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Esophageal Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 03/2018

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. Use the menu to see other pages. Think of that menu as a roadmap for this complete 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 healthy cells change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. 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, which are the tiny, bean-shaped organs that help fight infection, as well as the 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.

Types of esophageal cancer

There are 2 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, which make up less than 1% of esophageal cancers, include small cell neuroendocrine cancers, lymphomas, and sarcoma.

Looking for More of an Introduction?

If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to esophageal cancer. This fact sheet is available as a PDF, so it is easy to print out.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with esophageal cancer and general survival rates. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will find information about the number of people who are diagnosed with esophageal cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, an estimated 17,290 adults (13,480 men and 3,810 women) in the United States will be diagnosed with esophageal cancer. The disease accounts for 1% of cancers diagnosed in the United States. It is diagnosed more often in other parts of the world.

It is estimated that 15,850 deaths (12,850 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 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with esophageal cancer is 19%.

However, survival rates depend on several factors, including the stage of the cancer when it is first diagnosed. The 5-year survival rate of people with cancer located only in the esophagus is 43%. The 5-year survival rate for those with disease that has spread to surrounding tissues or organs and/or the regional lymph nodes is 23%. If it has spread to distant parts of the body, the survival rate is 5%.

It is important to remember that statistics on the survival rates for people with esophageal cancer are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. People should talk with their doctor if they have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2018, and the ACS website.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by esophageal cancer. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will find a drawing of the main body parts affected by esophageal cancer. Use the menu to see other pages.

This illustration shows the esophagus, a long, hollow, muscular tube that connects the throat to the stomach. A cross section of the esophagus shows two layers of muscle: the longitudinal muscle on the outside and the circular muscle on the inside, which surrounds the submucosa. The hollow interior of the esophagus is the lumen. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors. It explains the factors that may increase the chance of developing esophageal cancer. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Risk Factors

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will find out more about the factors that increase the chance of developing esophageal cancer. Use the menu to see other pages.

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. 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 3 to 4 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, such as 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 inflammation of the esophagus called esophagitis, 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 cleaning products, such as drain cleaners.

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

  • Human papillomavirus (HPV). Researchers are investigating HPV as a risk factor for esophageal cancer, but there is no clear link that squamous cell esophageal cancer is related to HPV infection. Sexual activity with someone who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. There are vaccines available to protect you from some HPV strains.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Screening

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will find out more about screening for esophageal cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for esophageal cancer

Regular screening tests to find esophageal cancer in people without symptoms are not used in the United States. People with Barrett's esophagus (see Risk Factors) may be advised to have regular endoscopic examinations. An endoscopic examination is a procedure that uses a flexible, lighted tube to look inside the esophagus. During these examinations, biopsies can be taken to remove a small amount of tissue for examination under a microscope. This type of screening can help find cancer early or find changes that could become cancerous over time. Learn more about these tests in the Diagnosis section.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems esophageal cancer can cause. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with esophageal cancer may experience the following symptoms or signs. Sometimes, people with esophageal cancer do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

  • 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

If you are concerned about any changes you experience, please talk with your health care team. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis. If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may be called palliative care or supportive care. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

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 are taken. An x-ray is a way to take a picture of the inside of the body. 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 looking area, 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. An upper endoscopy 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. Sedation is giving medication to become more relaxed, calm, or sleepy. If there is an abnormal looking area, 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 with an attached ultrasound that produces the sound waves is inserted into the esophagus through the mouth. The ultrasound is used to find out 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. This part of a person’s airway includes the trachea, or windpipe, and the area where the windpipe branches out into the lungs called the bronchial tree.

  • 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. A pathologist then analyzes the sample(s). A pathologist is 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 can help determine your treatment options.

    • PD-L1 and microsatellite instability (MSI) testing. Testing may be done for PD-L1 and high microsatellite instability (MSI-H), which may also be called a mismatch repair deficiency. The results of these tests help doctors find out if immunotherapy is a treatment option (see Types of Treatment). The PD-1/PD-L1 pathway may be called an immune checkpoint. These checkpoints are critical to the immune system’s ability to control cancer growth. Many cancers use these pathways to escape the immune system. The immune system responds to the cancer by blocking these pathways with specific antibodies called immune checkpoint inhibitors. Drugs that target this pathway can be effective against MSI-H esophageal cancers. PD-L1 and MSI testing is more common for patients with advanced or stage IV esophageal cancer.

    • HER2 testing. Human epidermal growth receptor 2 (HER2) is a specialized protein found on the surface of cells. Many people are more familiar with HER2 when discussing breast cancer. However, doctors are finding that HER2 is also important in other types of cancer. When a cancer has abnormally high levels of HER2, it can drive its growth and spread. These types of cancer are referred to as HER2-positive. For HER2-positive cancers, certain types of targeted therapy may work well to treat these cancers. For patients diagnosed with gastroesophageal adenocarcinoma, ASCO, the American Society for Clinical Pathology (ASCP), and the College of American Pathologists (CAP) recommend HER2 testing to help guide treatment.

  • Computed tomography (CT or CAT) scan. A CT scan creates takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Usually, a special dye called a contrast medium is given before the scan to provide better detail. This dye is generally injected into a patient’s vein.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. 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 usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a 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 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 in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Stages

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. In addition to stage, a cancer’s growth may also be described by its grade, which describes how much cancer cells look like healthy cells. To see other pages, use the menu.

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 find out 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, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How deeply has the primary tumor grown into the wall of the esophagus and the surrounding tissue?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Doctors also describe this type of cancer by its grade (G). The grade describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called “differentiated.” If the cancerous tissue looks very different from healthy tissue, it is called “poorly 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 2 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

For squamous cell carcinoma, the stages may be divided based on whether the tumor is in the upper, middle, or lower part of the esophagus, as well as the grade (G) of the tumor cells.

Stage 0: The cancer is found in only the top lining of the esophagus.

Stage IA: The cancer is in only the top layers of the esophagus.

Stage IB: Either of these conditions:

  • The cancer is in the top layers of the esophagus, but the tumor cells are less differentiated.

  • The tumor is in the third layer of the esophagus, but it has not spread to the lymph nodes or other parts of the body.

Stage IIA: Any of these conditions:

  • The tumor is in the third layer of the esophagus. Cancer cells have spread into but not through the muscle wall of the esophagus.

  • The tumor is in the outer layer of the upper or middle part of the esophagus.

  • The tumor is in the outer layer of the lower part of the esophagus.

Stage IIB: Any of these conditions:

  • The tumor is in the outer layer of the upper or middle part of the esophagus. The tumor cells are less differentiated.

  • The tumor is in the outer layer of any part of the esophagus.

  • The tumor is in any part of the esophagus, and cancer cells have spread into the lining of the esophagus and underneath layers. Cancer has also spread to 1 or 2 lymph nodes near the tumor.

Stage IIIA: Any of these conditions:

  • The tumor is in any part of the esophagus, and cancer cells have spread into the lining of the esophagus and underneath layers. Cancer cells have also spread to 3 to 6 lymph nodes near the tumor.

  • The tumor is in any in any part of the esophagus and has grown into the third layer of the esophagus. Cancer cells have spread to 1 or 2 lymph nodes.

  • Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body.

Stage IIIB: Any of these conditions:

  • The tumor is in any part of the esophagus and has grown into the third layer of the esophagus. It has also spread to 3 to 6 lymph nodes.

  • The tumor is in any part of the esophagus, has grown into the outer layer of the esophagus and to either 1 to 2 or 3 to 6 lymph nodes.

  • The tumor is in any part of the esophagus and has spread to structures surrounding the esophagus. It has either spread to no lymph nodes or only 1 to 2 lymph nodes.

Stage IVA: Either of these conditions:

  • The tumor is in any part of the esophagus and has spread to nearby structures. It may also have spread to up to 3 to 6 lymph nodes.

  • The cancer has spread to 7 or more regional lymph nodes.

Stage IVB: The cancer has spread to other parts of the body.

Staging of adenocarcinoma of the esophagus

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

Stage 0: The cancer is found in only the top lining of the esophagus.

Stage IA: Cancer cells have spread into the lining of the esophagus and the layers underneath.

Stage IB: Either of these conditions:

  • The cancer has spread to the layers underneath the lining of the esophagus. The tumor cells are moderately differentiated.

  • The cancer has grown into a layer of the esophagus called the submucosa.

Stage IC: Either of these conditions:

  • The cancer has grown into the layers underneath the lining of the esophagus or the submucosa. The cancer cells are poorly differentiated.

  • The cancer has grown into the third layer of the esophagus. The cancer cells are well or moderately differentiated.

Stage IIA: Cancer is in the third layer of the esophagus. The grade cannot be evaluated or the cells are poorly differentiated.

Stage IIB: Either of these conditions:

  • Cancer is in the outer layer of the esophagus.

  • Cancer is in an inner layer of the esophagus and has spread to 1 or 2 lymph nodes.

Stage IIIA: Either of these conditions:

  • Cancer is in the inner layers of the esophagus and has spread to 3 to 6 lymph nodes near the tumor.

  • Cancer is in the third layer of the esophagus and has spread to 1 or 2 lymph nodes.

Stage IIIB: Any of these conditions:

  • Cancer is in the third layer of the esophagus and in 3 to 6 lymph nodes.

  • Cancer is in the outer layer of the esophagus and has spread to 1 to 2 or 3 to 6 lymph nodes.

  • The tumor has spread to structures near the esophagus and either no lymph nodes or 1 to 2 lymph nodes.

Stage IVA: Any of these conditions:

  • The tumor has spread to structures near the esophagus and either no lymph nodes or up to 3 to 6 lymph nodes.

  • The tumor has spread to 7 or more lymph nodes.

Stage IVB: Cancer has spread to another part of the body.

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 the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis. Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Treatment Options

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with esophageal cancer. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for esophageal cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About 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. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the common types of treatments used for esophageal cancer are listed below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

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 all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment 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 different 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. Surgery may be used afterwards depending how well chemoradiotherapy worked. Recent studies show using 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 factors that increase the risks from surgery, such as a patient’s age or overall health. For advanced esophageal cancer, treatment usually involves chemotherapy and radiation therapy.

Care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment intended 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 is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer at the same time that they receive treatment to ease side effects. In fact, people who receive both at the same time 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, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or 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 the specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Surgery

Surgery is the removal of the tumor and some surrounding healthy 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 main 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) 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 affected part of 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.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

Surgery for palliative 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 surgery. To do this, surgeons and doctors called gastroenterologists, 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 person can eat enough food to maintain his or her weight and strength during treatment.

  • 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.

Endoscopic therapy

The following treatments use an endoscope (see Diagnosis) to treat esophageal cancer and to manage side effects caused by the tumor.

  • Endoscopy and dilation. This procedure expands the esophagus. It may have to be repeated if the tumor grows.

  • Endoscopy with stent placement. This procedure uses an endoscopy to insert a stent in the esophagus. An esophageal stent is a metal, mesh device that is expanded to keep the esophagus open.

  • 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.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or 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).

Proton beam therapy is being studied in clinical trials for esophageal cancer. Proton beam therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells.

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 the basics of radiation therapy.

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for esophageal cancer include:

  • Chemotherapy

  • Targeted therapy

  • Immunotherapy

Each of these types of therapies are discussed below in more detail. A person may receive only 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

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.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. As explained above, chemotherapy and radiation therapy are often given at the same time to treat esophageal cancer, called 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 after treatment is finished.

Learn more about the basics of chemotherapy.

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 healthy cells.

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. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Targeted therapy for esophageal cancer includes:

  • HER2-targeted therapy. For esophageal cancer, the targeted therapy trastuzumab (Herceptin, Ogivri) may be used along with chemotherapy as a first treatment for patients with metastatic esophageal adenocarcinoma. For patients with metastatic or recurrent gastroesophageal cancer that is HER2 positive, ASCO, ASCP, and CAP recommend a combination of chemotherapy and HER2-targeted therapy. If the cancer is HER2 negative, HER2-targeted therapy is not a treatment option for you, and your doctor will give you other options for treating the cancer.

  • Anti-angiogenesis therapy. The targeted therapy ramucirumab (Cyramza) is also an option if first-line therapy, or the first treatments given, has not worked. Ramucirumab is a type of targeted therapy called an anti-angiogenic. It is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Ramucirumab may be given by itself or with paclitaxel (Abraxane), a type of chemotherapy (see above).

Talk with your doctor about possible side effects for each specific medication you are prescribed and how they can be managed.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Pembrolizumab (Keytruda) is a type of immunotherapy that targets the PD-1/PD-L1 pathway (see Diagnosis). It is approved for patients when chemotherapy no longer works and if the cancer tests positive for PD-L1.

Different types of immunotherapy can cause different side effects. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Metastatic esophageal cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

For metastatic esophageal cancer, palliative or 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 treatment plan may include chemotherapy, as well as radiation therapy to help relieve pain or discomfort. For example, an esophageal stent, laser therapy, photodynamic therapy, or cryotherapy may help keep the esophagus open (see above).

For most people, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. You and your family are encouraged to talk about how you feel 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.

Remission and the chance of recurrence

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

A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your 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 new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments 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 suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects. People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your 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.

People who have advanced cancer and who are expected to live less than 6 months may want to consider 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option 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 loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 03/2018

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. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with esophageal cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some people, a clinical trial is the best treatment option available. Because standard treatments are not perfect, people are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are a way to contribute to the 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.

Insurance coverage of clinical trials costs differs by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” Placebos are usually combined with standard treatment in most cancer clinical trials. 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.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options, so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different than the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

People 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 people 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 they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for esophageal cancer, learn more in the Latest Research section.

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. In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for esophageal cancer. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Latest Research

Approved by the Cancer.Net Editorial Board, 03/2018

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. Use the menu to see other pages. 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 best diagnostic and treatment options for you.

  • Chemoprevention. Researchers are looking at using aspirin and acid-reducing medication 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. Learn about the basics of chemoprevention.

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

  • Chemotherapy advances. Doctors are studying combinations of different drugs, such as capecitabine (Xeloda), cisplatin (available as a generic), docetaxel (Docefrez, Taxotere), fluorouracil (5-FU, Efudex), irinotecan (Camptosar), oxaliplatin (Eloxatin) and paclitaxel. 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 adenocarcinoma, as well as combining trastuzumab with radiation therapy.

    • Researchers are looking at new drugs that block vascular endothelial growth factor (VEGF).

  • Immunotherapy. New drugs and combinations that include immunotherapy are continuing to be studied.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current esophageal cancer treatments 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 in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Coping with Treatment

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care” or “supportive care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for esophageal cancer are listed in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health. Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people do not know what to say in response. Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with esophageal cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of check-ups after cancer treatment is finished. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care. Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given. If the esophageal cancer is in remission, follow-up care may include CT scans and upper endoscopies (see Diagnosis) to watch for a possible recurrence.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them. For example, people who have had an esophagectomy should sleep with the head of the bed elevated to avoid acid reflux, since the stomach has been surgically moved up into the chest.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences. If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Survivorship

Approved by the Cancer.Net Editorial Board, 03/2018

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone. Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes. People recovering from esophageal cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices. It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible. Talk with your health care team to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 03/2018

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

Talking often with the health care team 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 a digital list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of esophageal cancer do I have?

  • Is the cancer located only in my esophagus?

  • What is the stage of the disease? What does this mean?

  • Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are available me? Where are they located, and how do I find out more about them?

  • Are there radiation therapy and surgery options to treat the 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 leading my overall treatment?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call with questions or problems?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term effects and complications of having this surgery?

Questions to ask about having radiation therapy, chemotherapy, targeted therapy, or immunotherapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Use the menu to choose a different section to read in this guide.

Esophageal Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 03/2018

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. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer 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 links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Esophageal Cancer. Use the menu to choose a different section to read in this guide.