How is esophageal cancer treated?

The approach to treatment depends on the stage and grade of the cancer. Treatment options that may be used for esophageal cancer include:

  • Surgery is the most common treatment for esophageal cancer. Surgery may be done to remove some or most of the esophagus, as well as some tissue around it, in a procedure called esophagectomy. If the esophagus is removed, the doctor may reposition the stomach (moving it up into the chest), or use a piece of intestine to preserve function. The doctor may also remove lymph nodes around the esophagus and look at them under a microscope to see if they contain cancer.
    Surgery can cure cancer in some patients who have no spread of the tumor beyond the esophagus. Unfortunately, less than 25 percent of esophageal cancers are discovered this early. Therefore, surgery is often offered to ease symptoms.
    Esophageal cancer surgery often requires extended hospitalizations. Some surgeons are now doing the procedures using minimally invasive techniques.
    Complications include: stomach emptying problems, narrowing where the surgery was performed and heartburn.
  • Radiation therapy is a way of treating disease using radiation (high-energy rays) or radioactive substances. It is used to kill or damage cancer cells, often by aiming a beam of radiation at the tumor. The radiation destroys the cancer cells by interfering with their growth and division. Radiation can be used alone, before surgery to shrink tumors, or after surgery to kill any cancer cells that may remain. During radiation treatments for esophageal cancer, a stent (small tube) is sometimes inserted into the esophagus to keep it open. This is called intraluminal intubation and dilation.
    Radiation therapy is mainly used as part of a larger treatment regimen to relieve difficulty swallowing.
  • Chemotherapy uses medicines to kill or stop the growth of cancer cells. Some chemotherapy drugs are taken as pills and some are placed directly into the bloodstream through a vein (intravenous). Chemotherapy drugs travel through the bloodstream and can kill cells throughout the body. For esophageal cancer, chemotherapy is sometimes used before surgery to help shrink the tumor.
    Chemotherapy can be given to control symptoms (palliative), before surgery to shrink the tumor, or can be used in conjunction with radiation.
  • Endoscopic submucosal dissection (EDS) or endoscopic mucosal resection (EMR) are procedures to treat early tumors that are smal. The tumors may be removed endoscopically without having to remove the esophagus.
  • Endoscopic laser therapy may be used to treat more advanced tumors that may cause a blockage in the esophagus. As part of palliative therapy, lasers can be used to cut a hole in the blockage to improve swallowing and allow the patient to eat.
  • Photodynamic therapy (PDT) uses photoactive drugs (drugs activated by non-thermal light) that are absorbed by cancer cells, thus destroying the cancer cells. This treatment may be used to help ease the symptoms of esophageal cancer, particularly difficulty swallowing.

People with esophageal cancer may participate in clinical trials. Clinical trials are research programs conducted with patients to evaluate new medical treatments, drugs or devices. New uses for chemotherapy and radiation therapy are being tested in clinical trials.

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