Esophageal Cancer Treatment
Esophageal Cancer Treatment
Treatment for esophageal cancer depends on the cancer's type and stage, its location, whether it can be removed surgically, tumor biomarkers, your overall health, and your preferences. Treatment is often complex and may involve several types of therapy. Whenever possible, treatment should be planned by a multidisciplinary team with experience treating esophageal cancer.
THE BASICS: Esophageal cancer treatment may include endoscopic therapy, surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy, or a combination. Early cancers may sometimes be removed endoscopically. Locally advanced cancers commonly require several treatments, while metastatic disease is generally treated with systemic therapy.
Endoscopic treatment
Some very early esophageal cancers can be treated without major surgery. Endoscopic treatments can include:
Endoscopic mucosal resection
Abnormal tissue is removed through an endoscope passed down the throat.
Endoscopic submucosal dissection
This technique allows doctors to remove larger or deeper areas of abnormal tissue in one piece.
Ablation
Techniques such as radiofrequency ablation can destroy abnormal Barrett's tissue that remains after precancerous or early cancerous areas have been removed. Endoscopic treatment is only appropriate for cancers that meet specific criteria.
Surgery
The main surgery used to treat esophageal cancer is an esophagectomy. During an esophagectomy, the surgeon removes part or most of the esophagus containing the cancer along with nearby lymph nodes. The stomach is commonly reshaped into a tube and moved upward to reconnect the digestive tract. Some operations use part of the intestine for reconstruction instead.
Minimally invasive esophagectomy
Some patients can have surgery using laparoscopic or robotic techniques through smaller incisions. Whether this approach is appropriate depends on the tumor and the surgical team's expertise. Esophagectomy is a complex operation. When possible, having surgery at a center that performs a high volume of esophageal cancer operations can be beneficial.
Chemotherapy
Chemotherapy uses medications that travel through the bloodstream to destroy cancer cells. It may be given:
Before surgery
Before and after surgery
With radiation
After certain treatments
For recurrent cancer
For metastatic cancer
Common drugs can include fluorouracil, capecitabine, oxaliplatin, cisplatin, paclitaxel, and docetaxel. The specific regimen depends on your cancer and treatment plan.
Radiation therapy
Radiation therapy uses high-energy radiation to destroy cancer cells. It is frequently combined with chemotherapy. This is called chemoradiation. Chemoradiation may be used before surgery or as the primary treatment when surgery is not recommended. Radiation can also help relieve symptoms of advanced disease, including pain and difficulty swallowing.
Immunotherapy
Immunotherapy helps the immune system recognize and attack cancer. Checkpoint inhibitor immunotherapies have become an important part of treatment for many patients with esophageal cancer. Examples include:
Nivolumab
Pembrolizumab
Immunotherapy may be used in several settings. Whether it is appropriate depends on factors such as cancer type, stage, previous treatment, PD-L1 expression, and other tumor characteristics.
Targeted therapy
Targeted therapies attack specific proteins or molecular features that cancer cells use to grow. Some adenocarcinomas of the esophagus and gastroesophageal junction are HER2-positive. HER2-positive advanced cancers may be treated with HER2-targeted therapy. Additional targeted treatments may be available depending on the tumor's molecular features.
Treatment for metastatic esophageal cancer
Stage IV esophageal cancer is generally treated with systemic therapy. Treatment may include combinations of:
Chemotherapy
Immunotherapy
Targeted therapy
Clinical trial treatments
The goal is usually to shrink or control the cancer, relieve symptoms, maintain quality of life, and help patients live longer.
Nutrition during esophageal cancer treatment
Nutrition is an especially important part of esophageal cancer care. Difficulty swallowing can make it challenging to consume enough calories and protein even before treatment begins. Surgery, chemotherapy, and radiation can create additional challenges. A registered dietitian can help you:
Find foods that are easier to swallow
Increase calorie and protein intake
Manage nausea and appetite changes
Prevent or address weight loss
Maintain muscle and strength
Adapt to eating changes after surgery
Some patients need temporary feeding tube support during treatment
Palliative and supportive care
Palliative care focuses on relieving symptoms and improving quality of life. It can be provided at any stage of cancer, including while you are receiving treatment intended to cure the cancer. Supportive treatment can address:
Difficulty swallowing
Pain
Fatigue
Nausea
Weight loss
Anxiety
Depression
Treatment side effects
Procedures such as esophageal dilation or stent placement may also help certain patients who have significant difficulty swallowing.