My 82-year-old father has cancer of the esophagus. Currently, he has no symptoms except for blood in his stool. The tumor is about half the size of your pinkie finger. What treatment options does he have at his age? What if he doesn't get treatment?

J.S.

Unfortunately, esophageal cancer often does not cause symptoms until the tumor is at an advanced stage. That's because small, early-stage tumors usually do not interfere with the flow of food down the esophagus and into the stomach. When the tumor grows larger, the most common symptom is difficulty swallowing solid foods. Another symptom may be weight loss. Generally, blood in the stool does not appear until a tumor is relatively advanced.

Untreated esophageal cancer will grow slowly and ultimately completely obstruct the esophagus, making swallowing impossible. The tumor can also potentially spread through the wall of the esophagus to invade nearby structures. Massive bleeding from the tumor can also occur as it enlarges and ulcerates.

The therapy for esophageal cancer depends on the location and size of the tumor, as well as the general health of the patient. For otherwise healthy patients who have a localized tumor (no evidence of spread beyond the esophagus on ultrasound or CT scans), surgery is the treatment of choice. Often, the patient may receive radiation and/or chemotherapy to shrink the tumor before surgery. The operation itself involves removing the esophagus and pulling the stomach up into the chest to reconstruct the passageway.

For patients who have very advanced cancer or who are not healthy enough (due to heart or lung disease) to undergo surgery, other therapeutic options may be available. It must be emphasized that these techniques are done only to make the patient more comfortable and are not done with the expectation of a long-term cure. These techniques (all performed through a tube called an endoscope) include laser therapy, electrocoagulative therapy and photodynamic therapy. For large tumors that threaten to obstruct the esophagus, doctors may also insert a small metal device, called a stent, to keep the esophagus open and allow the patient to continue to take nourishment by mouth. You should discuss the potential treatment options with your father and his gastroenterologist.