The main endoscopic non-excisional treatments include radiofrequency ablation (RFA), photodynamic therapy (PDT), argon plasma coagulation (APC), multipolar electrocoagulation ( multipolar electrocoagulation, MPEC), laser therapy, thermal probe therapy, cryotherapy and so on. Among them, radiofrequency ablation (RFA) and photodynamic therapy (PDT) are more frequently used in the treatment of esophageal cancer.
Am I a candidate for endoscopic non-excisional treatment?
First of all, it is important to understand that there are two categories of endoscopic treatment: endoscopic resection and non-resective treatment. As long as your condition meets the indications for endoscopic treatment, that is, the lesion only invades the mucosal layer and lymph node and other organ metastases are excluded, then both types of treatment can destroy the tumor and both can achieve radical results.
However, if you are not physically able to tolerate endoscopic resection, such as advanced age, poor general condition, or the presence of severe comorbidities in other organs, you may try endoscopic non-excisional treatment. Your doctor will evaluate the effectiveness of the treatment and if the lesion is judged not to be completely inactivated, other complementary treatments, such as radiotherapy and chemotherapy, will be required.
Some patients and families do not want to undergo invasive surgery, so endoscopic non-excisional treatment is also an option. It is important to note, however, that the latter does not allow for obtaining a sample of the lesion, and a definitive postoperative pathological diagnosis is not available. Therefore, if you are physically able to tolerate invasive treatment, the first choice, and the one recommended by your doctor, is endoscopic resection.
How long does endoscopic non-excisional treatment take?
When you choose to have endoscopic non-excisional treatment, many patients are concerned about how long the treatment will take and whether they can afford it. In general, the duration of treatment ranges from 30 minutes to 2 hours, depending on which method is chosen and factors such as the location and size of the lesion.
In photodynamic therapy, for example, you will need to come in roughly 3 times over 4 days, with the main process including: a 24-hour advance injection of the photoactivating drug – the first formal treatment – and a second treatment 48 hours later.
First visit, injection of photoactivator
On arrival at the Endoscopy Center clinic, the nurse will first give you a skin test for the photosensitizer and observe for 15 to 20 minutes. If it is negative, you can continue with the intravenous photosensitizer. After the injection, you can go home. You will need to keep your body wrapped and wear sunglasses on the way home, and try not to expose your skin to the sun. When you get home, it is also important to avoid all strong stimulating light sources and it is best to stay out of the house.
Second visit for formal treatment
After 24 hours, you will be ready to come in for your formal treatment. You will need to fast the night before treatment to ensure that your esophagus and stomach are clean and free of food debris.
Treatment is performed in the photodynamic therapy darkroom of the endoscopy clinic. Through the endoscope, the doctor aims a special laser at the lesion, causing changes in the photosensitizers that collect inside the cancer cells, producing a variety of reactive oxygen species that directly kill the tumor cells.
After about 15 to 20 minutes, the illumination is over. The doctor looks around the lesion through the gastroscope, and if there is no significant bleeding, the gastroscope and light-guided fibers can be slowly withdrawn and the treatment is over. If you do not feel any other discomfort, you can go home. On the road, again, avoid direct exposure to sunlight.
Third visit for repeat treatment
After 48 hours, you will need to come back for a repeat treatment. The doctor first looks through the gastroscope, and if there is evidence of tissue necrosis in the location of the lesion, it means that the first treatment was effective. The doctor then removes the necrotic tissue and then performs a second photodynamic treatment. Sunlight exposure is avoided for 30 days after treatment to prevent the development of photoallergic dermatitis.
Co-written by:
Yuan Peng, Department of Gastrointestinal Oncology, Peking University Cancer Hospital