Patients diagnosed with stomach cancer or oesophageal cancer often want to know whether the tumour can be removed without major surgery. For selected early cancers, the answer may be yes. Advanced endoscopic techniques can remove certain lesions through the digestive tract, avoiding the need to remove part of the stomach or oesophagus. However, these procedures are appropriate only when the cancer’s characteristics make endoscopic treatment a reasonable option.
Understanding the differences between endoscopic treatment and surgery can help patients prepare for an informed discussion with their specialist.
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What Is Endoscopic Treatment For Cancer?
Upper gastrointestinal endoscopy, also known as an oesphagogastroduodenoscopy (OGD) or gastroscopy, involves passing a flexible tube with a camera through the mouth to examine the oesophagus and stomach. In addition to diagnosis, specialised endoscopic techniques can be used to remove certain abnormal tissues.
One such technique is endoscopic submucosal dissection, or ESD. It is used to remove selected superficial lesions, including some early stomach and oesophageal cancers.
During ESD, the specialist identifies the lesion, marks its boundaries and carefully separates the affected tissue from the underlying layers of the digestive tract. The tissue is removed and sent for pathological examination.
Unlike conventional surgery, ESD does not require an abdominal or chest incision to access the tumour. However, it is still a complex medical procedure with potential complications, and it requires appropriate expertise and facilities.
Who May Be Suitable For Endoscopic Submucosal Dissection?
ESD may be considered for selected cancers that are confined to the superficial layers of the digestive tract and have a sufficiently low risk of lymph node spread.
The criteria differ between stomach and oesophageal cancers and depend on factors such as:
- The size and location of the tumour.
- How deeply the cancer has invaded the tissue.
- The tumour’s appearance and characteristics.
- Biopsy findings and the suspected cancer subtype.
- Whether there are signs suggesting lymph node involvement.
For stomach cancer, some early lesions may be suitable for endoscopic removal if they meet accepted clinical criteria. Similar principles apply to selected superficial oesophageal cancers, although the criteria and implications of treatment differ.
The assessment may involve endoscopy, biopsy, imaging and, where indicated, endoscopic ultrasound or other investigations.
Importantly, a lesion that appears small during endoscopy is not necessarily suitable for ESD. The depth of invasion and the likelihood of lymph node involvement are also relevant.
When Is Surgery More Appropriate?
Surgery may be recommended when endoscopic removal is unlikely to provide adequate cancer treatment.
For example, if the cancer has invaded deeper layers of the stomach or oesophagus, there may be a greater risk that cancer cells have spread to nearby lymph nodes. Endoscopic removal of the visible tumour would not address those lymph nodes.
Depending on the location and extent of the cancer, an operation may involve removing part of the stomach, the entire stomach or part of the oesophagus. Nearby lymph nodes may also need to be removed and examined.
For some patients, chemotherapy or other treatment may be recommended before or after surgery. The treatment sequence depends on the cancer stage, its location and the overall clinical assessment.
Surgery is more extensive than ESD, but it may offer a more appropriate way to remove the cancer and assess or treat potential lymph node involvement.
ESD Vs Surgery: What Are The Main Differences?
| Consideration | Endoscopic Submucosal Dissection | Cancer Surgery |
| How the tumour is accessed | Through the mouth using an endoscope | Through laparoscopic, robotic-assisted or open surgical access |
| Tissue removed | Selected superficial lesion and surrounding tissue | Part or all of the affected organ, as required, and usually relevant lymph nodes |
| Suitable cancer | Selected early cancers meeting specific criteria | Cancers requiring surgical removal, subject to stage and fitness for surgery |
| Recovery considerations | May involve a shorter initial recovery, but monitoring and complications remain possible | Recovery depends on the operation and may involve changes to eating and digestion |
| Lymph node treatment | Does not remove regional lymph nodes | Lymph nodes can be removed and examined |
| Further treatment | May be required if pathology shows higher-risk features or incomplete removal | May be recommended according to the final pathology and treatment plan |
These are general distinctions, not guarantees of an individual’s treatment experience. Both approaches carry risks, and the expected benefits depend on the clinical circumstances.
What Happens If ESD Results Show Higher-Risk Cancer?
Removing the lesion is not necessarily the end of treatment.
The tissue is examined under a microscope to determine whether the cancer has been completely removed and whether features suggest a higher risk of spread. These may include deeper invasion, cancer cells at the resection margin or other adverse pathological findings.
If the results suggest that endoscopic treatment alone may not be sufficient, the specialist may recommend further assessment or surgery. The decision depends on the pathology, the patient’s health and the potential benefits and risks of additional treatment.
This is why patients should understand before ESD that the procedure may not eliminate the need for surgery in every case.
Is Endoscopic Treatment Always Better Because It Is Less Invasive?
Not necessarily. A less invasive procedure is not automatically the most appropriate treatment if it does not adequately address the cancer.
The objective is to treat the disease effectively while taking account of the risks, recovery and long-term implications of each option. For an appropriately selected superficial lesion, ESD may avoid major surgery. For a cancer with a significant risk of lymph node spread, surgery may be necessary even if it involves a longer recovery.
Patients should be cautious about choosing a procedure based only on incision size, recovery expectations or the appeal of avoiding an operation. The suitability of each option should be established through clinical assessment.
What Questions Should You Ask Your Specialist About Your Cancer Treatment?
Before proceeding, consider asking:
- Is my cancer superficial enough for endoscopic removal?
- What is the estimated risk of lymph node involvement?
- How will the cancer’s depth and subtype be assessed?
- If I undergo ESD, what findings might mean I need surgery afterwards?
- What are the risks of ESD compared with surgery in my situation?
- If surgery is recommended, could it be performed laparoscopically or robotically?
- How will the removed tissue be examined, and when will the results be available?
Making An Informed Treatment Decision
Endoscopic treatment and surgery serve different purposes in the management of stomach and oesophageal cancer. ESD can be an option for selected early cancers, while surgery may be necessary when more extensive removal or lymph node treatment is required.
Health365 Preferred Doctor Your Can Consider
Dr Kim Guowei (Crest Surgical Practice) performs advanced endoscopy, including ESD, and upper gastrointestinal cancer surgery. Patients seeking to understand whether endoscopic treatment or surgery may be appropriate can review their biopsy and investigation results with a suitably qualified specialist.
Further information about Dr Kim’s clinical background is available through his health365 Preferred Doctor page. The appropriate treatment can only be determined after reviewing each patient’s individual circumstances.
Contact MedicalTravel.asiaFrequently Asked Questions
Some early stomach cancers can be removed using endoscopic submucosal dissection (ESD), which removes selected lesions through an endoscope passed through the mouth. Suitability depends on the tumour’s characteristics, depth of invasion and risk of lymph node spread. Surgery may still be necessary if the findings suggest that endoscopic treatment alone is insufficient.
Neither approach is universally better. ESD may be appropriate for selected superficial cancers, while surgery may be necessary when the cancer has a greater risk of lymph node involvement or cannot be adequately removed endoscopically. The most suitable option depends on the individual diagnosis and clinical assessment.
Not necessarily. If the removed tissue shows that the cancer has been completely excised and meets the relevant criteria for curative endoscopic treatment, further surgery may not be required. However, findings such as deeper invasion, an involved margin or other high-risk features may lead the specialist to recommend additional treatment, including surgery.
This medical content has been reviewed by Dr Kim Guowei, a highly skilled upper gastrointestinal, bariatric and robotic surgeon known for his expertise in robotics and advanced endoscopic techniques. He offers comprehensive care for complex digestive disorders, from traditional open surgery to minimally invasive procedures.
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