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Treatments and drugs
By Mayo Clinic staff
What treatments you receive for esophageal cancer are based on the type of cells involved in your cancer, your cancer's stage, your overall health and your own preferences for treatment.
Surgery
Surgery to remove the cancer can be used alone or in combination with other treatments. Operations used to treat esophageal cancer include:
- Surgery to remove very small tumors. If your cancer is very small, confined to the superficial layers of your esophagus and hasn't spread, your surgeon may recommend removing the cancer and margin of healthy tissue that surrounds it. Surgery for very early-stage cancers can be done using an endoscope passed down your throat and into your esophagus to access the cancer.
- Surgery to remove a portion of the esophagus (esophagectomy). During esophagectomy, your surgeon removes the portion of your esophagus that contains the tumor, along with nearby lymph nodes. The remaining esophagus is reconnected to your stomach. Usually this is done by pulling the stomach up to meet the remaining esophagus. In some situations, a portion of your colon is used to replace the missing section of your esophagus.
- Surgery to remove part of your esophagus and the upper portion of your stomach (esophagogastrectomy). During esophagogastrectomy, your surgeon removes part of your esophagus, nearby lymph nodes and the upper part of your stomach. The remainder of your stomach is then pulled up and reattached to your esophagus. If necessary, part of your colon is used to help join the two.
Esophageal cancer surgery carries a risk of serious complications, such as infection, bleeding and leakage from the area where the remaining esophagus is reattached. Surgery to remove your esophagus can be performed as an open procedure using large incisions or with special surgical tools inserted through several small incisions in your skin (laparoscopically). How your surgery is performed depends on your situation and your surgeon's experience and preferences.
Chemotherapy
Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before or after surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.
The chemotherapy side effects you experience depend on which chemotherapy drugs you receive.
Radiation therapy
Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can come from a machine outside your body that aims the beams at your cancer (external beam radiation). Or radiation can be placed inside your body near the cancer (brachytherapy).
Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It can be used before or after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to your stomach.
Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.
Combined chemotherapy and radiation
Combining chemotherapy and radiation therapy may enhance the effectiveness of each treatment. Combined chemotherapy and radiation may be the only treatment you receive, or combined therapy can be used before surgery. Combining chemotherapy and radiation treatments increases the likelihood and the severity of side effects.
Clinical trials
Clinical trials are research studies testing the newest cancer treatments and new ways of using existing cancer treatments. While clinical trials give you a chance to try the latest in cancer treatment, they can't guarantee a cure. Ask your doctor if you're eligible to enroll in a clinical trial. Together you can discuss the potential benefits and risks.
- Kleinberg LR, et al. Cancer of the esophagus. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone; 2008:1399.
- Esophageal cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/esophageal.pdf. Accessed March 9, 2009.
- Esophageal cancer treatment (PDQ) health professional version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/esophageal/healthprofessional/allpages. Accessed March 9, 2009.
- Esophageal cancer screening (PDQ) health professional version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/screening/esophageal/healthprofessional/allpages. Accessed March 9, 2009.
- Questions to ask the doctor. Cancer.Net. http://www.cancer.net/patient/Cancer+Types/Esophageal+Cancer. Accessed March 10, 2009.
- Eating hints for cancer patients: Before, during and after treatment. National Cancer Institute. http://www.cancer.gov/cancertopics/eatinghints/allpages/print. Accessed March 12, 2009.
- Adult cancer pain. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/pain.pdf. Accessed March 12, 2009.
- Esophageal cancer prevention (PDQ) health professional version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/prevention/esophageal/healthprofessional/allpages. Accessed March 9, 2009.
