Esophageal cancer

Esophagogastroduodenoscopy (EGDS) is a fundamental examination for the diagnosis of esophageal cancer. It consists of the introduction of a Thin flexible tube with a camera on the end (endoscope) through the mouth To directly visualize the esophagus. During endoscopy, tissue samples (biopsy) can be taken for histological examination.

The radiographs of the chest and abdomen with transit study and computed tomography (CT) scan can provide detailed images of the esophagus and surrounding structures to assess the extent of the tumor.

This procedure combines endoscopy with ultrasound to obtain high-resolution images of the walls of the esophagus and surrounding lymph nodes.

This examination provides information on the tumor’s ability to pick up labeled glucose and enables the more confidently localize the sites and extent of disease, sometimes doubtful after CT scans have been performed.

It is a endoscopic examination of the airways (trachea and bronchi) and is used to evaluate, in selected cases, direct involvement of these structures by esophageal neoplasia.

It is used to exclude in esophageal squamous cell carcinomas any synchronous tumors of the oral cavity which find, in cigarette smoking and alcohol intake, the same agents favoring the onset of esophageal disease.

Blood tests can provide information about the patient’s general health status and assess organ function. Tumor markers, namely CEA and Ca19.9, are also assayed: they are not specific for esophageal cancer and can also be detected in other conditions; they can, therefore, be used as a general indicator of tumor activity, but not as a definitive diagnostic test for esophageal cancer.

Histologic examination is a process in which a pathologist carefully examines samples taken during an endoscopy under a microscope to identify any cellular abnormalities that may indicate the presence of esophageal cancer. They are, therefore, defined:

• The type of tumor (adenocarcinoma or squamous cell carcinoma);
• the “histological grade” or grading: describes the appearance of tumor cells under the microscope and indicates the degree of cell differentiation and how quickly they can grow;
• biomarkers, i.e., assessment by immunohistochemical techniques of protein expression on tumor cells on the biopsy that represent a prognostic and/or predictive factor for response (e.g., PDL1, HER2 only in selected cases).

Endoscopic treatment is often considered for early esophageal cancers, particularly carcinoma in situ or superficial tumors. These treatment options include:

• Endoscopic Mucosal Resection (EMR): is an endoscopic procedure to remove superficial or precancerous lesions of the esophagus without the need for open surgery;
• Endoscopic Dissection Stretched to the Submucosa (ESD): is an advanced endoscopic technique to remove larger, invasive tumors that extend to the submucosa of the esophagus.

The surgical approach is based onesophagectomy, which is thepartial or total surgical removal of the esophagus. It can be performed through atraditional incision (open surgery) or through a minimally invasive approach (laparo/thoracoscopic or robotic). Depending on the site of the neoplasm, surgery may require an abdominal, thoracic, and sometimes cervical approach.

Because it is a very complex procedure, it is crucial to identify patients who can tolerate this procedure and perform adequate preparation for surgery. For these reasons, esophagectomy is performed only in centers with experienced multidisciplinary teams and in centers that perform a high number of such procedures per year.

Following removal of the esophageal tract affected by the neoplasm, it is necessary to reconstruct the esophageal tract by using a portion of the stomach (esophago-gastric anastomosis) or another intestinal tract. During esophagectomy, removal of regional lymph nodes is also performed to assess the extent of the tumor and reduce the risk of metastatic spread.

Chemotherapy can be used in several settings in the treatment of esophageal cancer, including:

• • Neoadjuvant treatment: is administered before surgery to reduce tumor size and increase the chance of successful treatment;

• • Adjuvant treatment: is performed after surgery to destroy any remaining cancer cells and reduce the risk of recurrence;

• • perioperative treatment: is administered before and after surgery;

• • palliative treatment: when the tumor has spread to other organs, so it is metastatic, to relieve disease symptoms, improve quality of life and prolong survival.

Radiation therapy uses high-energy beams to destroy cancer cells. In the treatment of esophageal cancer, radiation therapy can be used in combination with chemotherapy as a neoadjuvant treatment before surgery to reduce the tumor mass or as an adjuvant post-surgical treatment to reduce the risk of local recurrence.

In the case of inoperable tumor lesions, radiation therapy can be used alone or in combination with chemotherapy for radical purposes.

In patients with locally advanced esophageal tumors, it can also be used for palliative purposes to reduce any algic or dysphagic symptoms.

Endoscopic treatment is often considered for early esophageal cancers, particularly carcinoma in situ or superficial tumors. These treatment options include:

• Endoscopic Mucosal Resection (EMR): is an endoscopic procedure to remove superficial or precancerous lesions of the esophagus without the need for open surgery;
• Endoscopic Dissection Stretched to the Submucosa (ESD): is an advanced endoscopic technique to remove larger, invasive tumors that extend to the submucosa of the esophagus.

The surgical approach is based onesophagectomy, which is thepartial or total surgical removal of the esophagus. It can be performed through atraditional incision (open surgery) or through a minimally invasive approach (laparo/thoracoscopic or robotic). Depending on the site of the neoplasm, surgery may require an abdominal, thoracic, and sometimes cervical approach.

Because it is a very complex procedure, it is crucial to identify patients who can tolerate this procedure and perform adequate preparation for surgery. For these reasons, esophagectomy is performed only in centers with experienced multidisciplinary teams and in centers that perform a high number of such procedures per year.

Following removal of the esophageal tract affected by the neoplasm, it is necessary to reconstruct the esophageal tract by using a portion of the stomach (esophago-gastric anastomosis) or another intestinal tract. During esophagectomy, removal of regional lymph nodes is also performed to assess the extent of the tumor and reduce the risk of metastatic spread.

Chemotherapy can be used in several settings in the treatment of esophageal cancer, including:

• • Neoadjuvant treatment: is administered before surgery to reduce tumor size and increase the chance of successful treatment;

• • Adjuvant treatment: is performed after surgery to destroy any remaining cancer cells and reduce the risk of recurrence;

• • perioperative treatment: is administered before and after surgery;

• • palliative treatment: when the tumor has spread to other organs, so it is metastatic, to relieve disease symptoms, improve quality of life and prolong survival.

Radiation therapy uses high-energy beams to destroy cancer cells. In the treatment of esophageal cancer, radiation therapy can be used in combination with chemotherapy as a neoadjuvant treatment before surgery to reduce the tumor mass or as an adjuvant post-surgical treatment to reduce the risk of local recurrence.

In the case of inoperable tumor lesions, radiation therapy can be used alone or in combination with chemotherapy for radical purposes.

In patients with locally advanced esophageal tumors, it can also be used for palliative purposes to reduce any algic or dysphagic symptoms.

Endoscopic treatment is often considered for early esophageal cancers, particularly carcinoma in situ or superficial tumors. These treatment options include:

• Endoscopic Mucosal Resection (EMR): is an endoscopic procedure to remove superficial or precancerous lesions of the esophagus without the need for open surgery;
• Endoscopic Dissection Stretched to the Submucosa (ESD): is an advanced endoscopic technique to remove larger, invasive tumors that extend to the submucosa of the esophagus.

The surgical approach is based onesophagectomy, which is thepartial or total surgical removal of the esophagus. It can be performed through atraditional incision (open surgery) or through a minimally invasive approach (laparo/thoracoscopic or robotic). Depending on the site of the neoplasm, surgery may require an abdominal, thoracic, and sometimes cervical approach.

Because it is a very complex procedure, it is crucial to identify patients who can tolerate this procedure and perform adequate preparation for surgery. For these reasons, esophagectomy is performed only in centers with experienced multidisciplinary teams and in centers that perform a high number of such procedures per year.

Following removal of the esophageal tract affected by the neoplasm, it is necessary to reconstruct the esophageal tract by using a portion of the stomach (esophago-gastric anastomosis) or another intestinal tract. During esophagectomy, removal of regional lymph nodes is also performed to assess the extent of the tumor and reduce the risk of metastatic spread.

Chemotherapy can be used in several settings in the treatment of esophageal cancer, including:

• • Neoadjuvant treatment: is administered before surgery to reduce tumor size and increase the chance of successful treatment;

• • Adjuvant treatment: is performed after surgery to destroy any remaining cancer cells and reduce the risk of recurrence;

• • perioperative treatment: is administered before and after surgery;

• • palliative treatment: when the tumor has spread to other organs, so it is metastatic, to relieve disease symptoms, improve quality of life and prolong survival.

Radiation therapy uses high-energy beams to destroy cancer cells. In the treatment of esophageal cancer, radiation therapy can be used in combination with chemotherapy as a neoadjuvant treatment before surgery to reduce the tumor mass or as an adjuvant post-surgical treatment to reduce the risk of local recurrence.

In the case of inoperable tumor lesions, radiation therapy can be used alone or in combination with chemotherapy for radical purposes.

In patients with locally advanced esophageal tumors, it can also be used for palliative purposes to reduce any algic or dysphagic symptoms.

Due to the high number of cases treated each year, the Candiolo Institute is a national reference for taking care of esophageal cancer. Our experience enables us to deal with even the most complex situations, always with a personalized approach built on the clinical and personal profile of each patient.

Establishing the treatment plan always starts with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies that allow accurate assessment of the extent of the disease.

In addition, the Institute offers advanced and sophisticated laboratory investigations, including molecular and genomic analyses, which are critical for identifying biological features of cancer and guiding therapeutic decisions.

When indicated, surgery is performed with minimally invasive techniques (laparoscopic or thoracoscopic), which reduce operative trauma, promote faster recovery, and improve postoperative quality of life. Every treatment choice is defined within the GIC, ensuring a consistent and integrated approach.

As an IRCCS, the Candiolo Institute combines clinical practice with a strong vocation for scientific research. Patients can be evaluated for inclusion in active clinical trials, which represent a real chance to access innovative therapies not yet available in standard practice. Collaboration between care and research is a distinctive value that translates into concrete opportunities for the patient.

The Interdisciplinary Care Group takes care of the person at every stage: from diagnosis to treatment to follow-up, with attention to nutritional support, psychological health, and reintegration into daily life. The organization of checkups, visits and treatment is designed to ensure continuity and serenity, always valuing the human dimension of care.