Esophageal cancer

Treatment

Seattle Cancer Care Alliance (SCCA) experts offer comprehensive care for esophageal cancer, including advanced treatments and new options available only through clinical studies.

New patients are seen at our Esophageal Cancer Specialty Clinic or at the SCCA outpatient clinic on Lake Union, based on the patient's individual needs. Often this means all of the specialists who will be involved in your care will meet to design treatment that's tailored to you. You will receive a multidisciplinary treatment plan in a single day — truly one-stop shopping. 

Some patients, such as those with metastatic esophageal cancer, see a single specialist, based on their individual needs. Either way, we see you quickly so you can start your treatment quickly.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Esophageal cancer expertise

Everything you need is here

We have surgeons, medical oncologists, radiation oncologists and pathologists who specialize in esophageal cancer; the most advanced diagnostic, treatment and recovery programs; and extensive support. 

Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation oncologist A physician who has special training in using radiation to treat cancer.
Innovative esophageal cancer therapies

SCCA patients have access to advanced therapies being explored in clinical studies for esophageal cancer conducted here and at our founding organizations Fred Hutchinson Cancer Research Center and UW Medicine.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease.
Esophageal cancer treatment tailored to you

We view treatment as a collaborative effort. Your SCCA doctors will explain all your options and recommend a treatment plan to get you the best results based on the type, stage and location of your cancer and your health, lifestyle and preferences.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Team-based approach

Your personal team includes more than your esophageal cancer doctors. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like a dietitian, pharmacist, social worker or palliative care professional.

Learn More About Supportive Care Services

Ongoing care and support

During and after treatment, your team continues to provide follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life as an esophageal cancer survivor.

Learn More About SCCA Survivorship Clinic

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at SCCA. 

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Endoscopic mucosal resection

Removing the cancerous tissue in your esophagus (and possibly in nearby structures) is important to treating your disease.

If you have small, early-stage cancer that has not gone deeper than the lining (mucosa) of your esophagus, doctors may be able to remove all of it using an outpatient method called endoscopic mucosal resection (EMR). Therapeutic gastroenterologists in Digestive Health at UW Medical Center do this procedure.

  • You are sedated (given medicine to make you sleepy and relaxed). 
  • The doctor inserts a thin, flexible tube (endoscope) into your mouth or nose and down into your esophagus. 
  • The endoscope has a light and a tiny camera on the end to take close-up images, which show on a video monitor in the exam room.
  • The doctor uses instruments to remove (resect) a small amount of tissue.
  • A pathologist checks the tissue under a microscope to determine if cancer is present and what type of cancer it is.  

EMR can be used both to diagnose cancer and, if all the cancer is removed this way, to treat cancer. It is less invasive than surgery and allows patients to resume their life immediately with better outcomes.

Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope.
Endoscopic mucosal resection

Removing the cancerous tissue in your esophagus (and possibly in nearby structures) is important to treating your disease.

Surgery

Your SCCA team may recommend surgery to remove part or all of your esophagus (esophagectomy) if:

  • You have early-stage cancer that cannot be removed with EMR.
  • You have locally advanced cancer (which may have spread through layers of your esophagus and to nearby structures, such as lymph nodes).

People with metastatic esophageal cancer (which has spread to distant parts of the body) have other treatment options. They typically do not have surgery because surgery cannot remove the cancer completely. 

SCCA patients receive esophageal cancer surgery from top surgeons at UW Medicine Thoracic Surgery Clinic and Center for Esophageal & Gastric Surgery, among only a few sites in the country that specialize in diagnosing and surgically treating thoracic and esophageal cancers. Here, the same experts take care of people with cancer in their stomach, esophagus or the place where these structures meet (gastroesophageal junction). Studies show that performing a high volume of esophagectomies, as our surgeons do, is a strong predictor of better patient outcomes, including lower risk of major complications. 

There are many ways to perform an esophagectomy.

  • The method your surgeon uses will depend on the location of your tumor.
  • UW Medicine surgeons are on the leading edge of developing new techniques and teaching these techniques to other doctors.
  • Whichever procedure you have, your SCCA team will work with you to ensure you receive the care you need before, during and after, as you recover.

Transhiatal esophagectomy

Your surgeon removes most of your esophagus through incisions in your neck and abdomen. Typically they attach your stomach to your remaining esophagus in your neck. Sometimes, a segment of the colon is used to connect the esophagus to the stomach. There’s no incision in your chest, and your lungs do not have to be deflated to reach your esophagus, so this method may reduce complications like pneumonia.

Transhiatal esophagectomy

Ivor-Lewis esophagectomy

Your surgeon removes the lower half of your esophagus through an incision in your abdomen. They attach your stomach to your upper esophagus through an incision in your chest along your ribs.

Ivor-Lewis esophagectomy

Total esophagectomy

For large tumors in the middle of your esophagus, your surgeon removes the entire esophagus. They separate your esophagus from other chest structures and organs through incisions in your neck, chest and abdomen, and they create a new passage for food from your throat to your stomach, typically with a segment of your intestine.

Total esophagectomy

Minimally invasive surgery

Most SCCA patients who need surgery for esophageal cancer can have minimally invasive surgery, done with a fiber-optic camera and small instruments through incisions only one-quarter to one-half inch long. The benefits include less pain, faster recovery and fewer problems than with longer incisions. Our surgeons are among the country’s leading experts in minimally invasive surgery in the chest (thoracoscopy) and abdomen (laparoscopy). 

Minimally invasive surgery

 

Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Pneumonia A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may reduce the amount of oxygen that blood can absorb from air breathed into the lung. A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may reduce the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia can be caused by infection, radiation therapy, allergy or irritation from inhaled substances. It may involve part or all of the lungs. Thoracic Having to do with the chest.
Surgery

Your SCCA team may recommend surgery to remove part or all of your esophagus.

Chemotherapy

Chemotherapy may be part of your treatment:

  • Before surgery to shrink your tumor
  • After surgery to destroy any remaining cancer cells 
  • As your main treatment to help control cancer if you don’t have surgery

Usually chemotherapy medicines are given by infusion into a vein. Then they enter your bloodstream and travel throughout your body. Some are given in pill form.

You may have chemo alone or in combination with radiation therapy (chemoradiation) because chemotherapy medicines can make cancer cells more sensitive to radiation. 

Your SCCA team will talk with you about the specific medicines we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout SCCA.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Infusion An injection of medications or fluids into a vein over a period of time. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body.
Chemotherapy

Chemotherapy may be part of your treatment.

Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy.  They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy).

Trastuzumab (Herceptin) is a type of targeted therapy called monoclonal antibody therapy. It uses antibodies to identify substances on cancer cells that may help cancer cells grow. The antibodies attach to these substances and kill the cancer cells, block their growth or keep them from spreading.

Trastuzumab preferentially attacks cancer cells that make too much of the HER2/neu protein. If you have adenocarcinoma that tests positive for HER2/neu, you would be a candidate for trastuzumab.

Antibody A protein made by immune system cells and released into the blood. Antibodies defend the body against foreign substances, such as bacteria. Antibody A protein made by immune system cells and released into the blood. Antibodies defend the body against foreign substances, such as bacteria. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Adenocarcinoma Cancer that forms in the glandular tissue that lines certain internal organs and makes and releases substances in the body, such as mucus, digestive juices or other fluids.

Cancer that forms in the glandular tissue that lines certain internal organs and makes and releases substances in the body, such as mucus, digestive juices or other fluids. Most cancers of the breast, pancreas, lung, prostate, colon, esophagus and stomach are adenocarcinomas.

Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy.  They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy).

Immunotherapy

Immunotherapies harness your body’s immune system to fight your cancer. One type is called an immune checkpoint inhibitor. These medicines block proteins that normally keep your immune cells in check so that they do not become overactive.

An immune checkpoint inhibitor used for esophageal cancer is pembrolizumab (Keytruda). It blocks the protein PD-1, taking the brakes off your T cells and allowing these immune cells to attack your cancer.

Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. T cell A type of white blood cell. T cells are part of the immune system and develop from stem cells in the bone marrow. They help protect the body from infection and may help fight cancer. A type of white blood cell. T cells are part of the immune system and develop from stem cells in the bone marrow. They help protect the body from infection and may help fight cancer. Also called T lymphocyte and thymocyte.
Immunotherapy

Immunotherapies harness your body’s immune system to fight your cancer.

Radiation therapy

You may have radiation therapy:

  • Before surgery to shrink your tumor
  • After surgery to destroy any remaining cancer cells
  • To control your disease if you’re not a candidate for surgery
  • To help with the effects of your cancer, such as a blocked esophagus

Radiation therapy uses high-energy rays or other types of radiation to kill cancer cells. Two main types are used for esophageal cancer: 

  • External-beam radiation therapy (EBRT) using X-rays 
  • Proton therapy, a unique form of EBRT that targets protons at tumors

X-ray EBRT

EBRT uses a machine called a linear accelerator to deliver invisible beams of radiation to your cancer. At our state-of-the-art radiation centers, we use four-dimensional scans to plan your care and account for the movement of your tumor as you breath. Using image guidance, we aim the beams precisely at your tumor at each treatment. 

Combining chemotherapy and radiation (chemoradiation) is common for esophageal cancer because chemotherapy medicines can make cancer cells more sensitive to radiation. Our highly trained specialists have extensive experience caring for people who are going through this aggressive form of treatment. 

Proton therapy

Proton therapy is an advanced therapy and an important alternative to conventional radiation for many types of cancer (and some noncancerous tumors).
 
Proton therapy is sometimes recommended for esophageal cancer because it may significantly limit radiation exposure to surrounding healthy tissue near your esophagus, such as your heart and lungs. The advantage of using protons to treat this cancer is that doctors can target high doses of radiation at the cancer with the goal of minimizing radiation to healthy tissues. This may reduce side effects.
 
SCCA Proton Therapy Center is the only facility in a seven-state region to offer this treatment. Learn more about proton therapy for gastrointestinal cancers.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Radiation therapy

Radiation therapy may be applied at different points in your treatment and through various types of radiation therapy.

Nutrition

During and after your treatment for esophageal cancer, it’s important to maintain good nutrition so you’re as strong and healthy as you can be. At times, this may be challenging because both the disease and its treatments might affect your desire and ability to eat and drink.

The best time to get nutritional advice is before you develop any nutritional problems. With the right guidance, you may be able to prevent problems before they start. But no matter where you are in your treatment, your SCCA team is ready to help.

Dietitians are available to work with you to:

  • Prepare your body for treatment by eating well before treatment starts.
  • Set specific goals for adequate nutrition and fluid intake, and check whether you’re getting enough.
  • Figure out which foods are easiest to tolerate with your symptoms.
  • Find ways to maintain or increase protein intake to help keep up muscle mass and weight.
  • Choose nutrient-dense foods to get as much nutrition as possible with every meal.
  • Change your diet after surgery, such as eating smaller portions of soft foods, avoiding high-fat and spicy dishes and not drinking liquids with meals.

Learn More About SCCA Nutrition Services

Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Nutrition

During and after your treatment for esophageal cancer, it’s important to maintain good nutrition so you’re as strong and healthy as you can be.