Improving Survival Rates in Esophageal Cancer: Why Early Referral Matters

Esophageal cancer presents significant clinical challenges, with a national five-year survival rate of only 21%, according to the National Cancer Institute. Despite advances in treatment modalities, early recognition of symptoms and prompt referral to specialized cancer centers remain crucial for optimal patient outcomes. At Moffitt Cancer Center, our Gastrointestinal Oncology Program’s comprehensive approach to esophageal cancer diagnosis and treatment has consistently yielded survival rates that exceed national averages across all disease stages.

Patients can be seen with our experts either in person or virtually within one week for a consultation appointment.  

Recognizing the Signs and Symptoms

Esophageal cancer often presents subtle symptoms that may be overlooked until disease progression. Physicians should maintain high clinical suspicion when patients complain of:

• Progressive dysphagia, initially with solids and eventually with liquids
• Sensation of food being "stuck" in the throat
• Persistent heartburn or indigestion is unresponsive to standard therapy
• Unexplained weight loss
• Chest pain, pressure, or burning sensations
• Chronic cough or vocal hoarseness (in advanced disease)
• Hiccups (potentially indicating phrenic nerve or diaphragm involvement)

Early referrals are particularly important for high-risk patients, including those with Barrett's esophagus, long-standing gastroesophageal reflux disease (GERD), or chronic heartburn, as these conditions can lead to cellular changes that increase esophageal cancer risk.

Diagnostic Approach

Upon referral, our patients undergo a comprehensive evaluation for suspected esophageal cancer. Advanced imaging scans are typically performed to confirm a diagnosis and may include CT scans, MRI, and PET scans to visualize abnormalities and assess potential spread. Our GI cancer experts excel in endoscopic procedures, including upper endoscopy with biopsy capabilities, endoscopic ultrasound for precise tumor assessment, and when necessary, bronchoscopy, thoracoscopy, or laparoscopy to evaluate cancer extension beyond the esophagus.

Blood tests are also utilized to detect anemia (which may indicate tumor bleeding) and assess liver function. This multilayered diagnostic approach allows for accurate staging, molecular characterization, and development of personalized treatment plans.

Treatment Options at Moffitt

Moffitt has pioneered the use of Robotic Assisted Minimally Invasive Esophagectomy (RAMIE) since 2010, with our surgeons accumulating extensive expertise in this technique, with more than 600 procedures. Our published research represents the largest RAMIE series in the world, with 350 patients reviewed between 2010-2019. The study demonstrated significant advantages of RAMIE compared to traditional open esophagectomy:

• Reduced hospital stays (9 days vs. 10 days for open surgery)
• Dramatically lower re-operative rates (2.3% vs. 12.2%)
• Smaller incisions resulting in less postoperative pain
• Expedited recovery with comparable oncologic outcomes
• High-definition, 3D visualization of the operative field

The robotic platform allows our surgeons to maintain the technical precision of traditional open approaches while minimizing surgical trauma and associated complications. Collectively, Moffitt’s surgeons have performed over 15,000 MIS cases since 2008. A milestone in our commitment to having high-quality robotic-assisted surgery available to more patients.

Beyond surgery, our GI program offers comprehensive treatment options including:

• Neoadjuvant Therapy: Chemotherapy and/or radiation before surgery to reduce tumor size and improve surgical outcomes
• Definitive therapy: Treatment for patients who are not healthy enough to have surgery, which includes chemotherapy/or radiation, and/or immunotherapy
• Access to Clinical Trials: Opportunities to participate in leading-edge research investigating novel therapeutic approaches before it is available anywhere else.
• Personalized Treatment Planning: Individualized protocols based on tumor characteristics, patient factors, and the latest evidence-based treatment approaches.

Collaboration and Referrals

Early referral to Moffitt provides esophageal cancer patients access to world-class gastroesophageal cancer expertise, innovative surgical techniques, and comprehensive care, resulting in superior survival outcomes. Our ability to see patients quickly ensures prompt evaluation and treatment initiation, which is critical in managing this challenging disease. Patients with a diagnosis of non-metastatic esophageal cancer cases can be seen in one week for an initial consultation.

For patient referrals or consultations, complete the online form or email our GI experts at GIsurgery@Moffitt.org. Patients can be seen with our experts either in person or virtually within one week for a consultation appointment.   

References:
*Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs Research
Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2021 Sub (2000-2019), National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2022, based on the November 2021 submission.©