Q&A with Dr. Vashi
What is radiation therapy?
Radiation therapy uses targeted energy (e.g., X-rays, radioactive substances) to destroy cancer cells, shrink tumors, and/or alleviate certain cancer-related symptoms. It may be used:
- As a primary treatment to destroy cancer cells
- In combination with other treatments to stop the growth of cancer cells
- Before another treatment to shrink a tumor
- After another treatment to stop the growth of any remaining cancer cells
- To relieve symptoms of advanced cancer
At Cancer Treatment Centers of America® (CTCA), our radiation oncologists are experienced in using advanced technologies to deliver targeted radiation therapy while also proactively managing side effects.
Types of radiation
Some radiation therapy delivery methods include:
- External beam radiation therapy – radiation is directed from a machine outside the body onto cancerous cells within the body. (Examples: 3D conformal radiation therapy, IMRT, IGRT, TomoTherapy, stereotactic radiosurgery)
- Internal radiation therapy – radioactive material is placed (via a catheter or other carrier) directly into or near a tumor. (Example: high-dose rate brachytherapy)
- Systemic radiation therapy – a radioactive substance (that is swallowed or injected) travels through the blood to locate and destroy cancerous cells. (Example: radioactive iodine therapy)
Experienced care team
Our radiation oncologists specialize in delivering maximum radiation doses to tumors with less damage to healthy tissues and organs. Our radiation oncologists will work closely with you and the rest of your care team to deliver radiation therapy based on your individual needs.
Individualized treatment approach
Radiation therapy is an important part of treatment for many of our patients. Since each cancer type requires a different approach, your treatment plan will be based on your unique needs and treatment goals.
Our radiation oncologists use advanced imaging techniques before and during radiation treatment so we can closely track the tumor. We use highly targeted radiation technologies to deliver maximum radiation doses to tumors, with less impact on healthy tissues and organs. Thereby, we can often provide options to patients who have reached their maximum tolerated dosage of traditional radiation.
Depending on your individual needs, you may receive radiation therapy alone or in combination with other treatment modalities like surgery, chemotherapy, hormone therapy and/or immunotherapy. Throughout your treatment, your radiation oncologist will monitor the effectiveness of the radiation therapy and modify your treatment plan accordingly.
Managing radiation side effects
Typical radiation therapy can be damaging to the body and cause unpleasant side effects, such as skin changes, fatigue, nausea, and other side effects, depending on the part of your body being treated. During your radiation treatment, clinicians from a variety of integrative oncology services will work with you to reduce side effects and improve your quality of life.
Dr. Pankaj Vashi offers insight into diagnosing and treating esophageal cancer, as well addressing quality of life.
How can people with gastroesophageal reflux disease (GERD) reduce their risk of esophageal cancer?
There are two kinds of esophageal cancer, adenocarcinoma and squamous cell carcinoma. In the United States, adenocarcinoma is most common. GERD, obesity and tobacco use are the main risk factors for adenocarcinoma, which typically develops in the lower part of the esophagus near the stomach. You should see your doctor if you have chronic GERD that does not respond to two weeks of treatment with over-the-counter medications such as Prilosec®, Nexium® and Prevacid®, especially if you are a smoker or obese. Difficulty swallowing solid food may suggest narrowing of the esophagus, which can be another symptom of esophageal cancer. Learn more about GERD and get tips to reduce your risk of esophageal cancer.
How is esophageal cancer diagnosed?
An upper endoscopy can diagnose precancerous lesions called Barrett’s esophagus, which develops when chronic acid reflux erodes the lining of the esophagus. For the procedure, your doctor will insert an endoscope, a thin tube with an attached camera, through your mouth to examine the esophagus, stomach and the beginning of the small intestine. If you are diagnosed with Barrett’s esophagus, you would not undergo treatment unless the condition is advanced. But you would have an upper endoscopy every three to five years to monitor the condition.
How does genomic tumor assessment help diagnose and treat esophageal cancer patients?
If you have advanced esophageal cancer that does not respond to standard of care treatments—radiation therapy, chemotherapy and surgery—you may be a candidate for genomic tumor assessment. For this testing, a biopsy is performed to obtain fresh tissue sample for testing. The sample is analyzed to identify potential genetic mutations that are driving the growth of your cancer. Understanding what’s happening at the genetic level may help identify specific targeted therapies that may be effective in treating your individual cancer.
What are recent advances in treatment for esophageal cancer?
We now have more sophisticated radiation therapy and chemotherapy agents that may help improve quality of life and may result in better outcomes. Intra-esophageal brachytherapy may be used on patients who’ve already undergone external beam radiation therapy (EBRT) for a primary esophageal lesion but still have a tumor causing obstruction or bleeding.
Intra-esophageal brachytherapy is an innovative way of treating a tumor that is partially blocking the esophagus. For the treatment, your doctor would place a wire through the tumor with the help of an endoscope. Radiation beams are sent through the wire and directly to the tumor. The treatment also may help with tumors that are bleeding. The goal of treatment is to make it easier to swallow and eat.
What can be done for patients who have difficulty swallowing or eating as a result of their cancer?
Maintaining good nutrition is critical during and after your treatment. Our dietitians work with you one-on-one to address how the cancer is affecting you and your nutritional needs. During treatment, we can put in a feeding tube in the stomach or small intestine to make sure you don’t lose weight and you can keep up your strength for radiation therapy and chemotherapy. Intra-esophageal brachytherapy, radiofrequency ablation, cryotherapy and esophageal stenting are additional treatments that may help improve swallowing and eating.
Radiation therapy for esophageal cancer
Radiation therapy is a preferred option for people with stage III esophageal cancer. It is often performed in conjunction with chemotherapy. If radiation therapy is successful in down-staging esophageal cancer, surgery may be performed.
Before, during and after your esophageal cancer treatment, we take a proactive approach to preventing and managing radiation side effects, such as difficulty swallowing. A stent will often be placed in the esophagus before radiation therapy begins. A temporary feeding tube may also be necessary, so you continue to receive proper nutrients.