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NCCN Guidelines for Patients


Esophageal Cancer, Version 1.2016


Treatment guide: Adenocarcinoma

Early cancer

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.

Guide 15

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

large area.

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.

Guide 16

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

Advanced cancer