Surgical Oncology — Esophageal cancer

Management

Esophageal cancer forms in tissues lining the esophagus, the muscular tube through which food passes from the throat to the stomach. There are two types of esophageal cancer, which are diagnosed and managed in similar ways:

• Squamous cell carcinoma: This begins in flat cells lining the esophagus, usually in the upper part of the esophagus.
• Adenocarcinoma: This begins in cells that make and release mucus and other fluids, and is usually found in the lower part of the esophagus. Adenocarcinoma is the most common esophageal cancer. 

The UC Davis Health System team uses a variety of surgical therapies to treat esophageal cancer as well as benign esophageal diseases. Benign diseases of the esophagus that may require surgical treatment include achalasia, paraesophageal hernia, esophageal diverticulum, esophageal perforation and benign esophageal tumors such as leiomyoma.

Surgical interventions

Surgery, either alone or together with chemotherapy and/or radiation therapy, can be curative for esophageal cancer. Specific surgical procedures may include: 

Esophagectomy, or removal of the esophagus. This is an advanced intervention for patients with a non-functioning esophagus or esophageal cancer. Esophagectomy is performed to reestablish intestinal continuity so patients can again swallow food comfortably. There are several types of esophagectomy; UC Davis surgeons will decide on the best option based on the disease process of the individual patient.  Types of esophagectomy include but are not limited to:

• Transhiatal esophagectomy. Transhiatal means without cutting through the chest. This less-invasive technique allows the esophagus to be removed, and the stomach attached to the remaining portion of esophagus in the neck, without entering the patient’s chest. Because the chest is not opened, the operation is usually shorter, and the patient may experience less pain during recovery, a quicker healing period and shorter hospital stay.
• Transthoracic esophagectomy. A transthoracic procedure goes through the open chest. It is more invasive, but allows for a direct visualization of the esophagus during the surgery, which facilitates mobilization of the esophagus for post-operative healing.
  Many esophagectomy surgeries can be done with a combination of minimally invasive and video-assisted techniques. One of the most important determinants of a patient’s successful outcome after esophagectomy is post-operative recovery. UC Davis employes a detailed esophagectomy post-operative pathway and recovery regimen and a highly skilled nursing team trained in swiftly identifying and managing potential postoperative complications. In addition, UC Davis has the highest ranking for esophageal resection by the LeapFrog Group for Patient Safety.

Clinical trials

Patients seen at the UC Davis Comprehensive Cancer Center will be eligible for trials that offer innovative and state-of-the-art therapy.  Several clinical trials are designed to help patients with early esophageal cancer.

Our general thoracic surgeons also work closely with our medical oncologists and scientists at the Jackson Laboratory–West to bring groundbreaking personalized molecular targeted therapy from “research bench to bedside” for the benefit of our patients.  This exciting work is highlighted in this PBS Newshour report.

Below is information about one of our active clinical trials:

"RTOG 1010: A Phase III Trial Evaluating the Addition of Trastuzumab to Trimodality Treatment of HER-2-Overexpressing Esophageal Adenocarcinoma".
An example of personalized targeted molecular therapy, and provides novel therapy for patients with locally advanced esophageal cancer.
VIEW STUDY DETAILS 

Publications

Cooke DT, Pickens A. Carcinoma of the Esophagus. Medical Management of the Thoracic Surgery Patient. Lewis MI, McKenna RJ, Falk JA, Chaux GE. eds., Saunders, Elsevier, 2010; 503-510.
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Cooke DT, Lin GC, Lau CL, Zhang L, Si MS, Lee J, Chang AC, Pickens A, Orringer MB. Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy: Risk factors, presentation, detection. Annals of Thoracic Surgery. 2009 July; 88(1):177-85. 
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Cooke DT, Calhoun RF. Distance alone does not define the value of the posterior mediastinal route for esophageal reconstruction. Letter to the editor. Annals of Thoracic Surgery. 20090ct; 88(4):1390.
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Cooke DT,  Lau CL. Primary repair of esophageal perforation. Operative Techniques in Thoracic and Cardiovascular Surgery. 2008;13(2):126-137.
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Your Team

Surgical Oncology / Thoracic
David Tom Cooke, M.D.
Assistant Professor of Clinical Surgery
Associate Program Director of the Cardiothoracic Surgery Residency

Elizabeth A. David, M.D.
Assistant Professor of Surgery

Thoracic Surgery Nurse Coordinator
Valerie Kuderer, R.N.

Physician Assistants
Jessica Harvey-Taylor, PA-C
Felicia Tanner-Corbett, PA-C

Contact Us:
Physician to Physician Referrals
1-800-4-UCDAVIS (1-800-482-3284)

General Thoracic Surgery Direct Clinical Line (Monday -Friday, 8 a.m. to 4:30 p.m.)
(916) 734-5994

Email (non-urgent): thoracic.surgery@ucdmc.ucdavis.edu

Social Media:

Twitter: Twitter@UCD_ChestHealth
Blog: UC Davis ChestHealth

Diagnostic Radiology

John P. McGahan, M.D.
Professor of Radiology
Chief of Abdominal Imaging and Ultrasound

C. John Rosenquist, M.D.
Professor of Radiology
Chief of Gastrointestinal Radiology

Gastroenterology

Joseph W. Leung, M.D.
Professor of Medicine
Chief of Gastroenterology

Thomas Prindiville, M.D.
Professor of Medicine, Gastroenterology

Shiro Urayama, M.D.
Associate Professor of Medicine, Gastroenterology

Hematology and Oncology

I-Yeh Gong, M.D.
Assistant Professor of Medicine, Hematology and Oncology

Edward Kim, M.D., Ph.D.
Assistant Professor of Medicine, Hematology and Oncology

Jerry S. Powell, M.D. 
Director, Hemophilia and Thrombosis Center
Professor of Internal Medicine, Hematology and Oncology

Thomas J. Semrad, M.D., M.A.S.
Assistant Professor of Medicine, Hematology and Oncology

Michael Tanaka, Jr., M.D.
Associate Professor of Medicine, Hematology and Oncology

Radiation Oncology

Allen M. Chen, M.D.
Associate Professor
Director, Residency and Fellowship Training Program

Ruben Fragoso, M.D., Ph.D.
Assistant Professor

Arta Monjazeb, M.D., Ph.D.
Assistant Professor