NCCN Guidelines for Patients
Esophageal Cancer, Version 1.2016
Treatment guide: Adenocarcinoma
This section presents the treatment options for early
cancer. These cancers have not grown beyond the
second layer of the esophageal wall (submucosa).
The TMN scores for early cancers are Tis, N0, M0
(stage 0) and T1, N0, M0 (part of stage I). Options
range from the start of treatment to follow-up care on
pages 70 and 72.
lists options for initial treatment. Surgery
may be an option.Your doctor will assess if you are
able to undergo surgery by testing your lungs, heart,
and nutritional intake. Your doctor will also assess if
chemoradiation would do more help than harm.
For Tis and T1a tumors, endoscopic treatments are
preferred. These treatments include EMR, ESD,
and ablation. If you are able to have surgery, an
esophagectomy is another option. This may be the
best treatment if the Tis or T1 tumor has grown over a
T1b tumors have invaded the submucosa. Superficial
T1b tumors have only slightly grown into the
submucosa. For superficial tumors, EMR or ESD
followed by ablation and an esophagectomy are
options if you are able to have surgery. For deeper
T1b tumors, an esophagectomy is the best option.
If you are unable to have surgery, endoscopic
treatments are advised.
lists treatment options following an
esophagectomy. The results of surgery are used to
decide if more treatment is needed. Surgery results
include: 1) no cancer is in the surgical margin;
2) cancer is in the surgical margin; 3) not all the
cancer that the surgeon could see in or near the
esophagus was removed; and 4) cancer was found in
distant sites (M1 score).
Your surgeon may have been able to remove all the
cancer and a cancer-free surgical margin. In this
case, no more treatment is needed. The next step is
to start follow-up care.
If cancer is found in the surgical margin,
chemoradiation is advised. Chemoradiation will treat
any cancer that may remain in your body. Likewise,
if your surgeon wasn’t able to remove all the cancer
in or near your esophagus, chemoradiation is one of
two options. Chemotherapy with infusional 5-FU or
capecitabine before and after fluoropyrimidine-based
chemoradiation is advised.
Supportive care may be received in two cases. It
is a second option when cancer remains in or near
your esophagus after surgery. It is also advised if
M1 cancer is found during surgery. Supportive care
is addressed later in this chapter in the section