Treatment
Treatment for esophageal cancer depends on the form, stage, location, and severity of the disease. Esophageal cancer does not cause symptoms in its early stages of growth, so most patients are not diagnosed until the cancer has already reached a more advanced stage. Thus, doctors usually take an aggressive approach to treating this disease, administering chemotherapy and radiation to shrink the tumor, followed by surgery to remove it. Here are some of the procedures your doctor may recommend to treat esophageal cancer.
Surgery
The extent of your surgery depends on the location and severity of the tumor. The surgeon may remove the entire esophagus or only part of it. The surgeon may also need to remove nearby lymph nodes and part of the stomach. After removing the cancer, the doctor will reattach your stomach and esophagus, or use a piece of the intestine to connect the two. This is referred to as an esophagectomy. There are specific instances when surgery may NOT be recommended. When the tumor is a SCC type and there has been an excellent response to chemotherapy and radiation, physicians may discuss avoiding surgery in favor of frequent observation (imaging and endoscopy). When surgery is too high a risk to an individual patient or when it appears that surgery may not have completely removed all tumor burden from the body, observation may also be a recommended option.
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Radiation Therapy
Radiation therapy uses waves of high-energy rays produced by a machine to destroy cancer cells. Doctors give radiation therapy to shrink the tumor before surgery and eliminate any traces of cancer left after surgery. Typically, radiation is given during the same time intervals as chemotherapy. The two treatment methods combine to enhance the results of tumor reduction. The most common form of radiation for this disease is external beam radiation. For this therapy, a large machine delivers radiation to your tumor from outside the body directed from multiple different angles. This is referred to as intensity-modulated radiotherapy (IMRT).
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Proton beam radiation therapy
Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects.
- Please see Understanding Proton Therapy to learn more.
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Chemotherapy
Chemotherapy are drugs that kill rapidly growing cancer cells in an effort to destroy them. Chemotherapy medications may be given through the vein (intravenously) or by mouth (orally). Doctors give chemotherapy to shrink the tumor before surgery and destroy any traces of cancer left after surgery. In more advanced stages in which the cancer has spread, chemotherapy may be the best treatment option to relieve symptoms.
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Chemoradiation
Chemoradiation is a combination of chemotherapy and radiation therapy. Combining these two treatments makes both more effective. Doctors give chemoradiation to shrink the tumor before surgery and destroy any traces of cancer left after surgery.
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Endoscopic Mucosal Resection (EMR)
In this procedure, the surgeon uses an endoscope to remove small tumors and precancerous lesions from the inner lining of the esophagus. This procedure allows doctors to remove early-stage esophageal cancer before it progresses and requires surgery.
Targeted Therapy
Some cases of esophageal cancer contain cells that overexpress the HER2 protein, which causes the cancer to grow more aggressively. Targeted therapy specifically targets these cells, blocking the HER2 proteins from fueling cell growth.
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Immunotherapy
Immunotherapy stimulates your body's immune system to help it fight off cancer. There are immune checkpoint inhibitors which stimulate the body's own immune system to attack the cancer. Immunotherapy is primarily used to treat advanced stages of esophogeal cancer.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Some clinical trials are used to test the side effects of a drug or drug combination, these are called phase I, or early phase trials. Later phase clinical trials (phase II/III) are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may discover a new, more helpful treatment, or it may have no effect at all. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
Supportive Therapy
Doctors also use procedures to relieve symptoms caused by the cancer, particularly in advanced stages. Supportive procedures includes inserting a feeding tube (can be done by interventional radiology, endoscopy, or surgery), putting a stent into the esophagus, and burning or freezing tumor to relieve blockages inside the esophagus and allow food to pass.
