Esophageal and Gastric Cancers
Questions About Gastric Esophageal Cancer?
We’re here to help. Contact Vanessa Boral, MSN, RN at 203 276-2273 (Press 2).
The Bennett Cancer Center offers state-of-the art diagnosis and treatment for cancers of the esophagus and stomach. Because we know this type of cancer diagnosis is overwhelming, we offer the services of a Nurse Navigator who meets you early in your care and provides a familiar face and voice. Furthermore, since GI cancers tend to run in certain families, we also offer genetic counseling services.
Signs and symptoms of esophageal or gastric cancer:
- Weight loss
- Swallowing difficulties
- Acid reflux
- Upper abdominal/back pain
- Feeling full after meals
- Decreased energy
- Occasionally- blood in the stool
- Sometimes these lesions are found incidentally on studies performed for other complaints (such as heart burn) or endoscopic work-up for acid reflux/history of Barrett’s esophagus
What makes upper GI and esophageal cancer treatment unique at Stamford Health?
At Stamford Health, we'll give you access to advanced imaging technology including barium swallow (a scan of your esophagus during which you drink contrast), as well as CT and PET scans. To give you a proper diagnosis, our gastroenterologists also use upper GI endoscopy and other advanced endoscopic procedures. Results from these procedures take just a few days, at most, because we know your time and peace of mind are important.
Should the appropriate occasion arise, we present the most complex cases in front of a multidisciplinary tumor board. That means a large group of clinicians, all experts in their field, will review your individual experience to recommend the best course of treatment possible. Our well trained participants in these conferences include medical oncologists, radiation oncologists, surgical oncologists, dietitian, radiologist, pathologist, interventional radiologist, genetic counselor, and a gastrointestinal (GI) oncology nurse navigator.
What are the most common gastric and esophageal cancers we treat?
- Esophageal cancer, or cancer of the esophagus
- Gastric cancer, or cancer of the stomach
- Gastro-esophageal cancer, or when cancer develops at the point at which your esophagus joins your stomach
- Small bowel cancer, also known as small intestine cancer
- Tumors of the upper GI tract (primary and metastatic)
Treatment Options for Gastro-esophageal/Upper GI Cancers
Once a diagnosis is obtained, or confirmed, treatment depends on the type and stage of your gastro-esophageal/upper GI cancer. Options usually include endoscopic procedures like Endoscopic Mucosal Resection, laparoscopic or open surgery, chemotherapy, radiation therapy or a combination of these treatment modalities together.
Early Stage Esophageal Tumors
Accurate staging of any tumor is paramount. Especially true for esophageal conditions like high grade dysplasia in Barret’s or intramucosal carcinoma, as early stage tumors can sometimes be treated endoscopically (EMR). Endoscopic resection can also be used to determine the exact T stage of the tumor. Once the exact T stage is determined, a decision is made about further treatment. Surgery is a possibility.
Treatment of More Advanced Stage Esophageal Cancer
If a tumor penetrates into the esophageal wall deeper (T2 and above) or there is evidence or strong suspicion of regional nodal involvement, preoperative treatment with a chemotherapy, radiation, or most commonly a combination of both is usually indicated. This is also called neoadjuvant treatment of locally advanced esophageal cancer. A five to 6 week treatment course is followed by additional imaging studies as part of what we call restaging. If we find no new sites of disease during restaging we offer surgery.
Upfront treatment of certain larger tumors or locally advanced malignancies frequently results in downstaging of the tumor. Downstaging can convert inoperable tumors to operable tumors, or more extensive operations to less extensive surgeries.
A landmark study from Europe published in the New England Journal of Medicine in 2012 found that patients treated with neoadjuvant therapy and surgery had a near doubling in overall survival compared to the surgery alone arm in the setting of locally advanced esophageal cancer.
Treatment of Gastro-esophageal (GE) Cancer
Gastro-esophageal tumors are located at the gastero-esophageal junction. This is a very common location for distal esophageal cancers or proximal gastric cancers. These malignancies can behave more like gastric cancer or more like esophageal carcinoma. Distinguishing between the two entities can be difficult. We use radiographic , endoscopic and pathologic clues. Depending on the stage, these tumors may or may not require preoperative treatment. Locally advanced GE cancers can be treated similar to gastric cancers (usually preoperative chemotherapy) or similar to esophageal cancers (usually preoperative chemo-radiation). Similarly, these tumors may require a proximal/total gastrectomy versus a formal esophagectomy, depending on how high the proximal extension of the tumor is in the esophagus. This is part of the intraoperative decision making and we rely heavily on intraoperative endoscopy, performed in the operating room after the patient goes to sleep.
Treatment of More Advanced Stage Gastric Cancer
For the most accurate staging we prefer to perform and an EUS for all gastric cancers. This information helps us determine if a tumor should be considered locally advanced. Other signs of locally advanced tumors are enlarged lymph nodes on various imaging studies potentially harboring regional metastasis. Once a locally advanced gastric cancer is identified, most patients will receive neoadjuvant therapy, likely using systemic chemotherapy sometimes combined with radiation. Selected patients may undergo diagnostic laparoscopy prior to a final treatment plan being rendered. We strongly believe in the importance of peritoneal washings for all patients diagnosed with gastric cancer.
Major procedures our thoracic surgeons/surgical oncologists perform for the treatment of gastro-esophageal/upper GI malignancies:
- Esophagectomy (laparoscopic and open)
- Transhiatal esophagectomy
- Ivor-Lewis esophagectomy
- Selective abdominal lymphadenectomy for upper GI malignancies
- Partial gastrectomy (laparoscopic and open)
- Distal gastrectomy (laparoscopic and open)
- Proximal gastrectomy (laparoscopic and open)
- Total gastrectomy
- Small bowel resection
- Feeding tube insertion