NCCN Guidelines for Patients® | Esophageal Cancer - page 60

NCCN Guidelines for Patients
: Esophageal Cancer
Version 1.2013
Part 6: Adenocarcinomas
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.
After an esophagectomy, you may need adjuvant
treatment. If your doctors were able to remove all the
cancer that they could see and no cancer was found
in the surgical margins and lymph nodes, no more
treatment is needed. The next step of care is to start
follow-up testing. If cancer is found in the surgical
margins or lymph nodes, chemoradiation is needed.
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 6.3 for follow-up testing. If you will
receive supportive care, read Part 6.5 next
This chart lists the treatment options for when surgery
can’t be done. For a Tis tumor, endoscopic treatment—
EMR or ablation—is a safe option. EMR followed by
ablation can remove T1a and T1b tumors. Instead of
endoscopic treatment, chemoradiation may be given for
a T1b tumor that may have spread beyond the reach of
endoscopic treatment. The recommended chemotherapy
regimens for chemoradiation are:
Preferred regimens
• Cisplatin and fluoropyrimidine (5-FU or capecitabine)
• Oxaliplatin and fluoropyrimidine (5-FU or
• Paclitaxel and carboplatin
TNM scores
Primary treatment
Nonsurgical options
Tis, N0, M0
T1a, N0, M0
EMR, or
T1b, N0, M0
EMR then ablation
EMR then ablation, or
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