
and crying right after waking up.
There is more than one way to remove esophageal
cancer. Depending on the method, the surgery can take
3 to 6 hours to complete. Most people stay in the hospital
7 to 14 days to recover.
Standard open esophagectomy uses large surgical cuts
to remove tissue. There are two common types of open
surgery. A transthoracic esophagectomy removes tissue
through cuts into your chest and abdomen. A transhiatal
esophagectomy removes tissue through cuts into your
neck and abdomen.
Minimally invasive esophagectomy uses small tools
inserted through small cuts to remove tissue. Like a
laparoscopy described in Part 3.1, a laparoscope will
be inserted though a small cut into your abdomen.
Through this cut, work on your stomach can be done.
A thoracoscope, which is much like a laparoscope, will
also be inserted into a small cut made between your ribs.
This cut allows work to be done in the chest.
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