Treatment

The treatment of esophageal cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the clinical trials section.

Often, doctors recommend combining three types of treatment for people with a tumor that has not spread beyond the esophagus and lymph nodes: radiation therapy, chemotherapy, and surgery. The order of treatments varies, but more commonly chemotherapy and radiation therapy are being recommended before surgery (or instead of surgery in some cases). Two important studies show a benefit to using chemotherapy plus radiation therapy before surgery, rather than surgery alone. For advanced esophageal cancer, treatment usually involves chemotherapy and radiation therapy.

Surgery

Surgery has traditionally been the most common treatment for esophageal cancer. 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 the patient can swallow normally. The stomach or part of the intestine may sometimes be used to make the connection. The doctor also removes lymph nodes around the esophagus.

If the surgeon cannot remove the entire tumor, a combination of chemotherapy (see below) and radiation therapy (see below) 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.

To help patients eat and relieve symptoms caused by the cancer, surgeons can also:

• Put in a percutaneous gastrostomy or jejunostomy (also called a feeding tube), so a person can receive nutrition directly into the stomach or intestine. This may be done before chemotherapy and radiation therapy is given to ensure 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); this procedure is rarely used.

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

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. 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, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

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 through Cancer.Net’s Drug Information Resources, which provides links to searchable drug databases.

Photodynamic therapy

Photodynamic therapy is 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 normal cells. A laser is directed at the tumor, destroying the cancer cells. Although photodynamic therapy may relieve swallowing problems for a brief period, it does not cure esophageal cancer.

Advanced and recurrent esophageal cancer

Cancer of the esophagus is most successfully treated when it is found in the earliest stages, before it has spread. However, since early esophageal cancer causes few symptoms, it is usually advanced at the time of the diagnosis. In advanced or recurrent esophageal cancer, the goal of treatment is usually to prolong life, while relieving 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.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment.