What You Need to Know about Esophageal Cancer

Treatment Methods

Cancer of the esophagus usually cannot be cured unless it is found in the earliest stages, before it has begun to spread. Unfortunately, early esophageal cancer causes few symptoms, and the disease is usually advanced when the diagnosis is made. However, advanced esophageal cancer can be treated and symptoms can be relieved.

Esophageal cancer is usually treated with surgery, radiation therapy (also called radiotherapy), or chemotherapy. The doctor may use just one treatment method or combine them, depending on the patient's needs.

In some cases, the patient is referred to doctors who specialize in different kinds of cancer treatment. Often, specialists work together as a team to plan and carry out the patient's care. The medical team may include a gastroenterologist, surgeon, oncologist (cancer specialist), radiation oncologist, nurse, dietitian, and social worker.

Surgery is often part of the treatment plan. Many patients with esophageal cancer have an operation called esophagectomy. Generally, the surgeon removes the tumor along with a portion of the esophagus, nearby lymph nodes, and other tissue in the area. Usually, it is possible to connect the stomach to the remaining part of the esophagus. In a few cases, the surgeon forms a new passageway from the throat to the stomach, using tissue from another part of the digestive tract (such as the colon) to replace the esophagus.

If a tumor blocks the esophagus but cannot be removed, the surgeon may be able to create a bypass, a new pathway to the stomach. In some cases, the surgeon can dilate (widen) the esophagus. This procedure may have to be repeated as the tumor grows. Sometimes, the doctor puts a tube into the esophagus to keep it open. Recently, some surgeons have used a laser to destroy cancerous tissue and relieve blockages.

Radiation therapy is the use of high-energy rays to damage cancer cells and stop them from growing. Like surgery, radiation therapy is local therapy; it affects cells only in the treated area. Radiation therapy can be used to shrink a tumor before surgery or to destroy cancer cells that may remain in the area after surgery. Radiation may also be used instead of surgery, especially if the size or location of the tumor would make an operation difficult. In some cases, radiation therapy is recommended for patients who cannot have surgery for other health reasons. Even if the tumor cannot be removed by surgery or destroyed entirely by radiation therapy, radiation therapy can still help relieve pain and make swallowing easier.

In radiation therapy for esophageal cancer, the energy usually comes from a machine outside the body (external radiation). Some patients also need treatment with radioactive materials placed in the tumor (implant radiation). Usually, patients receive external radiation therapy 5 days a week for several weeks. Most patients can stay at home and go to the hospital or clinic each day for this treatment. For implant radiation, patients must stay in the hospital for a short time. More information about radiation therapy can be found in the NCI booklet Radiation Therapy and You.

Chemotherapy is the use of drugs to kill cancer cells. The doctor may suggest one drug or a combination of drugs. Chemotherapy may be used alone or combined with radiation therapy to shrink a tumor before surgery or to destroy cancer cells that remain in the body after surgery. Chemotherapy may also be used if surgery is not possible and for patients whose cancer returns after surgery or radiation therapy.

Most anticancer drugs for esophageal cancer are given by injection into a vein or muscle. Some may be taken by mouth. Chemotherapy is systemic therapy, meaning that the drugs travel through the bloodstream and can reach cancer cells all over the body. Often the drugs are given in cycles: a treatment period followed by a rest period, then another treatment and rest period, and so on. Many patients have their chemotherapy as outpatients at the hospital, in the doctor's office, or at home. Depending on the drugs, the treatment plan, and the patient's general health, however, a hospital stay may be needed. The NCI booklet Chemotherapy and You has helpful information about this type of treatment.

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