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How is esophageal cancer treated?

Treatment for esophageal cancer is based on the patient's stage of disease, cancer type and the patients general health. Surgery, chemotherapy and radiation therapy are used as single treatment modalities or in combination.

Surgery

In general, surgery is the most common treatment and provides the best chance for long-term survival. An esophagectomy involves the removal of part or most of the esophagus and surrounding lymph nodes. Surgery involves physically removing a portion of the esophagus (esophagectomy) in an operating room. The surgery is complicated and technically challenging because of the position of the esophagus as it travels from the neck through the chest and into the abdomen. After the esophagus is removed with the upper part of the stomach, it needs to be replaced. The rest of the stomach is pulled up through the diaphragm and reconnected to the remaining healthy esophagus. The stomach forms the new esophagus and the swallowing function is nearly the same. Surgery is generally reserved for patients with early stage disease, meaning that it has not yet spread oustide of the esophagus.

Click here to read a more comprehensive guide to surgery procedures.

Chemotherapy

Chemotherapy involves injecting chemicals into the bloodstream that will injure and potentially destroy the cancer cells. Chemotherapy plays an important part in the management of esophageal cancer. It is used in combination with radiation to increase the tumor killing effect of this form of treatment. It is also used to eliminate cancer cells that are outside the area treated with radiation to prevent spread of disease to other organs. In addition, chemotherapy is used to treat esophageal cancer that has spread to other organs and is not otherwise treatable with surgery or radiation.

Chemotherapy may be given prior to surgery, often with radiation, to decrease the extent of disease prior to an operation. This is called neoadjuvant chemotherapy. Chemotherapy may also be given after an operation, once again often with radiation, to decrease the risk of recurrence. This is called adjuvant chemotherapy.

Many different chemotherapy drugs are used to treat esophageal caner. The medical oncologist works closely with the surgeon and radiation oncologist to determine which combination is best for any individual. For optimal care, the treatment plan must be selected carefully for each person and may vary between individuals depending on disease status and presence of other health problems. In addition, many patients may be eligible to participate in clinical research trials that may allow access to novel treatment strategies.

There are potential side effects associated with chemotherapy for esophageal cancer. These can include nausea, fatigue, infection and hair loss, among others. Side effects vary among individuals and may differ depending on the drug combination used. Patients are monitored closely for side effects and appropriate measures are taken to decrease the severity of these symptoms.

Radiation therapy

External beam radiation therapy plays an integral part in the treatment of esophageal cancer. A linear accelerator is used to generate high energy x-rays that are targeted at the esophageal tumor area, with the goal being to damage the cancer cell's DNA, causing cancer cell death. Radiation treatment for esophageal cancer is often given with chemotherapy and can be delivered before surgery, after surgery, or without surgery, as indicated for each individual case. Radiation therapy alone can be very effective in managing the symptoms caused by recurrent esophageal cancer or esophageal cancer that has spread to different areas of the body (metastasis).

Radiation therapy treatments are usually administered five days per week and depending upon the technique used, may take ten to 30 minutes to deliver. Free and easily accessible parking is available steps away from the Radiation Oncology Department entrance. Daily treatments are painless, well-tolerated, do not require that patients be given intravenous medications and do not require an empty stomach, unlike other radiology procedures. Additional side effects will be explained to you by your radiation oncology physician and nurse team.
 

Virginia Piper Cancer Institute
Abbott Northwestern Hospital
800 East 28th Street, Minneapolis, MN 55407
612-863-4633

First published: 10/17/2005
Last updated: 10/17/2005

Reviewed by: Dr. Daniel Dunn, Marge Watry