Treatment Options

The treatment for esophageal cancer requires a multidisciplinary approach, with input and coordination from medical oncologists, radiation oncologists and surgical oncologists. 

Three types of treatment can be used 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 most often, chemotherapy and radiation therapy are used before or instead of surgery. In general, studies have shown a benefit to using chemotherapy plus radiation therapy before surgery, rather than surgery alone. For very small, local tumors without lymph node involvement, surgery alone may be an option. For advanced, or metastatic, esophageal cancer that has spread beyond the esophagus to other organs, treatment usually involves chemotherapy to control the disease.

Radiation Therapy

Radiation therapy is an effective treatment for esophageal cancer, either before surgery (called neoadjuvant therapy) to shrink the tumor, or after surgery to destroy any remaining cancer cells.

External-beam radiation therapy uses a machine to deliver X-rays to the site of the body where the cancer is located. Radiation treatment is given five days a week for several weeks.

Side Effects

People who receive radiation feel fatigued and can have skin reactions, upset stomach, pain with swallowing, and nausea. Some patients may require feeding tubes to be placed into the stomach so that they can receive adequate nutrition until the radiation course is completed and the side effects of therapy improve. Side effects can be worst for most patients towards the end of treatment, and can sometimes take a few weeks to resolve, even after treatment has completed. Our dieticians and nurses can provide a great deal of information on managing side effects and optimizing nutrition.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. It is usually injected directly into a vein, although some chemotherapy can be given as a pill.

Side Effects
Although there are medications to help reduce the side effects, chemotherapy may cause vomiting, nausea, diarrhea, or mouth sores. Patients usually feel very tired, and there is an increased risk of infection and neuropathy (tingling or numbness in feet or hands).

Hair loss can occur, depending on which chemotherapy drugs are used.. There are medications to ease most side effects, including nausea, neuropathy, and diarrhea, and mouth sores.. If side effects are particularly difficult, the dose of drug may be lowered or a treatment session may be postponed. These side effects usually go away once treatment is finished.

Surgery
Surgery has traditionally been the most common treatment for esophageal cancer. If the esophagus has to be reomoved, your surgeon will perform an esophagectomy and then connect the remaining healthy part of the esophagus to the stomach so you can swallow normally. The stomach or part of the intestine may sometimes be used to make the connection. Lymph nodes around the esophagus are also removed at this time.

If the tumor can’t be removed entirely, you will receive a combination of chemotherapy and radiation 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 this cancer, your surgeon may give you a feeding tube or a percutaneous gastrostomy. This may be done before chemotherapy and radiation to ensure that you can eat enough food to maintain weight and strength during treatment.

Your surgeon may decide to dilate your esophagus, which may have to be repeated if the tumor grows, or an esophageal stent may be used to create more space. An esophageal stent is a metal, mesh device that is expanded to keep the esophagus open.

Photodynamic therapy (using lasers or light therapy) may destroy cancerous tissue and relieve blockages. Your surgeon can also create a bypass, or new pathway, to the stomach if a tumor blocks the esophagus but cannot be removed.