Endoscopic Treatment

If endoscopic biopsies confirm the presence of Barrett’s esophagus with either low- or high-grade dysplasia, then patients are candidates for endoscopic eradication therapy. Our gastroenterologists at Johns Hopkins will use advanced endoscopic techniques to ablate the areas of dysplasia in order to prevent progression to esophageal cancer.

A patient with superficially invasive esophageal cancer (cancer that does not invade deep into the wall of esophagus) may be a candidate for endoscopic management. At Johns Hopkins, our gastroenterologists have advanced, specialized training to perform these endoscopic resections (either an endoscopic mucosal resection or endoscopic submucosal dissection). These endoscopic resections will often be curative and importantly the patient will not require an esophagectomy (removal of the esophagus).

Esophageal Cancer Treatment

At Johns Hopkins, patients with esophageal cancer are evaluated and treated by a multidisciplinary team consisting of oncologists, surgeons, radiologists, and pathologists.

Treatment of esophageal cancer depends upon the stage of the cancer - how far it has spread (T stage) and whether or not it has spread to lymph nodes (N stage) or other organs (M stage). Each patient is staged (evaluated to assess the extent of disease) using various diagnostic tools, including CT scan, MRI, endoscopic ultrasound, and laparoscopic examination.

A surgeon is best qualified to assess whether surgery is a possible option. Surgery typically consists of removal of the esophagus (esophagectomy). When adenocarcinoma is detected at an early, usually pre-symptomatic stage in patients with Barrett's esophagus, the chance of surgical cure is high - 50 to 80%.

Esophageal cancers are often treated with pre-operative chemotherapy and radiation. Approximately 30% of the esophageal cancers treated with pre-operative chemoradiation have no residual cancer cells in the excised specimen. These patients have prolonged survival over those treated by surgery alone.

There are other treatment options for esophageal cancer that cannot be removed surgically. These include chemotherapy, radiation, immunotherapy, and clinical trials in some cases. These types of treatments can be discussed with your oncologist (doctor who specializes in treating tumors).

Esophageal cancer illustration