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Esophageal Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Esophageal Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the esophagus

The esophagus is a 10-inch long, hollow, muscular tube that connects the throat to the stomach. It is part of a person’s gastrointestinal (GI) tract. When a person swallows, the walls of the esophagus squeeze together to push food down into the stomach.

About esophageal cancer

Cancer begins when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Esophageal cancer, also called esophagus cancer, begins in the cells that line the esophagus.

Specifically, cancer of the esophagus begins in the inner layer of the esophageal wall and grows outward. If it spreads through the esophageal wall, it can travel to lymph nodes (the tiny, bean-shaped organs that help fight infection), blood vessels in the chest, and other nearby organs. Esophageal cancer can also spread to the lungs, liver, stomach, and other parts of the body.

There are two major types of esophageal cancer:

  • Squamous cell carcinoma. This type of esophageal cancer starts in squamous cells that line the esophagus. It usually develops in the upper and middle part of the esophagus.
  • Adenocarcinoma. This type begins in the glandular tissue in the lower part of the esophagus where the esophagus and the stomach come together.

Treatment is similar for both of these types of esophageal cancer. Other, very rare tumors of the esophagus (less than 1% of esophageal cancers) include small cell neuroendocrine cancers, lymphomas, and sarcoma.

Looking for More of an Overview?

If you would like additional introductory information, explore this related item. Please note this link takes you to another section on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a one-page fact sheet (available in PDF) that offers an easy-to-print introduction to this type of cancer.

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Esophageal Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 18,170 adults (14,660 men and 3,510 women) in the United States will be diagnosed with esophageal cancer. It is estimated that 15,450 deaths (12,450 men and  3,000 women) from this disease will occur this year. Esophageal cancer is the seventh most common cause of cancer death among men.

The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases.  The five-year survival rate of people with esophageal cancer is about 17%.

However, survival rates depend on several factors, including the stage (or extent) of the cancer at the time of diagnosis. The five-year survival rate of people with cancer located only in the esophagus is about 39%. The five-year rate for those with disease that has spread regionally is 21%; if it has spread to distant organs, about 4%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with esophageal cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2014.

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Esophageal Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find a basic drawing about the common body parts affected by this disease. To see other pages, use the menu on the side of your screen.

Bladder Anatomy

Larger image

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Esophageal Cancer - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find out more about what factors increase the chance of this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing esophageal cancer:

Age. People between the ages of 45 and 70 have the highest risk of esophageal cancer.

Gender. Men are three to four times more likely than women to develop esophageal cancer.

Race. Black people are twice as likely as white people to develop the squamous cell type of esophageal cancer.

Tobacco. Using any form of tobacco—including cigarettes, cigars, pipes, chewing tobacco, and snuff—raises the risk of esophageal cancer, especially squamous cell carcinoma.

Alcohol. Heavy drinking over a long period of time increases the risk of squamous cell carcinoma of the esophagus, especially when combined with tobacco use.

Barrett's esophagus. This condition can develop in some people who have chronic gastroesophageal reflux disease (GERD) or esophagitis (inflammation of the esophagus), even when a person does not have symptoms of chronic heartburn. Damage to the lining of the esophagus causes the squamous cells in the lining of the esophagus to turn into glandular tissue. People with Barrett's esophagus are more likely to develop adenocarcinoma of the esophagus, but the risk of developing esophageal cancer is still fairly low.

Diet/nutrition. A diet that is low in fruits and vegetables and certain vitamins and minerals can increase a person's risk of developing esophageal cancer.

Obesity. Being severely overweight and having too much body fat can increase a person's risk of developing esophageal adenocarcinoma.

Lye. Children who have accidently swallowed lye have an increased risk of squamous cell carcinoma. Lye can be found in some cleansing products, such as drain cleaners.

Achalasia. Achalasia, a condition when the lower muscular ring of the esophagus does not relax during swallowing of food, increases the risk of squamous cell carcinoma.

Human papillomavirus (HPV). There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers. Researchers are investigating HPV for esophageal cancer, but there is no clear link that squamous cell esophageal cancer is related to HPV infection.

Screening

Regular screening tests to find esophageal cancer in people without symptoms are not used in the United States. People with Barrett's esophagus (see above) may be advised to have endoscopic examinations (looking inside the esophagus through a flexible, lighted tube) and biopsies (removal of a small amount of tissue for examination under a microscope) regularly to help find cancer early or to find changes that could become cancerous over time. Learn more about these tests in the Diagnosis section.

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Esophageal Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with esophageal cancer may experience the following symptoms or signs. Sometimes, people with esophageal cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.    

  • Difficulty and pain with swallowing, particularly when eating meat, bread, or raw vegetables. As the tumor grows, it can block the pathway to the stomach. Even liquid may be painful to swallow.
  • Pressure or burning in the chest
  • Indigestion or heartburn
  • Vomiting
  • Frequent choking on food
  • Unexplained weight loss
  • Coughing or hoarseness
  • Pain behind the breastbone or in the throat

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often.

If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.  

Esophageal Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose esophageal cancer:

Barium swallow (also called an esophagram). The patient swallows a liquid containing barium and then a series of x-rays (pictures of the inside of the body) are taken. Barium coats the surface of the esophagus, making a tumor or other unusual changes easier to see on the x-ray. If there is an abnormal finding, your doctor may recommend an upper endoscopy and biopsy to find out if it is cancerous (see below).

Upper endoscopy (also called esophagus-gastric-duodenoscopy, or EGD). This test allows the doctor to see the lining of the esophagus. A thin, flexible tube with a light and video camera on the end, called an endoscope, is passed down the throat and into the esophagus while the patient is sedated. If there is an abnormal finding, a biopsy will be performed to find out if it is cancerous. An endoscopy using an inflatable balloon to stretch the esophagus can also help widen the blocked area so that food can pass through until treatment begins.

Endoscopic ultrasound. This procedure is often done at the same time as the upper endoscopy. During an ultrasound, sound waves provide a picture of the wall of the esophagus and nearby lymph nodes and structures. During an endoscopic ultrasound, an endoscopic probe that has an attached ultrasound that produces the sound waves is inserted into the esophagus through the mouth. The ultrasound is used to see if the tumor has grown into the wall of the esophagus, how deep the tumor has grown, and whether cancer has spread to the lymph nodes or other nearby structures. An ultrasound can also be used to help get a tissue sample from the lymph nodes.

Bronchoscopy. Similar to an upper endoscopy, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the windpipe, and into the breathing passages of the lungs. A bronchoscopy may be performed if a patient’s tumor is located in the upper two-thirds of the esophagus to find out if the tumor is growing into the person’s airway, including the trachea (windpipe) and bronchial tree (area where the windpipe branches out into the lungs).

Biopsy. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A biopsy is the removal of a small amount of tissue from the suspicious area for examination. The tissue sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see Treatment Options).

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Usually, a contrast medium (a special dye) is injected into a patient’s vein or given orally (by mouth) to provide better detail.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium is usually injected into a patient’s vein to create a clearer picture.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.  

Esophageal Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? For esophageal cancer, this refers to how deep the tumor has grown into the wall of the esophagus. (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for esophageal cancer:

Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the tumor, including whether the cancer has grown into the wall of the esophagus or nearby tissue, and if so, how deep. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0: There is no cancer in the esophagus.

Tis: This is called carcinoma (cancer) in situ. Carcinoma in situ is very early cancer. Cancer cells are in only one small area of the top lining of the esophagus without any spread into the lining.

T1: There is a tumor in the lamina propria and submucosa (the two inside layers of the esophagus). Cancer cells have spread into the lining of the esophagus.

T2: The tumor is in the muscularis propria (the third layer of the esophagus). Cancer cells have spread into but not through the muscle wall of the esophagus.

T3: The tumor is in the adventitia (the outer layer of the esophagus). Cancer cells have spread through the entire muscle wall of the esophagus into surrounding tissue.

T4: The tumor has spread outside the esophagus into areas around it. Cancer cells have spread to structures surrounding the esophagus, including the aorta (large blood vessel coming from the heart), windpipe, diaphragm, and pleural lining of the lung.

Node. The “N” in the TNM staging system stands for lymph nodes. In esophageal cancer, lymph nodes near the esophagus and in the chest are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The lymph nodes cannot be evaluated.

N0: The cancer was not found in any lymph nodes.

N1: The cancer has spread to one or two lymph nodes in the chest, near the tumor.

N2: The cancer has spread to three to six lymph nodes in the chest, near the tumor.

N3: The cancer has spread to seven or more lymph nodes in the chest, near the tumor.

Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body.

MX: Metastasis cannot be evaluated.

M0: The cancer has not spread to other parts of the body.

M1: The cancer has spread to another part of the body.

Grading

Tumor grade. Grade may also be used to describe the tumor, using the letter “G,” in addition to the TNM system. Grade is determined based on how similar the tumor cells are to healthy cells when viewed under a microscope. Healthy tissue usually has different types of cells grouped together (also called differentiated tissue). Tissue that is cancerous usually is made up of cells that look more like each other. In general, the more differentiated the tissue, the better the prognosis.

G1: The tissue looks more like healthy cells (well differentiated).

G2: The cells are somewhat different than healthy cells (somewhat differentiated).

G3: The tumor cells barely look like healthy cells (poorly differentiated).

G4: The cancer cells look almost alike and do not look like healthy cells (not differentiated).

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications. There are separate staging systems for the two most common types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. The staging system for each is described below.

Staging of squamous cell carcinoma of the esophagus

In addition to the TNM classifications, for squamous cell carcinoma, the stages may be subdivided based on the location of the original tumor (the upper, middle, or lower section of the esophagus), as well as the grade (G) of the tumor cells.

Stage 0:  This is the same as Tis cancer, in which cancer is found in only the top lining of the esophagus (Tis, N0, M0, G1).

Stage IA: This is the same as T1 cancer, in which the cancer is located in only the two inside layers of the esophagus (T1, N0, M0, G1).

Stage IB: Either of these two conditions:

  • The cancer is located in only the two inside layers of the esophagus, but the tumor cells are less differentiated (T1, N0, M0, G2 or G3).
  • The tumor is located in the lower part of the esophagus, and the cancer has spread to either of the two outer layers of the esophagus, but not to the lymph nodes or other parts of the body (T2 or T3, N0, M0, G1).

Stage IIA: Either of these two conditions:

  • The tumor is located in the upper or middle part of the esophagus, and the cancer is in either of the two outer layers of the esophagus (T2 or T3, N0, M0, G1).
  • The tumor is located in the lower part of the esophagus, and the cancer is in either of the two outer layers of the esophagus. The tumor cells are less differentiated (T2 or T3, N0, M0, G2 or G3).

Stage IIB: Either of these two conditions:

  • The tumor is located in the upper or middle part of the esophagus, and cancer is in either of the two outer layers of the esophagus. The tumor cells are less differentiated (T2 or T3, N0, M0, G2 or G3).
  • Cancer is in the inner layers of the esophagus and has spread to one or two lymph nodes near the tumor (T1 or T2, N1, M0, any G).

Stage IIIA: Any of these three conditions:

  • Cancer is in the inner layers of the esophagus and has spread to three to six lymph nodes near the tumor (T1 or T2, N2, M0, any G).
  • Cancer is in the outside layer of the esophagus and has spread to one or two lymph nodes (T3, N1, M0, any G).
  • Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body (T4a, N0, M0, any G).

Stage IIIB: Cancer is in the outside layer of the esophagus and in three to six lymph nodes (T3, N2, M0, any G).

Stage IIIC: Any of these three conditions:

  • Cancer has spread beyond the esophagus into nearby tissue. Cancer is also in six or less lymph nodes (T4a, N1 or N2, M0, any G).
  • Cancer has spread beyond the esophagus into nearby tissue and cannot be removed by surgery (T4b, any N, M0, any G).
  • Cancer has spread to seven or more lymph nodes but not to distant parts of the body (any T, N3, M0, any G).

Stage IV: Cancer has spread to another part of the body (any T, any N, M1, any G).

Staging of adenocarcinoma of the esophagus

For adenocarcinoma, doctors use the T, N, and M classifications, as well as the grade (G).

Stage 0:  This is the same as Tis cancer, in which cancer is found in only the top lining of the esophagus (Tis, N0, M0, G1).

Stage IA: This is the same as T1 cancer, in which the cancer is located in either of the two inside layers of the esophagus only (T1, N0, M0, G1 or G2).

Stage IB: Either of these two conditions:

  • The cancer is located in either of the two inside layers of the esophagus only, and the tumor cells are poorly differentiated (T1, N0, M0, G3).
  • The cancer has spread to an outer layer of the esophagus but not to the lymph nodes or other parts of the body (T2, N0, M0, G1 or G2).

Stage IIA: Cancer is in an outer layer of the esophagus, and the cells are poorly differentiated (T2, N0, M0, G3).

Stage IIB: Either of these two conditions:

  • Cancer is in the outside layer of the esophagus but not beyond (T3, N0, M0, any G).
  • Cancer is in an inner layer or the muscularis propria of the esophagus and has spread to one or two lymph nodes (T1 or T2, N1, M0, any G).

Stage IIIA: Any of these three conditions:

  • Cancer is in the inner layers of the esophagus and has spread to three to six lymph nodes near the tumor (T1 or T2, N2, M0, any G).
  • Cancer is in the outside layer of the esophagus and has spread to one or two lymph nodes (T3, N1, M0, any G).
  • Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body (T4a, N0, M0, any G).

Stage IIIB: Cancer is in the outside layer of the esophagus and in three to six lymph nodes (T3, N2, M0, any G).

Stage IIIC: Any of these three conditions:

  • Cancer has spread beyond the esophagus into nearby tissue. Cancer is also in six or less lymph nodes (T4a, N1 or N2, M0, any G).
  • Cancer has spread beyond the esophagus into nearby tissue and cannot be removed by surgery (T4b, any N, M0, any G).
  • Cancer has spread to seven or more lymph nodes but not to distant parts of the body (any T, N3, M0, any G).

Stage IV: Cancer has spread to another part of the body (any T, any N, M1, any G).

Recurrent: Recurrent cancer is cancer that has come back after treatment. It may come back in the esophagus or in another part of the body. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.  

Esophageal Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

For people with a tumor that has not spread beyond the esophagus and lymph nodes, doctors often recommend combining three types of treatment: radiation therapy, chemotherapy, and surgery. The order of treatments varies, and several factors are considered, including the type of esophageal cancer.

Particularly for squamous cell cancer, chemotherapy and radiation therapy (a combination called chemoradiotherapy) are commonly recommended as the first treatment, with surgery afterwards depending how well chemoradiotherapy worked. Recent studies show using either chemotherapy or chemoradiotherapy before surgery is better than surgery alone. 

For adenocarcinoma, the most common treatment in the United States is chemotherapy and radiation therapy followed by surgery. Surgery is almost always recommended after chemoradiotherapy, unless there are risk factors such as a patient’s age or overall health.

For advanced esophageal cancer, treatment usually involves chemotherapy and radiation therapy. 

More detailed descriptions of these treatment options are listed below.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery has traditionally been the most common treatment for esophageal cancer. However, currently, surgery is used as the primary (first) treatment only for patients with early-stage esophageal cancer.

For patients with locally-advanced esophageal cancer, a combination of chemotherapy and radiation therapy (see below), or only chemotherapy in some situations, may be used before surgery to shrink the tumor. For people who cannot have surgery, the best treatment option is often a combination of chemotherapy and radiation therapy.

The most common surgery to treat esophageal cancer is called an esophagectomy, where the doctor removes the esophagus and then connects the remaining healthy part of the esophagus to the stomach so that the patient can swallow normally. The stomach or part of the intestine may sometimes be used to make the connection. The surgeon also removes lymph nodes around the esophagus.

Surgery for supportive care

In addition to surgery to treat the disease, surgery may be used to help patients eat and relieve symptoms caused by the cancer. This is called supportive or palliative surgery. To do this, surgeons and gastroenterologists (doctors who specialize in the gastrointestinal tract) can:  

  • Put in a percutaneous gastrostomy or jejunostomy (also called a feeding tube), so that a person can receive nutrition directly into the stomach or intestine. This may be done before chemotherapy and radiation therapy is given to make sure that the patient can eat enough food to maintain his or her weight and strength during treatment.
  • Dilate (expand) the esophagus. This procedure may have to be repeated if the tumor grows.
  • Put an esophageal stent into the esophagus. An esophageal stent is a metal, mesh device that is expanded to keep the esophagus open.
  • Use photodynamic therapy (lasers or light therapy; see below) to destroy cancerous tissue and relieve blockages
  • Create a bypass, or new pathway, to the stomach (if a tumor blocks the esophagus but cannot be removed with surgery); this procedure is rarely used.

People who have had trouble eating and drinking may need intravenous (IV; into a vein) feedings and fluids for several days before and after surgery, as well as antibiotics to prevent or treat infections. Patients learn special coughing and breathing exercises to keep their lungs clear.

Learn more about cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation treatment is given directly inside the body, it is called internal radiation therapy or brachytherapy. For esophageal cancer, this involves temporarily inserting a radioactive wire into the esophagus using an endoscope (see Diagnosis).

Side effects from radiation therapy may include fatigue, mild skin reactions, soreness in the throat and esophagus, difficulty or pain with swallowing, upset stomach, nausea, and loose bowel movements. Most side effects go away soon after treatment is finished.

Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

As explained above, chemotherapy and radiation therapy are often given at the same time to treat esophageal cancer, called chemoradiotherapy. Recent studies also show that chemotherapy without radiation therapy may work as well, but more research is needed to understand any benefits of chemotherapy without radiation therapy compared with chemoradiotherapy.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about targeted treatments.

For esophageal cancer, the targeted therapy trastuzumab (Herceptin) may be used along with chemotherapy for patients with metastatic esophageal adenocarcinoma. Trastuzumab targets a protein called human epidermal growth receptor 2 (HER2). About 20% to 30% of esophageal adenocarcinomas make too much HER2. Talk with your doctor about possible side effects for each specific medication you are prescribed and how they can be managed.

Photodynamic therapy

Photodynamic therapy is a palliative or supportive option used to make swallowing easier, especially for people who cannot or choose not to have surgery, radiation therapy, or chemotherapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor and stays longer in cancer cells than in healthy cells. A laser is then aimed at the tumor, destroying the cancer cells. Although photodynamic therapy may relieve swallowing problems for a short period of time, it does not cure esophageal cancer.

Electrocoagulation 

This type of palliative treatment helps kill cancer cells by heating them with an electric current. This is sometimes used to help relieve symptoms by removing a blockage caused by the tumor.

Cryotherapy

This is a type of palliative treatment that uses an endoscope with a probe attached that can freeze and remove tumor tissue. It can be used to reduce the size of a tumor to help a patient swallow better.

Recurrent esophageal cancer

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.    

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, and radiation therapy) but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

Metastatic esophageal cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

For metastatic esophageal cancer, supportive care is very important to help relieve symptoms and side effects. The goal of treatment is usually to lengthen a person’s life, while easing symptoms such as pain and problems with eating. Your health care team may recommend a treatment plan that includes chemotherapy, as well as radiation therapy to help relieve pain or discomfort. An esophageal stent, laser therapy, photodynamic therapy, or cryotherapy may help keep the esophagus open (see above).

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and bereavement.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.  

Esophageal Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with esophageal cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating esophageal cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with esophageal cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent.   During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for esophageal cancer, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.  

Esophageal Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about esophageal cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Chemoprevention. Researchers are looking at using aspirin and antacids to prevent esophageal adenocarcinoma in people with Barrett’s esophagus. Research is still ongoing, and people are encouraged to talk with their doctor before taking any medications or dietary supplements for this reason.

PET scan. In addition to help find out the cancer’s stage (see Staging), PET scans may be used to find out how well chemotherapy is working to shrink a tumor before surgery. Researchers are studying the use of PET scan to evaluate and possibly change chemotherapy before surgery.

Chemotherapy advances. Doctors are studying combinations of different drugs, such as cisplatin (Platinol), fluorouracil (5-FU, Adrucil), paclitaxel (Taxol), irinotecan (Camptosar), docetaxel (Docefrez, Taxotere), oxaliplatin (Eloxatin), and capecitabine (Xeloda). And, research is ongoing to find new drugs that are effective for esophageal cancer.

Targeted therapy. Several types of targeted therapies are currently being studied for esophageal cancer.

  • In addition to trastuzumab, researchers are looking at newer drugs that target HER2 for advanced esophageal adenocarcinomas, as well as combining trastuzumab with radiation therapy.
  • Another type of growth factor, called c-MET, may play an important role in helping metastatic esophageal adenocarcinomas grow. Researchers are studying drugs that stop c-MET from helping a cancer grow combined with chemotherapy for patients with metastatic esophageal adenocarcinomas.
  • Researchers are also looking at the drug ramucirumab in combination with chemotherapy or by itself after chemotherapy.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current esophageal cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More about the Latest Research?

If you would like additional information about the latest areas of research regarding esophageal cancer, explore these related items that take you outside of this guide:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.  

Esophageal Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for esophageal cancer are described in detail within the Treatment section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with esophageal cancer. Learn more about caregiving.

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care.

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.  

Esophageal Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for esophageal cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

If the cancer is in remission, follow-up care may include CT scans and upper endoscopies (see Diagnosis) to watch for a possible recurrence.

People who have had an esophagectomy should sleep with the head of the bed elevated to avoid acid reflux, as the stomach has been surgically moved up into the chest.

People recovering from esophageal cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. For esophageal cancer survivors who smoke, quitting smoking can help recovery and reduce the risk of cancer recurrence. Learn more about stopping tobacco use after a cancer diagnosis.

Moderate exercise can help you rebuild your strength and energy level. Talk with your doctor about helping you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.  

Esophageal Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What type of esophageal cancer do I have?
  • Is the cancer located only in my esophagus?
  • What is the stage and grade of the disease? What does this mean?
  • Can you explain my pathology report (laboratory test results) to me?
  • What are my treatment options?
  • What clinical trials are open to me?
  • Are there radiation therapy and surgery options to treat my cancer?
  • Is surgery needed as part of treatment?
  • How experienced is the surgeon with this type of surgery?
  • Can chemotherapy control the cancer?
  • What treatment plan do you recommend? Why?
  • What is my prognosis?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • What are the possible side effects of each treatment, both in the short term and the long term?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • What follow-up tests will I need, and how often will I need them?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.  

Esophageal Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Esophageal Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

This is the end of Cancer.Net’s Guide to Esophageal Cancer. Use the menu on the side of your screen to select another section, to continue reading this guide.