Endoscopic treatments for large esophageal cancers

Many patients who are diagnosed with a large esophageal adenocarcinoma (Barrett's esophagus associated cancer) have problems swallowing as their main symptom. In these cases, especially if the patient is not a good candidate for esophagectomy (surgical removal of the esophagus), an endoscopic treatment may be recommended. Endoscopic treatments are performed through a long black tube with a light on the end called an endoscope which is passed through the mouth into the esophagus by a stomach and intestines doctor (a gastroenterologist). Endoscopic treatments allow food and saliva to pass by the tumor into the stomach. Endoscopic treatments may be combined with chemotherapy and radiation therapy to try and shrink a large tumor, but endoscopic treatments usually do not cure the cancer if the cancer is large and advanced. Two examples of endoscopic therapies are ablation therapy and esophageal dilation.

Esophageal dilation
One endoscopic treatment commonly performed is esophageal dilation (stretching the esophagus to open the area narrowed by the tumor). In order to keep the area opened, an esophageal stent or tube may be inserted into the esophagus. The stent is usually made of plastic or metal and is placed through the endoscope into the esophagus in the area of the tumor. The stent is opened at both ends so that food and liquid can pass through the stent and the area of the tumor into the stomach. One main problem with stents is that they can become clogged and stop working after a while. Other endoscopic treatments such as ablation treatments, aim to destroy much of the tumor so that the patient can swallow. Two types of ablation treatments are laser and photodynamic therapies which have been used to shrink esophageal tumors and work well in some patients. Complications can be severe, and include making a hole in the esophagus, making a fistula (connection) between the esophagus and airways of the lung, bleeding, and rarely death.