Treatments for Esophageal Cancer
Cancer of the esophagus represents about 1% percent of all cancers diagnosed in the United States, with 17,650 new cases found in 2019. Treatment for this cancer depends on the stage of cancer when it is discovered. Unfortunately, by the time common symptoms appear—such as difficulty swallowing—the cancer has often advanced.
A wide variety of options exist to treat esophageal cancer, ranging from chemotherapy, radiation, immunotherapy and targeted therapy to surgical procedures. If you are diagnosed with esophageal cancer, your health team will discuss treatment options with you, based on the type, stage and location of your cancer.
Early-Stage Esophageal Cancer Treatments
The earliest stage is precancer, or stage 0. Abnormal cells may be found in the inner lining of the esophagus, but not in the deeper layers. If you have Barrett's esophagus, a condition affecting about 10 to15% of people with GERD (gastroesophageal reflux disease), you are at risk for these precancerous cells, called dysplasia.
The next stage is stage I, in which the cancer has grown past the inner layer into some deeper layers of the esophagus wall, but hasn't moved to the lymph nodes or other organs.
Early esophageal cancer treatment may include:
Photodynamic therapy: After a light-activated drug is injected into your vein, it settles in cancer cells. A few days later, an endoscope with a special laser light is inserted into your esophagus. The light activates the drug so that it kills the cancer cells. This targeted procedure works best with cancer cells near the inner surface lining of the esophagus, which can be reached by light, which is why it is more often used for early-stage cancer. Side effects include temporary swelling afterward as well as sensitivity to light for the next 4 to 6 weeks.
Radiofrequency ablation: A balloon carrying small electrodes is inserted via endoscope, then inflated so that the electrodes make contact with the inner lining of your esophagus. An electrical current then is activated, which heats and kills cancerous or precancerous cells in the lining. Rare side effects include bleeding or strictures in the esophagus.
Endoscopic mucosal resection (EMR): This is a less invasive way to remove tumors than surgery and in some early cancers, can be curative. With EMR, an endoscope with special instruments attached to the end is inserted into your esophagus. The instruments allow the doctor to cut out cancerous lesions. Possible (but treatable) side effects include bleeding, tearing of the esophagus or stomach, and narrowing of the esophagus or stomach.
Esophagectomy: Early stage esophageal cancer is often treated with removal of the esophagus. The surgeon will take out the cancerous part of the esophagus, as well as some surrounding healthy tissue, before reconnecting the esophagus to the stomach, sometimes reconstructing the esophagus using part of the stomach. The surgeon usually removes lymph nodes around the esophagus as well.
If you have stage I esophageal cancer, your doctor may also treat you with chemotherapy and/or radiation. Some patients receive just one of these therapies, while others receive both. If the therapies are done at the same time, the combination is chemoradiation. These therapies may be given before surgery to shrink tumors, or afterward to ensure cancer cells are completely destroyed. Medications and other therapies can help treat some of the side effects of chemotherapy and radiation therapy.
Later-Stage Esophageal Cancer Treatments
Esophageal cancer is considered stage II when it has either grown into the main muscle layer of your esophagus, into outer connective tissue, or to one or two nearby lymph nodes. In stage III cancer—a common stage for first diagnosis of esophageal cancer—the cancer has grown through the esophageal wall to the outer layer of the esophagus, into nearby organs or tissues, and/or to nearby lymph nodes. Stage IV esophageal cancer has spread to distant lymph nodes or distant organs.
If you have stage II or III esophageal cancer, you likely will first receive chemoradiation, then surgery. When and how these therapies are delivered varies depending on the location and size of the tumors. For example, if the cancer is where your esophagus joins your stomach, treatment may include chemotherapy without radiation therapy, followed by surgery. If the tumors are small, surgery may be all that's necessary.
If you have stage IV cancer, your doctor will likely design your treatment to hold off your cancer from advancing for as long as possible and to relieve your symptoms. You may receive chemotherapy, immunotherapy or targeted therapy, sometimes as part of a clinical trial for advanced esophageal cancer.
Palliative Treatments for Esophageal Cancer
Cancer treatment may involve palliative (not curative) treatments to relieve symptoms. Keep in mind these treatments and therapies may only be available at cancer centers. Possible palliative procedures include:
Internal radiation therapy, also known as brachytherapy: This technique delivers radioactive material close to the tumor via an endoscope, which avoids harming nearby healthy tissue. The material is left near the tumor for a few minutes at a time or for 1 to 2 days. Brachytherapy can't treat a very large area, so it is typically done with advanced cancers to make swallowing easier, rather than to attempt a cure.
Esophageal dilation: A procedure to stretch the part of the esophagus that's blocked by cancer to make swallowing easier. A small device is passed down the throat to stretch it open. It can be repeated as necessary, since the esophagus usually only stays open for a few weeks after a dilation.
Esophageal stent: The placement of a self-expanding, mesh stent, made of either metal or plastic to keep the esophagus open to improve swallowing. The stent is placed via an endoscope. Its effectiveness varies depending on the tumor's type and location.
Electrocoagulation: Killing cancer cells by heating them with an electric current (electrocoagulation), which can burn tumors off and help open blockages.
Laser ablation: An endoscope with a laser beam at its tip which blasts tumors. However, the cancer often grows back, so repeat procedures may be necessary.
Argon plasma coagulation: Argon gas and a high-voltage spark are delivered to the cancer site via endoscope. The spark heats up the gas, which is then targeted at the cancer to break it apart.
Feeding tube: Tube feeding may be necessary to deliver nutrition directly to the stomach.
Pain management: Medications are administered to ease pain. Pain management is part of curative and palliative treatment for esophageal cancer.
Your cancer care team can help determine the best approaches to fight your esophageal cancer, as well as help you cope with its symptoms. Some of these treatments may have side effects, which your health providers can also help treat. Support groups are another resource for information and comfort. It's best to consult with your physician if you are interested in alternative treatment.