Oesophageal Adenocarcinoma Stage II

Stage 2 oesophageal adenocarcinoma is a type of cancer that begins in the gland cells of the oesophagus and has grown into deeper layers of the oesophagus wall, sometimes spreading to nearby lymph nodes, but has not reached other parts of the body.

Table of contents

• What is stage 2 oesophageal adenocarcinoma?
• How is stage 2 adenocarcinoma classified?
• Treatment options
• Nutrition and eating support

What is stage 2 oesophageal adenocarcinoma?

Stage 2 oesophageal cancer means the cancer may have spread as far as the outer layer covering your oesophagus. Some stage 2 cancers have also spread into 1 or 2 nearby lymph nodes, which are small organs that help fight infection. However, the cancer has not spread to other body parts, structures or distant organs.^[1]

Adenocarcinoma is a type of cancer that develops in gland cells. These cells make mucus in the lining of the oesophagus. Adenocarcinomas usually form in the lower part of the oesophagus, near the stomach.^[1]

The staging of your cancer is very important because it helps your doctor understand how far the cancer has grown and guides decisions about treatment. Staging depends on what type of oesophageal cancer you have, the grade of your cancer (how abnormal the cells look), and whether doctors stage your cancer using tests and scans (called clinical staging) or after surgery (called pathological staging).^[1]

Your doctor might tell you your clinical stage first, based on tests and scans. If you go on to have surgery, your stage might change when the doctor finds out your pathological stage.^[1]

How is stage 2 adenocarcinoma classified?

Stage 2 adenocarcinoma can be found in any part of the oesophagus and can be any grade. It is split into 2 groups: stage 2A and stage 2B.^[1]

Stage 2A means the cancer has grown no further than the outer layer of the oesophagus wall but has not spread to nearby lymph nodes. Stage 2B means the cancer has grown into the thick muscle wall or supportive tissue of the oesophagus and has spread to 1 or 2 nearby lymph nodes.^[1]

Doctors use the TNM staging system to describe the cancer in more detail. This system describes the size of the primary tumour (T), whether the cancer has spread to the lymph nodes (N), and whether the cancer has spread to another part of the body (M).^[1]

Treatment options

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. You may have a feeding tube put in, so that you can gain weight and maintain good nutrition during treatment.^[4]

Chemotherapy and chemoradiation

Chemotherapy uses drugs to kill cancer cells. It is usually combined with radiation therapy to treat stage 2 oesophageal cancer. This combination is called chemoradiation. The 2 treatments are given during the same time period.^[4]

Chemoradiation may be offered for stage 2 oesophageal cancer before surgery (called neoadjuvant therapy) or after surgery (called adjuvant therapy), especially for oesophageal adenocarcinoma tumours. It may also be used as the main treatment for tumours that are found in the upper part of the oesophagus.^[4]

Chemotherapy by itself may be offered before surgery for stage 2 oesophageal tumours at the gastroesophageal (GE) junction, which is where the oesophagus joins the stomach. People with stage 2 oesophageal cancer who are not healthy enough to have surgery, or who do not want to have surgery, may be offered chemotherapy or chemoradiation as the main treatment.^[4]

The most common chemotherapy drugs used to treat stage 2 oesophageal cancer include combinations such as cisplatin and capecitabine, cisplatin and fluorouracil, carboplatin and paclitaxel, and many others. Your doctor will decide which combination is best for you.^[4]

Targeted therapy

Targeted therapy drugs may be used to treat stage 2 adenocarcinoma tumours at the gastroesophageal junction. They are usually combined with chemotherapy.^[4]

Trastuzumab is a targeted therapy drug used with chemotherapy drugs to treat HER2-positive tumours. HER2 is a protein that can be found on the surface of some cancer cells. The most common combinations are trastuzumab with cisplatin and fluorouracil, or trastuzumab with cisplatin and capecitabine.^[4]

Immunotherapy

Nivolumab (Opdivo) is an immunotherapy drug that may be offered for stage 2 oesophageal cancer. It may be given to people who still have cancer remaining after neoadjuvant therapy with chemoradiation and surgery to completely remove the tumour.^[4]

Surgery

Esophagectomy is surgery to remove all or part of the oesophagus and lymph nodes around it. Part of the stomach may be removed as well. Before you are offered surgery, your healthcare team will do tests to make sure that you are healthy enough to have it done.^[4]

Esophagectomy is the type of surgery offered for stage 2 oesophageal cancer when the person is healthy enough to have surgery. You may be offered surgery by itself or after chemoradiation.^[4]

Radiation therapy

External radiation therapy is the most common type of radiation therapy used to treat oesophageal cancer. Radiation therapy is combined with chemotherapy to treat stage 2 oesophageal cancer as chemoradiation. The 2 treatments are given during the same time period. Chemotherapy can make radiation therapy more effective in treating oesophageal cancer.^[4]

Nutrition and eating support

Oesophageal cancer can cause problems with swallowing and make it hard to eat well. It is important to eat and drink enough calories and protein to maintain your weight and strength. There will be a dietitian in the team looking after you. They can help you cope with eating problems and suggest ways of dealing with diet difficulties.^[16]

Most people with oesophageal cancer have difficulty swallowing (called dysphagia). This can develop if the tumour blocks the oesophagus, if food does not move down the oesophagus because the wave-like muscle contractions have changed, or if the oesophagus is inflamed because of radiation therapy.^[16]

If you find swallowing difficult, there are several ways to help. You can eat small amounts more often, eat soft and moist foods, eat slowly and chew your food well, and take sips of a drink between mouthfuls. Try to make the most of the times during the day that you feel able to eat.^[16]

A soft diet can help you eat more comfortably. Try scrambled egg, soups and mashed potato. You can use sauces, cream and gravies to moisten food and make it easier to swallow. Soften meat and vegetables with long, slow cooking. Finely chop meat and vegetables in a food processor before or after cooking. Blend or process meat or vegetable casseroles or curries to make soups. Make fruit smoothies or milkshakes in a blender. Try tinned fruit and add custard or cream. Have ice cream, yoghurts and mousse.^[16]

You may need a feeding tube down your nose or put into your small bowel if you cannot eat and drink enough. You can go home with the feeding tube in place. Your team will teach you or your carer how to use the tube once you’re at home.^[16]

Most people with oesophageal cancer will lose a lot of weight. Severe weight loss is called cachexia. Weight loss can happen if you have problems swallowing caused by the tumour or by treatments for oesophageal cancer. It is important for you to eat well and maintain your weight during and after treatment for oesophageal cancer. Eating well can help your body fight disease and cope with the effects of cancer treatments.^[21]