Esophageal cancer

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Research in esophageal cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help prevent, find and treat esophageal cancer. They are also looking for ways to improve the quality of life of people with esophageal cancer.

The following is a selection of research showing promise for esophageal cancer. We’ve included information from PubMed, which is the research database of the National Library of Medicine. Each research article in PubMed has an identity number (called a PMID) that links to a brief overview (called an abstract).

Preventing esophageal cancer

Some substances or behaviours may prevent esophageal cancer or lower your risk of developing it. The following is noteworthy research into ways to prevent esophageal cancer or lower your risk.

Statins and nonsteroidal anti-inflammatory drugs (NSAIDs) may lower the risk for Barrett’s esophagus and esophageal cancer. Statins are drugs used to lower cholesterol, and NSAIDs lower inflammation. Some studies found that people who use statins or NSAIDs have a lower risk for Barrett’s esophagus. These studies also found that people with Barrett’s esophagus who took statins or NSAIDs (including aspirin) had a lower risk of developing esophageal cancer (Gastroenterology, PMID 26208896; Digestive Diseases and Sciences, PMID 26386857, PMID 25213077, PMID 25680872; BMJ Open, PMID 25633286; Current Opinion in Gastroenterology, PMID 27276368). More research is needed to understand the role that statins and NSAIDs may play in protecting against esophageal cancer before either drug is recommended as a way to lower risk.

Find out more about research in cancer prevention.

Diagnosis and prognosis

A key area of research looks at better ways to diagnose and stage esophageal cancer. Researchers are also trying to find ways to help doctors predict a prognosis (the probability that the cancer can be successfully treated or that it will come back after treatment). The following is noteworthy research into diagnosis and prognosis.

Biomarkers are substances, such as proteins, genes or pieces of genetic material like DNA and RNA, that are found naturally in the body. They can be measured in body fluids like blood and urine or tissue that has been removed from the body. A gene mutation or a change in the normal amount of a biomarker can mean that a person has a certain type of cancer. If your doctor thinks you might have esophageal cancer, biomarker tests that look for these changes may help confirm the diagnosis. Biomarker tests can also help doctors predict the prognosis or response to treatment in people with esophageal cancer. Researchers are looking at the following biomarkers to see if they can help doctors diagnose, predict a prognosis for and find out which treatments will benefit a person with esophageal cancer:

Lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) may help doctors predict survival in people who are going to have surgery to remove part or all of the esophagus (called esophagectomy) to treat esophageal cancer. Lymphocytes, monocytes and neutrophils are types of white blood cells. People with a low LMR before surgery seem to have a worse prognosis than people with a high LMR before surgery (BMC Surgery, PMID 27650456; European Journal of Surgical Oncology, PMID 28034501). People with a high NLR before surgery seemed to have a worse prognosis than people with a low NLR before surgery (Annals of Surgical Oncology, PMID 26416715; Surgery Today, PMID 26036223).

Find out more about research in diagnosis and prognosis.

Treatment

Researchers are looking for new ways to improve treatment for esophageal cancer. Advances in cancer treatment and new ways to manage the side effects from treatment have improved the outlook and quality of life for many people with cancer. The following is noteworthy research into treatment for esophageal cancer.

Endoscopic surgery

Researchers are looking for better ways of using surgery and endoscopy to treat esophageal cancer. Endoscopic procedures use an endoscope (a thin, tube-like instrument with a light and lens) to view structures inside the body and to remove tissues.

Endoscopic mucosal resection (EMR) is a surgical procedure that uses an endoscope to remove a small part of the inner layer of the esophagus or another part of the digestive tract. EMR is an alternative to esophagectomy for people with Barrett’s esophagus and small, early cancers that are only in the mucosal layer and have not spread to the underlying layers of the esophagus (Medicine, PMID 28767573; Canadian Journal of Surgery, PMID 28338468).

 

Submucosal tunneling endoscopic resection (STER) is a surgical procedure that removes a small part of the second innermost layer of the esophagus (called the submucosa), as well as the innermost layer of the esophagus (called the mucosa). Researchers are studying STER as a treatment for large tumours in the submucosa of the esophagus and the esophagogastric junction (Journal of the American College of Surgeons, PMID 28923691; Annals of Surgery, PMID 28059965).

Endoscopic spray cryotherapy uses an endoscope to apply liquid nitrogen to a cancerous area of the esophagus. The liquid nitrogen is extremely cold, so it freezes and destroys the cells in the area. Researchers are studying endoscopic spray cryotherapy to treat Barrett’s esophagus (Diseases of the Esophagus, PMID 25708903; Current Gastroenterology Reports, PMID 28819902).

Robot-assisted esophagectomy may be used to treat people with esophageal cancer. During this laparoscopic procedure, the surgeon sits near the operating table and controls robotic arms that perform the operation through several small cuts (incisions) in the chest. Robot-assisted surgery appears to be safe and is less invasive than standard surgery (Diseases of the Esophagus, PMID 25809390, PMID 25487303, PMID 25716873, PMID 27149640; Annals of Thoracic Surgery, PMID 27938889; Journal of Gastrointestinal Oncology, PMID 27034787). More research is needed before robot-assisted surgery can become a standard treatment option for esophageal cancer. Robotic surgery requires special equipment that is very expensive, so it may not be available at all hospitals even if it does become an accepted treatment for esophageal cancer.

Find out more about research in cancer surgery.

Radiation therapy

Researchers are looking for better ways of using radiation therapy to treat esophageal cancer.

Intensity-modulated radiation therapy (IMRT) is a specialized form of radiation therapy. IMRT gives external beam radiation in a targeted way using computers to vary the shape of the radiation field and the intensity of the dose delivered. This technique maximizes radiation to the tumour and minimizes the amount of radiation that normal tissue is exposed to. Researchers are studying chemoradiation using IMRT in people with esophageal cancer (Cancer, PMID 26716915; Radiation Oncology, PMID 26852238; British Journal of Radiology, PMID 26891913; Medicine, PMID 29245275).

Proton beam radiation therapy uses proton beams instead of x-ray beams to destroy cancerous tissue. X-ray beams release energy before and after they hit their target. Proton beams are different because they release most of their energy after travelling a certain distance. As a result, proton beams cause very little damage to tissues that they pass through and more radiation can be delivered to the tumour. Researchers are studying chemoradiation using proton beam radiation therapy in people with esophageal cancer (International Journal of Radiation Oncology, Biology, Physics, PMID 27084662, PMID 26847847; Cancer Medicine, PMID 26806272). The machines needed to make protons are expensive and this type of radiation therapy may not be available at all treatment centres.

Find out more about research in radiation therapy.

Chemotherapy

Chemotherapy is often used as part of chemoradiation to treat esophageal cancer. It may also be used on its own. The following chemotherapy drugs are showing promise in treating esophageal cancer:

Find out more about research in chemotherapy.

Targeted therapy

Targeted therapy drugs target specific molecules (usually proteins) that cause cancer cells to grow. The following targeted therapy drugs are showing promise in treating esophageal cancer:

Find out more about research in targeted therapy.

Supportive care

Living with cancer can be challenging in many different ways. Supportive care can help people cope with cancer, its treatment and possible side effects. The following is noteworthy research into supportive care for esophageal cancer.

Difficulty swallowing (called dysphagia) is a common problem for people with advanced esophageal cancer. Doctors use a number of endoscopic treatments to relieve it. Researchers are comparing the current methods used and looking for better ways to treat difficulty swallowing. Other studies found that oral steroids and endoscopic steroid injection can help prevent narrowing (stricture) of the esophagus (Surgical Endoscopy, PMID 26123341; Digestive Endoscopy, PMID 28803459; Clinical and Translational Gastroenterology, PMID 28230852).

Learn more about cancer research

Researchers continue to try to find out more about esophageal cancer. Clinical trials are research studies that test new ways to prevent, detect, treat or manage esophageal cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for esophageal cancer were first shown to be effective through clinical trials.

Find out more about cancer research and clinical trials.

chemoradiation

Treatment that combines chemotherapy with radiation therapy. Chemotherapy is given during the same time period as radiation therapy. Some types of chemotherapy make radiation therapy more effective.

Also called chemoradiotherapy.

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