Esophageal cancer

Sometimes surgery or local techniques are used to alleviate or prevent symptoms related to the disease.

Some of these procedures are:

• Percutaneous gastrostomies or jejunostomies: is the placement by endoscopy of a tube or tube in the stomach (gastrostomies) or jejunum (jejunostomies) through the abdominal wall.
• Esophageal balloon dilation: with this procedure an attempt is made by inserting a small device to push through the narrowed area to stretch it.
• Placement of an esophageal prosthesis (stent).
• Electrocoagulation (electrofulguration): with this procedure a probe is passed into the esophagus through an endoscope to burn the tumor with electric current.
• Laser ablation: consists of directing a laser beam through the endoscope to destroy the cancerous tissue.
• Photodynamic therapy: this technique consists of the intravenous administration of a light-activated drug (photofrin). In the following days, the drug will accumulate in the cancerous cells, at which time a special type of laser light must be directed through the endoscope.

Chemotherapy is the medical treatment that consists of the application of chemical substances to the organism. It is mainly administered intravenously or orally, although there are other less common forms of administration.

Sometimes it is necessary to place a device called a port-a-cath. Treatment is prescribed according to a specific schedule depending on the regimen chosen. Prior to the administration of the medication, an assessment of the patient and an analytical determination must be made. Each administration is called a cycle, with the possibility of each cycle being divided into several sessions.

Depending on the moment of the administration of the treatment it is called:

• Neoadjuvant treatment: is the administration of chemotherapy prior to possible surgery. The objective is to reduce the size of the tumor and thus facilitate surgery.
• Adjuvant treatment: is the administration of chemotherapy after surgical resection. The objective is to eliminate possible microscopic disease in order to avoid recurrence of the disease.
• Palliative treatment: is the administration of treatment in a palliative manner. The intention is to reduce the burden of the disease and thereby derive a clinical benefit. 

The Department of Medical Oncology of the Clínica Universidad de Navarra has a specialized area nurse who is in permanent contact with the patients to minimize the side effects derived from the medication. In addition, a telephone follow-up is carried out during treatment to detect possible toxicities and alleviate them in an early and effective manner.

Biological therapies are substances that are produced by living organisms. This substance is produced either naturally in the organism or in the laboratory. From an oncological point of view, there are different biological therapies, each of which has the function of stimulating or inhibiting the immune system.

Other types of biological therapies attack cancer cells in a specific way because they have a specific characteristic, such as monoclonal antibodies.

Immunotherapy is another type of biological therapy. These substances are used to stimulate or inhibit the immune system and thus help the body fight cancer.

Radiotherapy is a fundamental part in the management of esophageal cancer, either before definitive surgery or as an exclusive treatment combined with chemotherapy. The location of the esophagus, surrounded by important structures such as the heart, lungs or spinal cord, makes it very important to treat with the utmost precision. Combinations of external irradiation with brachytherapy, or, in the best of scenarios, treatments with proton therapy, achieve the best results both in terms of cure and tolerance.

The Clínica Universidad de Navarra has a Proton Therapy Unit. This therapy, due to its lower toxicity, is especially indicated for the treatment of tumors that are difficult to access or close to organs at risk.

In esophageal cancer, radiotherapy is used either in combination with chemotherapy in patients with locally advanced disease preoperatively or adjuvantly after surgery with risk factors.

In patients with advanced disease it can be an effective therapy for pain relief (antalgic radiotherapy), bleeding (hemostasis radiotherapy) or local control.

In addition to all of the above, we must not forget the emotional aspect of cancer patients.

At the Clínica Universidad de Navarra we have the possibility of carrying out a joint evaluation with the Palliative Medicine Service in order to achieve an adequate symptomatic management as well as the possibility of expressing and orienting the possible emotional effects that this disease causes in the patient and his family.

The combination of an adequate symptomatic and emotional control has shown a better tolerance to medication and a better coping with the adverse events that occur during the evolution of this process.