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Esophageal Cancer our Pleaseonline surveycomplete at NCCN.org/patients/survey NCCN GUIDELINES FOR PATIENTS® 2018 Esophageal Cancer Presented with support from: ECAA Esophageal Cancer Awareness Association Available online at NCCN.org/patients Ü Esophageal Cancer that you have cancer LEARNING can be overwhelming. The goal of this book is to help you get the best care. It explains which cancer tests and treatments are recommended by experts in esophageal cancer. The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 27 leading cancer centers. Experts from NCCN have written treatment guidelines for doctors who treat esophageal cancer. These treatment guidelines suggest what the best practice is for cancer care. The information in this patient book is based on the guidelines written for doctors. This book focuses on the treatment of esophageal cancer in adults. Key points of the book are summarized in the related NCCN Quick Guide™. NCCN also offers patient books on lung cancer, melanoma, and many other cancer types. Visit NCCN.org/patients for the full library of patient books, summaries, and other resources. NCCN Guidelines for Patients®: Esophageal Cancer, 2018 1 About These patient guidelines for cancer care are produced by the National Comprehensive Cancer Network® (NCCN®). The mission of NCCN is to improve cancer care so people can live better lives. At the core of NCCN are the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). NCCN Guidelines® contain information to help health care workers plan the best cancer care. They list options for cancer care that are most likely to have the best results. The NCCN Guidelines for Patients® present the information from the NCCN Guidelines in an easy-to-learn format. Panels of experts create the NCCN Guidelines. Most of the experts are from NCCN Member Institutions. Their areas of expertise are diverse. Many panels also include a patient advocate. Recommendations in the NCCN Guidelines are based on clinical trials and the experience of the panelists. The NCCN Guidelines are updated at least once a year. When funded, the patient books are updated to reflect the most recent version of the NCCN Guidelines for doctors. For more information about the NCCN Guidelines, visit NCCN.org/clinical.asp. Dorothy A. Shead, MS Laura J. Hanisch, PsyD Erin Vidic, MA Director, Patient Medical Writer/Patient Medical Writer Information Operations Information Specialist Rachael Clarke Alycia Corrigan Guidelines Data and Medical Writer Layout Coordinator NCCN Foundation was founded by NCCN to raise funds for patient education based on the NCCN Guidelines. NCCN Foundation offers guidance to people with cancer and their caregivers at every step of their cancer journey. This is done by sharing key information from leading cancer experts. This information can be found in a library of NCCN Guidelines for Patients® and other patient education resources. NCCN Foundation is also committed to advancing cancer treatment by funding the nation’s promising doctors at the center of cancer research, education, and progress of cancer therapies. For more information about NCCN Foundation, visit NCCNFoundation.org. © 2018 National Comprehensive Cancer Network, Inc. Based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Esophageal Cancer (Version 2.2018). Posted 07/11/2018. All rights reserved. NCCN Guidelines for Patients® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of NCCN. No one, including doctors or patients, may use the NCCN Guidelines for Patients® for any commercial purpose and may not claim, represent, or imply that the NCCN Guidelines for Patients® that has been modified in any manner is derived from, based on, related to or arises out of the NCCN Guidelines for Patients®. The NCCN Guidelines are a work in progress that may be redefined as often as new significant data become available. NCCN makes no warranties of any kind whatsoever regarding its content, use, or application and disclaims any responsibility for its application or use in any way. National Comprehensive Cancer Network (NCCN) • 275 Commerce Drive, Suite 300 • Fort Washington, PA 19034 • 215.690.0300 NCCN Guidelines for Patients®: Esophageal Cancer, 2018 2 Supporters Endorsed and sponsored in part by Esophageal Cancer Awareness Association (ECAA) The ECAA strongly supports NCCN’s efforts to provide accurate and easy to read information ECAA to anyone affected by esophageal cancer. Patients, family and friends can better understand Esophageal Cancer this disease thanks to these comprehensive guidelines and resources to help move forward Awareness Association with treatment. www.ecaware.org Endorsed by Endorsed by Esophageal Cancer Action Network, Inc. (ECAN) ECAN is proud to endorse the NCCN Guidelines for Patients. ECAN understands how critically important it is for patients and families to understand all of their options when facing the life and death decisions so often confronted in Esophageal Cancer. These Guidelines illuminate complex issues as they help answer the important questions that can direct patients on a path to appropriate, life-saving care. www.ecan.org With generous support from Jan & Paula Buckner The Honorable Ellen O. Tauscher Marcie Reeder in honor of Dr. Lawrence A. Rodgers NCCN Guidelines for Patients®: Esophageal Cancer, 2018 3 NCCN Guidelines for Patients®: Esophageal Cancer, 2018 4 Esophageal Cancer Contents 6 How to use this book 81 Dictionary 7 Part 1 85 Acronyms Esophageal cancer basics Explains what cancer is and how it affects the 86 NCCN Panel Members for esophagus. Esophageal Cancer 11 Part 2 87 NCCN Member Institutions Cancer staging Describes how doctors rate the extent of 88 Index esophageal cancer. 24 Part 3 First steps Presents the first steps toward treating your cancer. 33 Part 4 Overview of cancer treatments Describes the treatments used to cure or control esophageal cancer. 44 Part 5 Treatment guide: Squamous cell carcinoma Presents the treatment options for this type of esophageal cancer. 58 Part 6 Treatment guide: Adenocarcinoma Presents the treatment options for this type of esophageal cancer. 73 Part 7 Making treatment decisions Offers tips for choosing the best treatment. NCCN Guidelines for Patients®: Esophageal Cancer, 2018 5 How to use this book Who should read this book? Does this book include all options? This book is about treatment for esophageal cancer. People with esophageal cancer and those who This book includes treatment options for most support them—caregivers, family, and friends—may people. Your treatment team can point out what find this book helpful. It may help you discuss and applies to you. They can also give you more decide with doctors what care is best. information. While reading, make a list of questions to ask your doctors. The treatment options are based on science and Are the book chapters in a the experience of NCCN experts. However, their certain order? recommendations may not be right for you. Your doctors may suggest other options based on your Starting with Part 1 may be helpful. It explains what health and other factors. If other options are given, esophageal cancer is. Read Part 2 to learn about ask your treatment team about anything you don’t how esophageal cancer is staged. Part 3 talks about understand. the health tests you may need to take in order to plan the best treatment for you. The main ways to treat esophageal cancer are explained in Part 4. The two main kinds of esophageal cancer are squamous cell Help! What do the words carcinoma and adenocarcinoma. Recommendations mean? for treating these cancer types are presented in Parts 5 and 6. The last chapter is Part 7. This In this book, many medical words are included. chapter offers help for making treatment decisions. These are words you will likely hear from your treatment team. Most of these words may be new to you, and it may be a lot to learn. Don’t be discouraged as you read. Keep reading and review the information. Feel free to ask your treatment team to explain a word or phrase that you don’t understand. Words that you may not know are defined in the text or in the Dictionary. Acronyms are also defined when first used and in the Glossary. Acronyms are short words formed from the first letters of several words. One example is DNA for deoxyribonucleic acid. NCCN Guidelines for Patients®: Esophageal Cancer, 2018 6 Explains what cancer is and how it affects the esophagus. 1 Esophageal cancer basics 8 The esophagus 9 How cancer works 10 Review NCCN Guidelines for Patients®: Esophageal Cancer, 2018 7 1 Esophageal cancer basics The esophagus You’ve learned that you have esophageal The most important facts for you to know about the cancer. It’s normal to feel shocked and esophagus are: confused. This chapter goes over the basics of cancer and how it affects the The wall of the esophagus has four layers. esophagus. This first look at your cancer will help prepare you for next steps. Cancer starts on the inside (layer 1) and grows outward through layers 2, 3, and 4. There are 2 main kinds of esophageal cancer— squamous cell carcinoma and adenocarcinoma. The esophagus Squamous cell carcinoma is usually found in The esophagus is part of your digestive system. It the middle or top part of the esophagus. is the hollow, muscular tube that moves food and liquids from your mouth to your stomach. See Adenocarcinoma is usually found at the bottom Figure 1 for a picture of the esophagus in the body. of the esophagus, near the stomach. Figure 1. The esophagus The esophagus moves food from your mouth to your stomach. Cancer starts on the inside and grows through the four layers of the esophagus wall. NCCN Guidelines for Patients®: Esophageal Cancer, 2018 8 1 Esophageal cancer basics How cancer works How cancer works Your body is made of over 30 trillion cells.
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