NCCN Guidelines for Patients® | Esophageal Cancer - page 45

NCCN Guidelines for Patients
: Esophageal Cancer
Version 1.2013
Part 5: Squamous cell carcinomas
Par t 1
Par t 2
Par t 3
Par t 4
Par t 5
Par t 6
Par t 7
Par t 8
Par t 9
This chart maps another course of treatment for
esophageal cancers not within the neck and that can
be treated with surgery. An esophagectomy without
neoadjuvant treatment is recommended when it is likely
to remove all the cancer.
The results of surgery are used to decide if adjuvant
treatment is needed. If your doctors were able to remove
all the cancer that they could see and the surgical
margins are cancer-free, no more treatment is needed.
The next step of care is to start follow-up testing.
If cancer is found in the surgical margins, chemoradiation
is needed since some cancer may remain in your
body. Likewise, if your doctors weren’t able to remove
all the cancer they could see or cancer was found in
distant sites, chemoradiation or supportive care are
options. The recommended chemotherapy regimens for
chemoradiation after surgery are:
• 5-FU before, during, and after radiation,
• 5-FU before and after radiation with capecitabine,
• Capecitabine before and after radiation with 5-FU, and
• Capecitabine before, during, and after radiation.
Next steps:
When you are finished with cancer
treatment, read Part 5.3 for follow-up testing. If you will
receive supportive care, read Part 5.5 next.
TNM scores
Primary treatment
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
Tumors not within the neck: Option 2
T2, N0, M0
T3, N0, M0
T4a, N0, M0
T1b, N+, M0
T2, N+, M0
T3, N+, M0
T4a, N+, M0
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