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Esophageal Cancer Treatment

Once your doctor confirms a diagnosis of esophageal cancer, you begin your course of treatment. The goal of treatment depends on the severity of the cancer.

Your course of treatment will also depend on your medical condition and personal preferences. Treatment options for esophageal cancer include:

Technique for transhiatal esophagectomy; A: removal of the esophagus; B: translocation of the stomach
Technique for transhiatal esophagectomy; A: removal of the esophagus; B: translocation of the stomach (click to enlarge)

Your doctor may decide to combine treatments. For example, you may receive chemotherapy and radiation at the same time.

Esophageal Cancer Treatment: Surgery

In early-stage esophageal cancer, resecting (removing) the tumor is often an option. Your doctor may remove the entire esophagus, a part of your stomach, or only the part with cancer. If the tumor has not spread beyond the esophagus, surgery may cure the cancer completely.

During the procedure, your doctor attaches your stomach to the remaining part of your esophagus. If that is not possible, then a piece of your intestine is used to attach the esophagus to the small intestine.

Esophageal Cancer Treatment: Radiotherapy

Radiotherapy, or radiation therapy, is a treatment approach that uses high-energy radiation beams to destroy cancer cells. In early-stage cancer, radiotherapy may be the only treatment approach necessary. You may have also radiotherapy before or after surgery, or in combination with chemotherapy.

There are two types of radiotherapy:

  • External radiation therapy : You lie on a table, and a large machine directs the radiation beam directly at the tumor. You will undergo several sessions of this therapy over a period of a few weeks.

  • Internal radiation therapy (brachytherapy) : Your doctor anesthetizes your throat and gives you a sedative to relax. Then, your doctor places a tube into your esophagus that emits radiation directly onto the tumor. Usually, only one treatment is necessary.

Radiotherapy may cause side effects including nausea, tender skin and fatigue. Your medical team will work with you to manage your pain and other symptoms during your treatment.

Esophageal Cancer Treatment: Chemotherapy

Chemotherapy is the use of medication to destroy cancer cells, and is used to treat patients with esophageal cancer. You receive the chemotherapy drugs through an intravenous (IV) line. A chemotherapy cycle includes several sessions of chemotherapy followed by a rest period.

Chemotherapy is a systemic treatment, meaning it affects your entire body. It can cause many side effects like nausea, hair loss and increased risk of infection. Your medical team will work with you to manage pain and any other side effects during your treatment. Many advances have been made in chemotherapy drugs and most patients are able to manage their side effects comfortably.

Your treatment may include chemotherapy in conjunction with other treatment options. You may undergo:

  • Radiation plus chemotherapy

  • Chemotherapy plus surgery

  • Chemoradiation (chemotherapy and radiation) plus surgery

Esophageal Cancer Treatment: Endoscopic Therapy

Endoscopic therapy is an effective, safer and less invasive therapy for early-stage esophageal cancer. You may be a candidate for endoscopic therapy if the cancer is in stage I and has not metastasized (spread) to other parts of your body.

  • Endoscopic mucosal resection . For early cancers that do not extend beyond the mucous lining of the esophagus, this is a highly effective, nonsurgical treatment option. During the endoscopic procedure small lesions and cancerous areas are removed

  • Mucosal ablation . During this procedure, your doctor applies heat energy to the mucous lining of your esophagus to destroy cancerous cells. The goal is for normal, healthy cells to replace them

  • Photodynamic therapy (PDT) . PDT uses photosensitizers, a substance that produces a reaction when it is exposed to light. You will be given a photosensitizer drug, either orally or through an IV. A special laser light activates the drug, causing a photochemical reaction that destroys the tumor tissue.

Metastatic Esophageal Cancer Treatment

Metastatic cancer means the cancer has spread beyond the esophagus. When the cancer is at a very advanced stage, your doctor may recommend multimodality therapy. Multimodality therapy uses two or more courses of treatment together. For patients who have had surgery, multimodality therapy offers improved survival rates. In nonsurgical patients, radiation and chemotherapy may be an option.

Sometimes, in patients with metastatic cancer, the cancer is too advanced to be cured completely. Your doctor may recommend palliative therapy. The goal of palliative therapy is not to cure the cancer, but to offer you relief from some of the symptoms and stress of advanced stage cancer.

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