NCCN Guidelines for Patients® | Esophageal Cancer - page 40

NCCN Guidelines for Patients
: Esophageal Cancer
Version 1.2013
Part 5: Squamous cell carcinomas
5.1 Local carcinomas
These cancers haven’t grown far into the esophageal
wall. A Tis tumor consists of abnormal cells that haven’t
grown beyond the epithelium. A T1 tumor consists of
cancer cells that haven’t grown beyond the submucosa.
These cancers have not spread to nearby lymph nodes
or elsewhere in the body.
Surgery may be a treatment option. Your doctors will
assess if you are able to undergo surgery by testing your
lungs, heart, and nutritional intake. Your doctors will also
assess if chemotherapy and chemoradiation would do
more to help than harm. Surgical and nonsurgical options
are presented next.
This chart lists the treatment options for when surgery
can be done. For a Tis tumor, endoscopic treatment—
EMR or ablation—is recommended. A T1a tumor hasn’t
grown into the submucosa, so EMR followed by ablation
can remove the tumor. Ablation may not be needed if
EMR fully removes the tumor. A second option for a T1a
tumor is an esophagectomy. T1b tumors have invaded
the submucosa, so an esophagectomy is the best option.
You won’t be able to eat right after an esophagectomy,
so a J-tube may be inserted into your intestine to give
you food.
Surgical options
TNM scores
Primary treatment
Tis, N0, M0
T1a, N0, M0
EMR, or
EMR then ablation, or
No cancer in the margins
Start follow-up testing
Surgical results
Adjuvant treatment
Cancer is in the margins
Supportive care
Chemoradiation, or
M1 disease was found
Some tumor was left behind
T1b, N0, M0
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