Penn Medicine specializes in a team approach to treatment with interdisciplinary care and innovative methods that use chemotherapy to target tumors prior to surgery. Our medical oncologists are experienced with providing chemotherapy to patients with esophageal cancer.
Chemotherapy uses drugs to kill cancer cells. It is delivered in the bloodstream intravenously or through a pill, and targets cancer cells throughout the body.
Depending on the stage of the tumor, chemotherapy in combination with radiation therapy, or chemoradiation therapy, may be used as a primary treatment or in combination with surgery.
Today, more and more people are surviving cancer thanks to clinical trials. Clinical trials benefit patients by providing access to breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:
- Diagnosing cancer has become more precise
- Radiation and surgical techniques have advanced
- Medications are more successful
- Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes
- Strategies to address the late effects of cancer and its treatment are improving quality of life
Endoscopy is performed using an endoscope, a long, narrow tube equipped with a light, video camera and other instruments, to examine the upper digestive system.
Endoscopic Mucosal Resection (EMR)
Endoscopic mucosal resection is performed using an endoscope. During endoscopic mucosal resection, the endoscope is passed down the throat to reach the abnormality in the esophagus. Instruments attached to the endoscope are used to remove the tumor.
Radiofrequency ablation is an endoscopic procedure involving targeted thermal energy to kill the cells lining in the esophagus as a treatment for Barrett’s esophagus, a precancerous condition. The radio waves kill the altered cells and prevent them from becoming cancer.
Endoscopic Stent Placement
Endoscopic stents may be placed for palliative relief of dysphagia.
Many people with esophageal cancer find it hard to eat because they have trouble swallowing. The esophagus can be narrowed by the tumor or as a side effect of treatment. Some patients may receive nutrition intravenously or through a feeding tube passed through the nose or mouth into the stomach until they are able to eat on their own. Endoscopic therapies including dilation and stent placement may improve the swallowing function and nutritional status.
A specialized oncology dietitian is available to help with swallowing difficulty, weight loss, specialized diets and nutritional assessment. Speech and swallowing therapists are also available to help with symptoms.
Radiation oncologists at Penn Medicine are recognized for techniques that target radiation precisely to the disease site while sparing nearby tissue. Penn is one of the only health care systems in the country to use proton therapy for cancer treatment.
Proton therapy at Penn Medicine is now being used to treat upper gastrointestinal cancers and recurrent tumors in the digestive tract. We are one of the only facilities in the country treating gastrointestinal cancers in this way.
Radiation therapy uses high-energy radiation to kill cancer cells. A radiation therapy schedule usually consists of a specific number of treatments given over an extended period of time. In many cases, radiation therapy is capable of killing all of the cancer cells.
Radiation oncologists at Penn Medicine use both internal and external forms of radiation therapy to treat cancer.
3-D Conformal Radiation Therapy
The imaging technology used by radiation oncologists at Penn Medicine helps shape the radiation treatment beam to the shape of the tumor. Known as conformal radiation therapy, this technology gives doctors more control when treating tumors.
In conformal radiation, a special computer uses CT imaging scans to create 3-D maps of the cancer's location in the body. The system permits the delivery of radiation from several directions and the beams can then be shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.
Intensity-Modulated Radiation Treatment (IMRT)
As national leaders in radiation therapy, radiation oncologists at Penn Medicine are experts in the use of the latest therapies, including intensity-modulated radiation therapy (IMRT), to treat cancer.
This advanced type of radiotherapy uses a computer-controlled device, called a linear accelerator, to deliver precise doses of radiation to tumors or specific areas within the tumors. Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells.
Using 4-D computed tomography (CT) images along with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the shape of the tumor by controlling, or modulating, the intensity of the radiation beam while tracking any movement of the tumor. The therapy allows higher radiation doses to be delivered to regions within the tumor while minimizing the dose to the surrounding area.
Volumetric-Modulated Arc Therapy (VMAT)
Volumetric modulated arc therapy (VMAT) is a type of specialized intensity modulated radiation therapy. VMAT delivers radiation by rotating the linear accelerator through one or more arcs while radiation is continuously delivered.
VMAT allows our radiation oncologists to treat complex cancers while minimizing exposure to surrounding healthy tissue. VMAT shortens radiation delivery time and offers patient more comfort because it does not require patients to lie completely still for long periods of time.
Penn radiation oncologists use RapidArc™ radiotherapy technology to treat hard to reach tumors.
Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials.
Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. Patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at Penn Medicine. Proton therapy is external beam radiotherapy in which protons are directed at a tumor.
The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.
Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. These particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.
Penn Medicine offers patients one of the largest gastrointestinal surgery programs in the United States with nationally recognized cancer specialists. Penn's GI surgery program has a record of high-quality patient care and long-term survival, offering better outcomes for patients having surgery.
Nationally, surgery is the most common treatment for esophageal cancer, though the use of endoscopic therapies for early tumors is rapidly increasing. For limited stage esophageal cancer, surgery may be the only treatment needed.
Esophagectomy is the most common form of surgery for patients with esophageal cancer. In this procedure, the part of the esophagus affected by cancer is removed. The healthy part of the esophagus is then connected to the stomach. Lymph nodes near the esophagus are also removed and examined for cancer. If the esophagus is blocked by a tumor, an expandable stent, or tube, may be placed prior to surgery to help keep the esophagus open to improve nutritional status, or after surgery to alleviate symptoms.
In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments — not take their place.