Esophageal cancer is a relatively rare cancer, with fewer than 17,000 cases each year in the United States. It begins in the esophagus (the tube that connects the mouth and the stomach). Smoking, obesity and conditions such as Barrett’s esophagus can increase your risk for esophageal cancer.

We diagnose esophageal cancer using advanced imaging techniques such as positron emission tomography (PET) scans or minimally invasive endoscopy, which uses a specialized camera to examine the inside of your throat. These tests help your doctor identify cancer and plan effective treatment. Our thoracic cancer care team will work with you to create a personalized treatment plan.

Gastroesophageal reflux disease (GERD) occurs when stomach acid flows up into your esophagus (the tube that connects your mouth to your stomach) twice a week or more. You may experience reflux if the opening between your stomach and esophagus is weakened or opens abnormally due to pregnancy, obesity or other conditions.

GERD can cause many symptoms, including painful heartburn, chest pain or difficulty swallowing. Over time, GERD can cause a condition called Barrett’s esophagus, which raises your risk for esophageal cancer.

Our experts can diagnose GERD with minimally invasive tests. We may use endoscopy to place a small camera in your esophagus to check for the causes or symptoms of GERD.

LINX® Device for GERD

The LINX^® device provides advanced treatment for gastroesophageal reflux disease (GERD). If medicine no longer helps control GERD, the LINX device provides a safe, alternative therapy to help protect the esophagus from stomach acid. 

The LINX device is a ring of magnets that is placed around the area where your esophagus meets your stomach. Your thoracic surgeon places this device during a minimally invasive surgery that requires just a few incisions. 

The magnets in the device provide enough magnetic strength to keep the esophagus closed and prevent stomach acid from entering the throat. The magnets also are weak enough to let food into your stomach when you eat.

Most patients go home on the same day as their surgery. You can return to your normal diet after surgery.

Like all surgeries, the LINX device has risks and benefits. You should speak to your doctor about whether this procedure is right for you and how it could help you avoid the pain and discomfort of GERD.

Orlando Health successfully completed the first LINX procedure in Central Florida, in 2016.

At the Rod Taylor Thoracic Center at Orlando Health Cancer Institute, our thoracic experts provide comprehensive and compassionate care for lung nodules. We can diagnose, monitor and treat lung nodules all in one convenient location.

What Are Lung Nodules?

A lung nodule is a small mass of tissue in the lung that usually does not cause symptoms. Most lung nodules are benign (noncancerous), but some can be cancerous.

Benign lung nodules are typically caused by:

• Inflammation
• Infections
• Scar tissue from a previous infection

Lung Nodule Diagnosis

Since lung nodules do not cause symptoms, they are usually diagnosed during a routine imaging scan of the chest, such as an X-ray or CT scan. A lung nodule shows up as a spot on the image.

Lung Nodule Follow Up Plans

Once the lung nodule is spotted, our experts set up a follow-up plan based on the size and appearance of the nodule.

Nodules that are less than 6 mm in size have a lower chance of becoming cancerous. Therefore, for smaller nodules of less than 6 mm, your personalized follow up plan may include:

• CT scans every three to 12 months after diagnosis to check the nodule(s)
• Follow-up appointments

For larger nodules over 1 cm or nodules with a concerning shape, your personalized follow up plan may include:

• Immediate biopsy and evaluation
• More frequent follow-up CT scans and appointments

Lung Nodule Biopsies

If your lung nodule is suspected to be cancerous, a biopsy (taking a sample of tissue to be analyzed in the lab) should be performed to confirm diagnosis.

We are one of the few centers to have multiple biopsies available, allowing our experts to create a personalized plan for every patient. Having access to the most advanced technology allows us to obtain a diagnosis faster, more accurately and with a less invasive technique.

We offer the following types of advanced biopsy techniques:

• Bronchoscopy biopsy with ultrasound (enter the lungs with a thin tube called abronchoscope with ultrasound guidance)
• Percutaneous (under the skin) needle biopsy using a CT scan for guidance
• The Monarch™ Platform and Ion™ Platform robotic technology, which allows us to reach further into the lung using navigation technology (like GPS), so we can biopsy more accurately with less risk of a collapsed lung or other complications

If your lung nodule is found to be cancerous, rest assured that we are experts in minimally invasive and robotic assisted lung surgery, providing a safer and less invasive technique to remove cancerous lung nodules.

First to Use the Monarch™ Platform and Ion™ Platform

The Orlando Health Cancer Institute is a pioneer in robotic bronchoscopy — being the first facility in Florida to use the Monarch™ Platform and one of the few programs in the country to also have the Ion™ Platform robotic technology for diagnosing cancerous lung nodules.

During this procedure, one of our surgeons controls the robotic arm, which uses a CT scan for guidance in navigating to the nodule(s) and taking a sample of tissue to be analyzed in the lab.

This robotic technology offers many advantages over traditional needle biopsies, including:

• Our experts can complete biopsies on difficult to reach nodules.
• Biopsies can be completed without any injury to the lungs.
• Safer because there is a lower risk of causing a deflated or collapsed lung.
• Faster and more accurate diagnosis.
• Faster recovery time.

Mediastinal tumors are rare cancers that grow in the tissues between your lungs. They often cause no symptoms. Even though not all mediastinal tumors are cancerous, they should be removed so they don’t affect your heart or lungs.

Our multidisciplinary team will evaluate your mediastinal tumor using chest X-rays and magnetic resonance imaging (MRI). We also may use a minimally invasive procedure called mediastinoscopy to place a small camera inside your chest and obtain a tissue sample for laboratory study.

Based on your diagnostic tests, your thoracic cancer care team will work with you to develop a personalized treatment plan.

More men and women lose their lives to lung cancer than any other type of cancer. Approximately 85 percent of lung cancers are non-small cell lung cancers, such as squamous cell carcinoma, adenocarcinoma and large cell carcinoma. These cancers, like all lung cancers, may be caused by damage to the lungs which the body cannot repair. Smoking, breathing in hazardous substances such as radon and asbestos, and other factors can damage the lungs.

Imaging tests are often the first techniques used to detect lung cancer. Your physician may use chest X-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI) to look for lung cancer. To confirm a lung cancer diagnosis, your physician may take a sample of your lung tissues using a needle (biopsy) or may look for cancer cells in your mucus. Your team of physicians will help find the right cancer treatment for you.

Though small cell lung cancer is less common than non-small cell lung cancer, it grows rapidly and spreads to other parts of the body faster. Early detection through lung cancer screenings can help you receive more effective care for this cancer.

We can detect lung cancer using imaging techniques such as chest X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) or positron emission tomography (PET) scans. Your physician may also look for cancer cells in your mucus or by taking a sample of your lung tissue using a needle (biopsy). Based on your test results, your team of physicians will guide you to a treatment plan that’s right for you.

Chemotherapy is a cancer treatment that involves taking medicines to kill cancer cells. You may receive chemotherapy through pills, intravenously (through a vein) or both. Chemotherapy can kill cancer cells in any part of your body.

Your thoracic cancer care team at Orlando Health Cancer Institute works with you to plan your chemotherapy treatment, identifying medicines that are safe and effective for you. Using the latest research, we deliver chemotherapy that has been proven to treat your type of cancer.

You may receive chemotherapy treatments such as: 

• Neoadjuvant chemotherapy. This type of chemotherapy is given before surgery. It can shrink your tumor or make its edges more defined, which makes surgery more effective.
• Adjuvant chemotherapy. The most common type of chemotherapy, it is administered after surgery. Adjuvant chemotherapy uses different medicines to kill cancer cells throughout the body.
• Immunotherapy. Using your body’s own immune system, immunotherapy attacks and destroys cancer cells. It is the most advanced type of chemotherapy available.

Your medical oncologist will work closely with other members of your care team to ensure you receive the most effective treatment for you. Your team will help manage your side effects to make you as comfortable as possible. Side effects should go away when your chemotherapy is completed.

New technology available at Orlando Health allows for more precise treatment of cancer tumors through real-time magnetic resonance imaging (MRI) during radiation therapy.

Called MRIdian®, the system enables physicians to target tumors in real time instead of relying on static images taken minutes or even days before a patient’s radiation session. Real-time visualization offers physicians the advantage of more accurate treatment as the location of a tumor inside the body may shift during subtle natural movements, such as when a patient breathes or digests food.

For more information on MRIdian®, MRI-guided radiation therapy, click here.

Radiation therapy uses beams of intense energy to kill cancer cells. Radiation may come from a machine (external radiation therapy or proton therapy) or by placing radioactive materials into your body temporarily (internal radiation therapy or brachytherapy). You may receive radiation therapy after your surgery to ensure all cancer cells are destroyed.

At Orlando Health Cancer Institute, we offer the newest, state-of-the-art radiation therapies to provide you the safest and most effective cancer treatments. We’re the first in Central Florida to offer proton therapy and MRIdian® therapy. Our radiation oncologists work with you to determine the right therapy technique for you and to reduce any side effects of your treatment.

Types of Radiation Therapy

Our radiation therapy experts design your treatment based on your specific needs. Types of radiation therapy include:

• External radiation therapy. Most patients receive this type of therapy for three to six weeks. During treatment, we deliver specific doses of radiation therapy to a targeted area of your body. Using the latest technology, we deliver radiation to the same, precise area — the radiation beam even moves with you as you breathe to help ensure surrounding, healthy cells aren’t damaged.
• Internal radiation (brachytherapy). During this treatment, radioactive seeds are inserted temporarily into your body where tumors or cancerous cells were removed. The seeds only target the small area of your body affected by cancer, leaving as many healthy cells as possible. This type of radiation therapy offers effective results with fewer sessions and shorter treatments.
• MRIdian^® real-time imaging radiation therapy. Orlando Health Cancer Institute is one of only two healthcare facilities in Florida, and the sixth in the nation, to offer live magnetic resonant imaging (MRI)-guided radiation treatment. The MRIdian^® system enables doctors to see a tumor’s exact location in real time while they are treating it, instead of relying on static imaging results taken before the start of a patient’s radiation session. This allows for more precise and safer radiation therapy by sparing healthy tissue and exposing patients to less overall radiation. 
• Proton therapy. This form of radiation treatment delivers a precise dose of radiation to tumors while sparing surrounding normal tissue. Orlando Health Cancer Institute is the first facility in Central Orlando to offer this technology. Unlike X-rays, protons can be manipulated to release most of their energy within the tumor with little or no dose in tissue surrounding the tumor. Proton therapy typically results in less side effects than conventional radiation treatment. It also exposes patients to less overall radiation.

Also known as robotic-assisted surgery, during robotic surgery, complex surgeries are performed through just a few small incisions. Miniaturized surgical instruments attached to robotic arms allow the surgeon to perform very precise maneuvers while guided by a high-definition 3-D image from inside the patient’s body.

For patients, robotic surgery offers several advantages over traditional open surgery, including  less scarring and trauma to surrounding tissue, less pain, shorter hospital stays and quicker recoveries.

Experience is key to successful robotic surgeries. Thoracic surgeons at Orlando Health Cancer Institute performed the region’s first robotic thoracic surgery in 2007, and continue to be leaders in the field of robotic surgery. As a recognized da Vinci^® epicenter for thoracic robotic surgery, our center hosts surgeons from across the globe who come to our facility to learn the latest robotic surgery techniques to treat thoracic cancers.

Robotic Esophageal Surgery

Robotic esophageal surgery is performed to treat:

• Esophageal cancer
• Gastroesophageal reflux disease (GERD)
• Hiatal hernia (stomach pushes through diaphragm muscle)
• Achalasia (condition in which a relaxed esophageal muscle prevents you from swallowing)
• Esophageal diverticulum (a bulge in the esophagus wall)

Robotic esophagectomy allows for this complex surgery to be performed with smaller incisions and less pain, often with a faster recovery and less risk for pulmonary complications such as pneumonia.

Recovery depends on the extent of the surgery and ranges from 1 day in the hospital for benign esophageal surgery to 7 days in the hospital for esophageal cancer surgery. Full recovery takes 3–8 weeks with a longer recovery for esophageal cancer patients.

Robotic Lung Cancer Surgery

Surgery for lung cancer most often includes removal of diseased lung tissue, a procedure known as a lobectomy. A robotic lobectomy allows the surgeon to perform lung cancer surgery using a less invasive technique than conventional open surgery. With smaller incisions, robotic surgery normally results in fewer complications, less pain, a shorter hospital stay and faster overall recovery.

In a robotic lobectomy, the surgeon removes the entire affected lobe. In certain patients, more lung function can be preserved through a robotic wedge resection in which a small, wedge-shaped portion of the lung is removed including the tumor and a certain amount of healthy tissue around it.

To diagnose lung cancer, our doctors can perform a robotic lymph node dissection (surgical removal of the nearby lymph nodes around the lung and mediastinum) to evaluate whether the cancer has progressed beyond the lungs. Our surgeons will also perform robotic biopsies of suspicious lung nodules to assess whether they are cancerous or benign.

Most patients with early or localized lung cancer are candidates for a robotic approach as long as they have adequate lung and heart function and are fit to undergo surgery. Patients with more advanced disease may be eligible for surgery following a complete evaluation by our team.

The hospital stay for robotic lung surgery is 2–4 days with a return to normal activity in 3–4 weeks. In comparison, conventional open lung surgery typically requires a hospital stay of 5–7 days and a recovery period of 6–8 weeks.

Robotic Surgery of Mediastinal or Chest Tumors

The mediastinum is a relatively narrow space or compartment between the lungs. Robotic mediastinal surgery removes masses such as thymic tumors, benign cysts, thymus gland tumors called thymomas, and other growths or lesions. Our doctors also perform chest wall resection surgery to remove benign and cancerous chest wall tumors.

In both of these robotic procedures, several small incisions are made for a much less invasive approach than traditional open surgery in which one large central incision is made in the chest.

Recovery from robotic chest or mediastinal surgery generally takes 3–4 weeks compared to 6–8 weeks for conventional open surgery.

Other Robotic Procedures

A number of other procedures are also available from doctors at the Rod Taylor Thoracic Care Center, including:

• Video-assisted thoracoscopic surgery (VATS) — a minimally invasive thoracic surgery that does not use a thoracotomy (a large incision into the chest wall). Our doctors perform VATs to diagnose and treat plural diseases, which include infection, fluid buildup or cancer surrounding the lungs.
• Robotic tracheal (windpipe) procedures to remove tumors and treat tracheal stenosis (a narrowing condition).
• Endobronchial ultrasound to diagnose lung cancer and enlarged lymph nodes.
• Navigational bronchoscopy for biopsy of small lung nodules.
• LINX® Reflux Management System procedure to treat gastroesophageal reflux (GERD), which involves implanting a band of magnetic beads around the lower esophageal sphincter.