Esophageal Cancer Treatment
Esophageal cancer is cancer that occurs in the esophagus a long, hollow tube that runs from your throat to your stomach. Your esophagus carries food you swallow to your stomach to be digested.
Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus, but in people in the United States, it occurs most often in the lower portion of the esophagus. More men than women get esophageal cancer.
Esophageal cancer isn’t common in the United States. In other areas of the world, such as Asia and parts of Africa, esophageal cancer is much more common.
Signs and symptoms of esophageal cancer include:
- Difficulty swallowing (dysphagia)
- Weight loss without trying
- Chest pain, pressure or burning
- Worsening indigestion or heartburn
- Coughing or hoarseness
- Early esophageal cancer typically causes no signs or symptoms.
It’s not clear what causes esophageal cancer.
Esophageal cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body.
Types of esophageal cancer
Esophageal cancer is classified according to the type of cells that are involved. The type of esophageal cancer you have helps determine your treatment options. Types of esophageal cancer include:
- Adenocarcinoma. Adenocarcinoma begins in the cells of mucus-secreting glands in the esophagus. Adenocarcinoma occurs most often in the lower portion of the esophagus. Adenocarcinoma is the most common form of esophageal cancer in the United States, and it affects primarily white men.
- Squamous cell carcinoma. The squamous cells are flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs most often in the middle of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide.
- Other rare types. Rare forms of esophageal cancer include choriocarcinoma, lymphoma, melanoma, sarcoma and small cell cancer.
It’s thought that chronic irritation of your esophagus may contribute to the DNA changes that cause esophageal cancer. Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:
- Drinking alcohol
- Having bile reflux
- Having difficulty swallowing because of an esophageal sphincter that won’t relax (achalasia)
- Drinking very hot liquids
- Eating few fruits and vegetables
- Having gastroesophageal reflux disease (GERD)
- Being obese
- Having precancerous changes in the cells of the esophagus (Barrett’s esophagus)
- Undergoing radiation treatment to the chest or upper abdomen
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 preferences for treatment.
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.
Surgery to remove a portion of the esophagus (esophagectomy). During esophagectomy, your surgeon removes the portion of your esophagus that contains the tumor and 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.
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.
Treatments for complications
Treatments for esophageal obstruction and difficulty eating can include:
Relieving esophageal obstruction. If your esophageal cancer has narrowed your esophagus, a surgeon may use an endoscope and special tools to place a metal tube (stent) to hold the esophagus open. Other options include surgery, radiation therapy, chemotherapy, laser therapy and photodynamic therapy.
Providing nutrition. Your doctor may recommend a feeding tube if you’re having trouble swallowing or if you’re having esophagus surgery. A feeding tube allows nutrition to be delivered directly to your stomach or small intestine, giving your esophagus time to heal after cancer treatment.
Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before (neoadjuvant) or after (adjuvant) 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.
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.
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. But combining chemotherapy and radiation treatments increases the likelihood and severity of side effects.