NCCN Guidelines for Patients® | Esophageal Cancer - page 59

NCCN Guidelines for Patients
: Esophageal Cancer
Version 1.2013
Part 6: Adenocarcinomas
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The first layer
of the esophgeal wall
Lymph node:
A small
group of disease-fighting
nutritional intake:
Ingested food and drinks
The second
layer of the esophageal
Read pages 28–38
for information on
cancer treatments.
6.1 Local adenocarcinoma
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.
TNM scores
Primary treatment
Tis, N0, M0
T1a, N0, M0
EMR, or
EMR then ablation, or
No cancer in
the margins or
lymph nodes
Start follow-up
Surgical results Adjuvant treatment
Cancer is in
the margins or
lymph nodes
Supportive care
Chemoradiation, or
M1 disease
was found
Some tumor
was left behind
Surgical options
T1b, N0, M0 Esophagectomy
This chart lists the treatment options for when surgery can be done. For a T
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. A second
option for a T1a tumor is an esophagectomy. T1b tumors have invaded the submucosa,
endoscopic mucosal
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