Laser treatment can be used for many things these days including eyes and skin. Our interest, however, is in using laser to improve people’s swallowing if they have cancer of the oesophagus.
One of the commonest oesophageal cancer symptoms is dysphagia. This means that it is either difficult to swallow food, or, after swallowing, the food sticks in the middle of the oesophagus (gullet) and does not go straight down into the stomach.
Oesophageal laser treatment is not a cure for cancer of the oesophagus. It is what is called a palliative treatment. This means that it improves oesophageal cancer symptoms but does not change oesophageal cancer prognosis – the long-term outcome of the disease.
Laser treatment can be used by itself, in combination with radiotherapy or as an extra treatment for patients who develop overgrowth of their tumour after an oesophageal stent has been inserted.
Oesophageal laser treatment is done during an endoscopy session. The actual treatment usually takes around 30 to 45 minutes and is done with the patient heavily sedated. It does not require general anaesthesia. The patient usually goes home the same day.
Swallowing generally gets a little worse for up to three days after laser treatment because the laser destroys the tumour by heating and vapourising it. This causes a degree of swelling which takes 72 hours to go down. After this time swallowing is usually very much improved.
The average person needs two laser sessions approximately one to two weeks apart to get maximum benefit.
The benefit from laser treatment can last for varying degrees of time. In some people repeat treatment will be needed four to six weeks later but in other people the benefit can be very much longer.
Laser treatment can be repeated as often as needed. There is no limit on the number of times this treatment can be given.
Sometimes patients require a dilatation of the oesophagus before the laser therapy is applied. This occurs particularly in people who have a very tight narrowing or stricture. Often the decision about whether to stretch the oesophagus is only made whilst the doctor is doing the endoscopy and assessing the tumour directly. For this reason an expert gastroenterologist must do the procedure.
In our practice we often use laser to get quick improvement in swallowing for patients who are only able to tolerate pureed foods or liquids. After one or two laser treatment sessions the patient then goes to the oncologist for radiotherapy treatment. This is usually very effective.
If a person has already had radiotherapy this option is usually often not available, although each case has to be assessed separately. An expert assessment of the oesophageal cancer symptoms is essential to ensure the correct treatment is offered.
Once again this is a very straightforward and successful treatment. People who have had an oesophageal stent for more than two or three months may develop blockages due to tumour overgrowth at the ends of the stent and very occasionally through the middle of the stent. Laser treatment can be a rapid and very successful way of relieving this problem. This does not change the oesophageal cancer prognosis, but can result in very significant improvement in symptoms, for which patients are very grateful.
The precise use of laser is extremely important and the risks are very low in the right hands. The success rate is over 90% and the likelihood of bleeding or perforation of the oesophagus is well below 5% when the treatment is done by expert endoscopists.
Oesophageal laser treatment is only one of a series of modalities of treatment for palliation of oesophageal cancer. It is important to discuss all the options with an expert gastroenterologist who can advise about the different treatment options. Many patients will require more than one treatment with different modalities at different times during their illness. It is also important to remember that laser treatment is used to improve oesophageal cancer symptoms and not oesophageal cancer prognosis. For this, other types of treatment are available.
The consultants at the London Gastroenterology Centre would be happy to advise you. Please telephone our London office and ask to speak to one of our oesophageal laser treatment experts.