Esophageal Cancer Treatment
Treatment for esophageal cancer depends on the type, location and stage of cancer as well as on your age, overall health and personal preferences. Decisions about therapy can be particularly complicated because various combinations of surgery, chemotherapy and radiation may be more effective than any single treatment. When cancer is advanced, choosing a treatment plan is a difficult decision, and it's important to take time to evaluate your choices.
You may also want to consider seeking a second opinion. This can provide additional information to help you feel more certain about the option you're considering.
The goal of treatment is to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or causing more harm. In some cases, an approach called palliative care may be best. Palliative care refers to treatment aimed not at removing or slowing the disease, but at helping relieve symptoms and making you as comfortable as possible.
Surgical options
Surgery is the most common treatment for esophageal cancer, either as a therapy for the cancer itself or as a way to relieve symptoms, especially difficult swallowing. It's also recommended if you consistently have very abnormal cells (high-grade dysplasia) occurring with Barrett's esophagus.
Depending on the nature of the cancer, the operation may be performed in one of two ways:
Esophagectomy. Doctors generally recommend this approach for early-stage esophageal cancer that doesn't involve your stomach. During the procedure, 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 so you can still swallow. In some cases the stomach is pulled up to the esophagus. In others, part of your large intestine is used to replace the missing section of your esophagus.
Esophagogastrectomy. In this procedure, which is used for more advanced cancer, 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.
Surgery for esophageal cancer is complex and carries risks that include infection, bleeding and leakage from the area where the remaining esophagus is reattached. Hospitals where surgeons perform a large number of esophagectomies have significantly lower mortality rates than do hospitals where few esophagectomies are performed. If you're considering this surgery, look for a hospital or medical center whose surgeons are highly experienced in the procedure.
Chemotherapy
Using drugs to kill cancer cells is another option for treating esophageal cancer. Chemotherapy medications, which can be injected into a vein or taken by mouth, travel throughout your body, attacking cancer cells that have spread beyond your esophagus. You usually receive a combination of anticancer drugs given in cycles, with periods of recovery alternating with periods of treatment.
Chemotherapy can help in several ways — before surgery to shrink the tumor, in combination with radiation when surgery isn't an option or to relieve symptoms in advanced cases of esophageal cancer.
Unfortunately, anticancer drugs affect normal cells as well as malignant ones, especially fast-growing cells in your digestive tract and bone marrow. For that reason, side effects — including nausea and vomiting, mouth sores, an increased chance of infection due to a shortage of white blood cells, and fatigue — are common. Not everyone experiences side effects, however, and there are now better ways to control them if you do. Be sure to discuss any questions you may have about side effects with your treatment team.
Radiation therapy
Radiation is usually most effective against esophageal cancer when used in combination with chemotherapy, either before surgery or as the primary treatment. It's also used to relieve pain and improve swallowing. Most often, the radiation comes from a machine outside your body (external beam radiation), but sometimes thin plastic tubes containing radioactive material are implanted near the cancer cells in your esophagus (brachytherapy).
You commonly receive radiation therapy five days a week for five to seven weeks. The most common side effects are fatigue — which generally becomes more noticeable later in the course of treatment — skin rash or redness in the area being treated, loss of appetite, and mouth sores or increased problems with swallowing. In fact, swallowing may become so difficult that your doctor will recommend a feeding tube to provide nourishment during treatment.
These side effects generally aren't permanent, and most can be treated or controlled. Long-term side effects are rare, but they can be serious when they do occur and include inflammation or scarring in the lungs, esophagus, heart or spinal cord.
Photodynamic therapy
This therapy is generally used to relieve pain and obstruction in the esophagus, but it's also being studied as a treatment for early-stage esophageal cancer. During the procedure, you receive an injection of a light-sensitive drug that remains in cancer cells longer than it does in healthy ones. A laser light is then directed at your esophagus through an endoscope. This stimulates the production of an active form of oxygen that destroys the cancer cells while sparing healthy tissue.
Photodynamic therapy isn't without side effects. It makes your skin and eyes sensitive to light for at least six weeks after treatment, so you'll need to wear protective clothing and sunglasses every time you go outdoors. It can also make swallowing more difficult for a short period of time.
Areas of research
Scientists are continually seeking more effective and less harmful treatments for esophageal cancer. Some areas of research include:
Gene therapy. Researchers have identified many of the genetic changes that cause healthy esophageal cells to become malignant. Understanding these changes may eventually lead to gene therapies that help repair abnormal DNA.
Chemotherapy. Scientists are studying a range of chemotherapy options, including new anticancer drugs such as tyrosine-kinase inhibitors. Protein-tyrosine kinases are substances that help regulate signals between cells, especially those having to do with the cell growth and mortality. Because abnormal signals from protein-tyrosine kinases have been linked to a number of different cancers, some researchers have focused on finding ways to selectively inhibit these signals. Also under investigation are new combinations of existing drugs and different combinations of radiation and chemotherapy.
Immunotherapy. This therapy stimulates your immune system to fight cancer. One approach uses monoclonal antibodies, which are produced by fusing antibody-forming cells and tumor cells, to treat esophageal adenocarcinomas.
Clinical trials
If you have advanced esophageal cancer, you may want to consider participating in a clinical trial. This is a study that's used to test new forms of therapy — typically new drugs, different approaches to surgery or radiation treatments, and novel methods such as photodynamic therapy. If the therapy being tested proves to be safer or more effective than current treatments, it will become the new standard of care.
The treatments used in clinical trials haven't yet been shown to be effective. They may have serious or unexpected side effects, and there's no guarantee you'll benefit from them.
On the other hand, cancer clinical trials are closely monitored by the federal government to ensure they're conducted as safely as possible. And they offer access to treatments that wouldn't otherwise be available to you.
If you're interested in finding out more about clinical trials, talk to your treatment team. You can also call the National Cancer Institute's Cancer Information Service at (800) 4-CANCER, or (800) 422-6237. The call is free, and trained specialists are available to answer your questions.
Esophageal Cancer Treatment
