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Guide 19. Initial treatment

TNM scores

What are the options if approved

and agree to have surgery?

What are the options if not approved

or decline surgery?

T2, N0, M0

T3, N0, M0

T4a, N0, M0

T1b, N+, M0

T2, N+, M0

T3, N+, M0

T4a, N+, M0

• Esophagectomy in some cases

• Chemoradiation to shrink cancer

• Chemotherapy to shrink cancer

• Chemotherapy before and after

esophagectomy (perioperative)

• Chemoradiation to cure cancer if

you don’t want to have surgery

But able to have chemoradiation

• Chemoradiation to cure cancer

And unable to have chemoradiation

• Supportive care with or without

radiation therapy

T4b, N+, M0

• Chemoradiation to cure cancer

• Same as above


NCCN Guidelines for Patients


Esophageal Cancer, Version 1.2016


Treatment guide: Adenocarcinoma

Invasive cancer

Invasive cancer

This section presents the treatment options for

invasive cancer. These cancers have grown

beyond the second layer of the esophageal wall

(submucosa). There may be cancer in nearby

Iymph nodes but not in distant sites. Options range

from the start of treatment to follow-up care on

pages 78 and 79.

TNM scores of invasive cancers are listed in

Guide 19. Cancer in nearby lymph nodes is

represented by “N+” since the number of lymph

nodes with cancer can’t be known before surgery.

Guide 19

lists options for initial treatment.

Surgery may be a treatment option for these

cancers. 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 or chemotherapy would do more

help than harm.

Approved and agree to surgery

An esophagectomy may be an option if the

operation is likely to remove all the cancer. You

may receive another type of treatment before

or after surgery. Treatments before surgery

include chemoradiation or chemotherapy with

the intent to shrink the cancer. This is called

preoperative treatment. Another option is to receive

chemotherapy before and after surgery. This is

called perioperative chemotherapy.

Chemotherapy regimens for preoperative

chemoradiation are:

Preferred regimens

• Paclitaxel and carboplatin

• Cisplatin and 5-FU (or capecitabine)

• Oxaliplatin and 5-FU (or capecitabine)

Other regimens

• Irinotecan and cisplatin

• Paclitaxel and 5-FU (or capecitabine).