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Information for Patients: Treatment of Esophageal Cancer |
Early detection and cure of esophageal cancer is among the most challenging problems facing cancer researchers and health care providers today. Unfortunately, esophageal cancer often goes undetected until it has advanced beyond the stage where cure is possible. When cure is not possible, the goal becomes palliation, or maintaining quality of life and keeping the patient comfortable as long as possible.
Esophageal cancer may be treated with surgery, radiotherapy (radiation), chemotherapy or a combination of these. When esophageal cancer is found early in the course of the disease, surgery may cure the disease. Many patients receive combination therapy, such as radiation and surgery. The choice of treatment should be a collaborative effort among, patient, family and physician. As a patient, it is important to understand your options in order to make informed decisions. The purpose of this page is to provide a brief overview of esophageal cancer treatment options with emphasis on the role of PDT. This information is, of course, not intended to take the place of your physician's advice.
Photodynamic therapy is approved by the United States Food & Drug Administration (FDA) for the treatment of advanced esophageal cancer. In advanced esophageal cancer, the tumor can partially or completely block the esophagus, making it difficult or impossible to swallow. This problem is known as dysphagia in medical terminology. When dysphagia is very severe, the patient cannot even swallow his own saliva.
There are a number of ways to reduce the size of the tumor blocking the esophagus and improve swallowing. Some of these are dilating the esophagus with a balloon-like device, vaporizing the tumor with a high-powered laser, freezing the tumor (known as cryotherapy), and inserting a device known as a stent to hold the esophagus open.
PDT can also be very effective in reducing the size of tumors that block the esophagus. In some cases, PDT has advantages over the other methods of opening up the esophagus. For example, it may be technically easier to open a completely blocked esophagus with PDT than with laser vaporization. PDT may be more desirable than a stent when the tumor is located in the lower one-third of the esophagus. The effects of PDT may last longer than balloon dilation. Each patient's situation is unique. Before making any decisions, patients are encouraged to speak to their physician about the advantages and disadvanatages of various treatment options.
Photodynamic therapy is tumor-selective. This means that PDT does not kill healthy cells as chemotherapy and radiation can. Unlike radiation and chemotherapy, PDT can be repeated as necessary. PDT does not preclude the use of other treatments, such as surgery, in the future. Unlike chemotherapy, PDT is not specific to the microscopic cell type of the tumor. This is why PDT can be useful in treating a variety of types of cancers. PDT works quickly; patients begin to experience relief of dysphagia a few to several days after PDT. Lastly, PDT carries few side effects. The major side effect of PDT with Photofrin® is photosensitivity, or sensitivity to light, that lasts for 4-6 weeks. Patients must protect their skin and eyes from bright light during this period. For further information about the side effects of PDT, patients are encouraged to contact their physician or nurse.
Photodynamic therapy does not work for cancers in locations where it is difficult or impossible to deliver laser light. Some tumors deep within the body, such as bone tumors, are not accessible with the devices currently in use for PDT. Newer devices that are implanted within the body are being developed for use in the future. Only time will tell how many different light-delivery devices for PDT will be developed. Tumors in other locations may be treated in the future with other photosensitizing drugs. The only drug currently approved for PDT in the United States is Photofrin®.
Some people are not candidates for PDT. These include people with a disease known as porphyria and people with a tumor that has eroded into a large blood vessel. People with a complication known as tracheoesophageal fistula are not candidates for PDT either. Tracheoesophageal fistula means that tumor growth has created an opening between the esophagus and the trachea, or airway. Again, it is best to talk to a physician or other health care provider with knowledge of PDT if you have questions about whether or not you may benefit from PDT.
There are several ways to treat esophageal cancer. Often, surgery is the best choice for prolonging life and reducing the symptoms of esophageal cancer. Chemotherapy and radiotherapy are often effective together or in combination with surgery. PDT can be a useful alternative for patients who cannot undergo surgery or choose not to have surgery. PDT can be used before or after surgery, radiotherapy and chemotherapy. Working in collaboration with health care providers, patients and their families should evaluate options for treatment and choose a treatment plan that fits their needs and expectations. Patients are encouraged to work closely with a health care provider who is acquainted with PDT and other treatments for esophageal cancer.
This page authored by Teresa Goodell, RN, and copyrighted by Oregon Medical Laser Center, 1999.