NCCN Guidelines for Patients® | Esophageal Cancer - page 64

64
NCCN Guidelines for Patients
®
: Esophageal Cancer
Version 1.2013
Part 6: Adenocarcinomas
This chart maps another course of treatment for people
healthy enough for surgery. First, chemotherapy can be
given to shrink the tumor before an esophagectomy. The
recommended chemotherapy regimens before surgery are:
• Epirubicin, cisplatin, and 5-FU,
• Epirubicin, oxaliplatin, and 5-FU,
• Epirubicin, cisplatin, and capecitabine,
• Epirubicin, oxaliplatin, and capecitabine, and
• 5-FU and cisplatin.
After the esophagectomy, you may need adjuvant
treatment depending on the surgery results. 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, you may have chemotherapy, or instead
of treatment, you could start follow-up testing. The
chemotherapy regimens used after surgery are the same
as those used before surgery.
If no cancer is in the surgical margins but is in the
lymph nodes, you have three options. One option called
observation, is testing on a regular basis for cancer growth.
TNM scores
Neoadjuvant
treatment
Primary treatment
Option 2
Chemotherapy Esophagectomy
Start follow-up testing, or
Surgery
results
Adjuvant treatment
Observation,
Supportive care
Chemoradiation, or
Chemotherapy
Chemoradiation, or
Chemotherapy
No cancer in the margins
or lymph nodes
No cancer in margins
but in lymph nodes
M1 disease was found
Some tumor was left behind
Cancer is in the
margins
Observation, or
Chemoradiation
T2, N0, M0
T3, N0, M0
T4a, N0, M0
T1b, N+, M0
T2, N+, M0
T3, N+, M0
T4a, N+, M0
1...,54,55,56,57,58,59,60,61,62,63 65,66,67,68,69,70,71,72,73,74,...100
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