NCCN Guidelines for Patients® | Esophageal Cancer - page 43

NCCN Guidelines for Patients
: Esophageal Cancer
Version 1.2013
Part 5: Squamous cell carcinomas
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Read pages 16–17
for definitions of
TNM scores.
5.2 Locally advanced carcinomas
These cancers have spread beyond the submucosa but not to distant sites. They
include T2, T3, and T4 tumors without cancer in the nearby lymph nodes. Also
included are T1b, T2, T3, or T4 tumors with cancer in the nearby lymph nodes.
Below, cancer in nearby lymph nodes is represented by ‘N+’ since the number of
lymph nodes with cancer can’t be known before surgery.
Surgery may be a treatment option for these cancers. 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.
Surgical options
Tumors not within the neck: Option 1
TNM scores
Treatment results
No signs of cancer
T1 – T4a disease
T4b or M1 disease
Primary treatment
Start follow-up testing
Esophagectomy, or
Supportive care
Esophagectomy, or
Supportive care
This chart maps one course of treatment for esophageal cancers not within the
neck and that can be treated with surgery. First, neoadjuvant treatment is given
to try to shrink the tumor. Concurrent chemoradiation is recommended.
T2, N0, M0
T3, N0, M0
T4a, N0, M0
T1b, N+, M0
T2, N+, M0
T3, N+, M0
T4a, N+, M0
Chemotherapy and
radiation therapy given at
the same time
Lymph node:
A small
group of disease-fighting
nutritional intake:
Ingested food and drinks
The second
layer of the esophageal
endoscopic mucosal
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