Esophageal CancerLast Updated: January 06, 2012 This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/11 Overview
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 grow into lymph nodes, 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:
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. Find out more about basic cancer terms used in this section. Looking for More of an Overview? If you would like additional introductory information, explore this related item on Cancer.Net:
Or, choose “Next” (below, right) to continue reading this detailed section. To select a specific topic within this section, use the icon panel located on the right side of your screen. Statistics
This year, an estimated 16,980 adults (13,450 men and 3,530 women) in the United States will be diagnosed with esophageal cancer. It is estimated that 14,710 deaths (11,910 men and 2,800 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 (percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) of people with esophageal cancer is about 17%. 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. These statistics also combine the survival rates of people with advanced esophageal cancer that has spread and people with cancer that is located only in the esophagus. People with cancer that has not metastasized (spread) are likely to have a higher survival rate compared with those with more advanced disease. Learn more about understanding statistics. Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2011. Medical Illustrations
Our staging illustrations are currently being updated to comply with the new 2010 American Joint Committee on Cancer staging guidelines. We apologize for the inconvenience. Risk Factors
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can 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 abnormal changes in cells. People with Barrett's esophagus are more likely to develop adenocarcinoma of the esophagus. 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. Screening Regular screening tests to find early 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 detect cancer early or to find changes that could become cancerous over time. Learn more about these tests in the Diagnosis section. Symptoms and Signs
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.
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. Diagnosis
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 metastasized. Your doctor may consider these factors when choosing a diagnostic test:
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 a change, 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 an unusual change is found, 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 expand the blocked area so that food can temporarily 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 structures inside the body. During an endoscopic ultrasound, a small machine that produces the sound waves is inserted into the esophagus through the mouth. The ultrasound can identify if the tumor has grown into the wall of the esophagus, how deep the tumor has grown, and whether cancer is in 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). 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. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein 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 may be 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 substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues 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. Learn more about what to expect when having common tests, procedures, and scans. 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. Learn more about the first steps to take after a diagnosis of cancer. Staging
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and whether it is affecting the functions of other organs in 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. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. 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. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of 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, the tiny, bean-shaped organs that help fight infection. 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:
Stage IIA: Either of these two conditions:
Stage IIB: Either of these two conditions:
Stage IIIA: Any of these three conditions:
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:
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:
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:
Stage IIIA: Any of these three conditions:
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:
Stage IV: Cancer has spread to another part of the body (any T, any N, M1, any G). Recurrent: Recurrent cancer is cancer that comes 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 (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. Treatment
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 standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current 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. 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. 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 chemotherapy alone in some situations, may be used before surgery to shrink the tumor. For people who cannot undergo surgery, the best treatment option is often a combination of chemotherapy and radiation therapy. A doctor may remove the esophagus in an operation called an esophagectomy and then connect 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 palliative or supportive care. To do this, surgeons and gastroenterologists (doctors who specialize in the gastrointestinal tract) can:
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, 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. Recent studies also show that chemotherapy alone (without radiation therapy) may work as well, but more research is needed to understand any benefits of chemotherapy alone 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, 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. 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 directed 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. Recurrent esophageal cancer Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear. 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. 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 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. Your health care team may recommend a treatment plan that includes a combination of the treatments discussed above. In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time. For advanced esophageal cancer, the goal of treatment is usually to lengthen a person’s life, while easing symptoms such as pain and problems with eating. Treatment for advanced esophageal cancer usually involves chemotherapy. Radiation therapy can help relieve pain or discomfort. An esophageal stent, laser therapy, or photodynamic therapy may help keep the esophagus open (see above). A diagnosis of advanced cancer is stressful, and it may be difficult to discuss. 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. Learn more about advanced cancer care planning. Find out more about common terms used during cancer treatment. About Clinical Trials
Doctors and scientists are always looking for better ways to treat patients with esophageal cancer. To make scientific advances, doctors create research studies involving people, 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. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find clinical trials. For specific topics being studied for esophageal cancer, learn more in the Current 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. 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 trials ends, and/or if the patient chooses to leave the clinical trial before it ends. Side Effects of Cancer and Cancer Treatment
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Be sure to talk with your doctor 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 are well. For many patients, a diagnosis of esophageal cancer is stressful and can bring difficult emotions. 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 medical care. A side effect that occurs months or years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. For more information on late effects or long-term side effects, please read the After Treatment section or talk with your doctor. After Treatment
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 complete remission (no more signs and symptoms of cancer), follow-up care may include a CT scan and an upper endoscopy (see Diagnosis) to watch for 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 tobacco. 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. Find out more about common terms used after cancer treatment is complete. Current Research
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. Chemotherapy advances. Doctors are studying combinations of different drugs, such as cisplatin (Platinol), fluorouracil (5-FU, Adrucil, Efudex, Fluoroplex), paclitaxel (Taxol), irinotecan (Camptosar), docetaxel (Taxotere), oxaliplatin (Eloxatin), and capecitabine (Xeloda). And, research is ongoing to find new drugs that are effective for esophageal cancer. 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, usually leading to fewer side effects than other cancer medications. Many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them.
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. Learn more about common statistical terms used in cancer research. Looking for More about Current Research? If you would like additional information about the latest areas of research regarding esophageal cancer, explore these related items:
Or, choose “Next” (below, right) to continue reading this detailed section. Questions to Ask the Doctor
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.
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
