immediate investigation in the form of an upper endoscopy ( gastroscopy ). This procedure uses a flexible camera which is guided down into the oesophagus to allow direct imaging and a biopsy to be taken of any tumour or cancer . Early treatment is imperative for a better outcome and prognosis and to enhance the chance of survival .
Staging of the cancer is the next step with CT scans to determine whether the cancer is localised or has already spread . The only cure is surgery to excise the cancer . However , if the cancer has spread to distant organs , it will unfortunately mean that the only treatment is palliation with chemotherapy and maybe placing a stent across the tumour to allow the passage of food . If the cancer is more advanced but still localised , then chemotherapy with or without radiotherapy and immunotherapy may be given before or after surgery . This helps to increase the potential of a cure with surgery .
Surgery is a major undertaking involving operating in both the abdominal and chest cavity to remove cancer from the long oesophagus . Traditionally , this operation is performed by open surgery with a large incision in the chest ( thoracotomy ) and a similar long incision in the abdomen . Once the oesophagus is removed , the stomach is made into a thin tube ( two-finger width ) and pulled up into the chest to reconnect the remaining oesophagus to the stomach .
With the technical advances in medical equipment and surgical techniques , keyhole surgery ( minimally invasive laparoscopic or thoracoscopic surgery ) has been demonstrated to be superior in outcome compared to conventional open surgery , and this is also true for oesophageal cancer . With keyhole surgery , there ’ s a shorter hospital stay , less requirement for intensive care unit admission , lower overall complication rates , and a faster return to normal function . The risk of pneumonia is also reduced by as much as 40 percent with this method .
After surgery , eating large meals will no longer be possible since the stomach , which previously acted as a large reservoir bag ( normally holding up to 1.5 litres of fluid and food ), has been reduced to a long narrow tube . However , the type of diet can remain the same , and recovery is dependent on eating healthily with a good amount of proteins and nutritional supplements over the following four to six weeks . Further treatment such as chemotherapy may be needed after surgery if the cancer has been found to have extended outside the oesophagus to the lymph glands that were removed and examined .
Unfortunately , the prognosis for patients with advanced oesophageal cancer is poor . If it can be detected early and surgery undertaken , the five-year survival rate will be more than 90 percent . For more advanced cases , the survival rate reduces to 47 percent for bigger cancers , 25 percent if the spread is nearby , and less than five percent if the cancer has spread to distant organs . Early detection along with surgery are crucial to surviving from this disease .
Dr Kan Yuk Man
• Stage I : Five-year survival is 55 percent
• Stage II : Five-year survival is 30 percent
• Stage III : Five-year survival is 15 percent
• Stage IV : Sadly , many people don ’ t live beyond a few months The chance of the cancer recurring after surgery even with additional treatment is ever present for every patient over the following 5-10 years . Patients should still live a healthy life but will require very close follow up with yearly gastroscopy and CT scans to ensure that the cancer has not returned .
Early detection is paramount to surviving this disease and to enable a cure . Any worrying symptoms of persistent heartburn or dysphagia should ring alarm bells and signal the need to seek a medical opinion . Prevention is always the key-point with any condition , and therefore avoiding any risk factor is crucial . In preventing oesophageal cancer , risks factors which we can control are smoking , excessive alcohol , obesity , reflux , and dietary risks . Living and working in modern society should not negate one ’ s health , so keeping healthy remains important for enjoying our lives with our family and loved ones . Keep safe and well .
Dr Kan Yuk Man is a senior consultant surgeon specialising in surgical oncology at Farrer Park Hospital and Mount Elizabeth Hospital in Singapore .
Contact us : Dr Kan Yuk Man Senior Consultant Surgeon
KYM Surgery 1 Farrer Park Station Road # 13-05 / 06 Connexion Singapore 217562 Tel : + 65 6443 3133
GlobalHealthAsiaPacific . com OCTOBER 2021
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