Cancer of the esophagus starts in the inner layer, known as the mucosa,
and grows outward through the submucosa and the muscle layer. There are
two main types of esophageal cancer, squamous cell carcinoma and adenocarcinoma
Squamous cell carcinoma
The esophagus is normally lined with squamous cells. Cancer starting in
these cells is called squamous cell carcinoma. This type of cancer can
occur anywhere along the esophagus, but is most common in the portion
of the esophagus located in the neck region and in the upper two-thirds
of the chest cavity.
Cancers that start in gland cells (cells that make mucus) are called adenocarcinomas.
This type of cancer usually occurs in the distal, or the lower third part
of the esophagus. Before an adenocarcinoma can develop, gland cells must
replace an area of squamous cells, which is what happens in Barrett’s
esophagus. This occurs mainly in the lower esophagus.
For some earlier stage cancers, surgery can be used to remove the cancer
and some of the normal surrounding tissue. In some cases, it might be
combined with other treatments, such as chemotherapy and/or radiation therapy.
Some procedures are done through incisions in the neck, chest, and abdomen.
You and your surgeon should discuss in detail the operation planned for
you and what you can expect.
In this procedure, surgeons remove some or most of the esophagus. Often
a small part of the stomach is removed as well. The upper part of the
esophagus is then connected to the remaining part of the stomach. Part
of the stomach is pulled up into the chest or neck to become the new esophagus.
In this standard, open technique, the surgeon operates through one or more
large incisions in the neck, chest, or abdomen. Many different approaches
can be used to remove part of the esophagus.
Transthoracic esophagectomy: The esophagus is removed with the main incisions in the abdomen and the chest.
Transhiatal esophagectomy: In this procedure, the main incisions are in the abdomen and neck.
Minimally invasive esophagectomy
For some early cancers, the esophagus can be removed through several small
incisions instead of large incisions. The surgeon passes a scope through
one of the incisions to see everything during the operation, while surgical
instruments go in through the other small incisions. To do this type of
procedure well, the surgeon needs to be highly skilled and have a great
deal of experience. Because it uses smaller incisions, minimally invasive
esophagectomy may allow the patient to leave the hospital sooner and recover faster.
Esophagectomy is not a simple operation, and it may require a long hospital
stay. It is very important to have it done by specialists that have experience
treating these cancers and performing these procedures.