Treatments for esophageal cancer
If you have esophageal cancer, your healthcare team will create a treatment plan just for you. It will be based on your personal needs and may include a combination of different treatments. When deciding which treatments to offer for esophageal cancer, your healthcare team will consider:
- the stage of the cancer
- the location of the tumour
- the type of esophageal cancer
- your overall health
- your ability to tolerate major surgery, chemotherapy or radiation therapy
- your personal preferences
Your healthcare team may include a number of doctors who specialize in:
- treating cancer with surgery (called a surgical oncologist)
- treating cancer with drugs (called a medical oncologist)
- the digestive system (called a gastroenterologist)
- treating cancer with radiation therapy (called a radiation oncologist)
A dietitian is another important member of your healthcare team. Esophageal cancer can make it difficult to swallow, so you may not eat enough and you may lose weight. Before you start treatment, a dietitian will do a nutritional assessment to see how esophageal cancer has affected your nutrition. If you aren’t getting enough nutrition, you may need to have a stent or feeding tube placed before you receive chemotherapy and radiation therapy. This is to make sure you get enough nutrition to maintain your weight and strength during treatment.
If you are a smoker, your healthcare team will talk to you about how they can help you quit. Smoking can limit how well your cancer treatment works, so it is important to quit before you start treatment.
You may be offered the following treatments for esophageal cancer. Your treatment plan may include a combination of different treatments.
Depending on the stage and size of the tumour, and where it is in the esophagus, you may be offered surgery.
Esophagectomy is the most common surgery used to treat esophageal cancer. It removes part or all of the esophagus, as well as nearby lymph nodes. Sometimes part of the stomach is also removed.
Radiation therapy may be used to treat esophageal cancer. It is usually given together with chemotherapy (chemoradiation).
Radiation therapy may be used on its own as the primary treatment for esophageal cancer if you are not healthy enough to have, or choose not to have, surgery or chemoradiation.
Radiation therapy may also be used to treat symptoms of advanced cancer. This is called palliative radiation therapy.
Chemotherapy may be used to treat esophageal cancer. It may be given alone or as part of chemoradiation.
Chemotherapy may be given before surgery (called neoaduvant chemotherapy). It may also be used after surgery (called adjuvant chemotherapy).
Chemotherapy may be used alone to treat recurrent esophageal cancer that can’t be removed by surgery or that has already been treated with radiation therapy.
Chemotherapy may be used alone as the primary treatment if you are not healthy enough to have, or choose not to have, surgery or chemoradiation.
Chemotherapy may also be used alone to treat symptoms of advanced esophageal cancer. This is called palliative chemotherapy.
Chemoradiation is 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.
Chemoradiation may be given before surgery to treat esophageal cancer (called neoadjuvant chemoradiation). In some cases, chemoradiation may be offered as an alternative to treatment with surgery. Chemoradiation may also be used after surgery (called adjuvant chemoradiation) for adenocarcinoma that has spread to the lymph nodes.
Targeted therapy uses drugs or other substances to target specific molecules (usually proteins) involved in cancer cell growth while limiting harm to normal cells. Targeted therapy is sometimes used to treat esophageal cancer. The most common targeted therapy drug used to treat pancreatic cancer is trastuzumab (Herceptin).
Endoscopic treatments are done using an endoscope placed in the esophagus. You may be offered endoscopic treatments to relieve the symptoms of advanced esophageal cancer, such as difficulty swallowing. This is called palliative therapy. Some endoscopic treatments may also be used to treat precancerous conditions and early stage cancers in the esophagus.
Endoscopic mucosal resection (EMR) is used to treat precancerous conditions of the esophagus. It is sometimes used to treat early stage cancers in the esophagus. During EMR, the doctor injects a liquid or uses suction to first lift a tumour away from the submucosa and then removes it.
Photodynamic therapy (PDT) uses drugs that make cells sensitive to light (called photosensitizers) to destroy cancer cells. PDT may be used to treat precancerous conditions and early stage cancers in the esophagus. It may also be used to treat symptoms of advanced esophageal cancer (called palliative PDT).
Laser surgery uses an intense, narrow beam of light to destroy cancer cells. It may be used to treat symptoms of advanced cancer.
Radiofrequency ablation (RFA) is a procedure that uses a high-frequency electrical current to destroy cancer cells. RFA may be used to treat precancerous conditions of the esophagus. It is also offered as an alternative to surgery for stage 0 esophageal cancers. RFA may also be used to treat symptoms of advanced esophageal cancer (called palliative RFA).
Electrocoagulation or argon plasma coagulation uses an electrical current to destroy cancer cells. These treatments may be used to treat precancerous conditions of the esophagus. They may also be used to treat symptoms of advanced esophageal cancer (called palliative therapy).
Esophageal dilation may be done to open up an area of narrowing, or stricture, in the esophagus caused by cancer.
An esophageal stent is a tube placed in the esophagus to keep it open.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 2 years after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment.
Some clinical trials in Canada are open to people with esophageal cancer. Clinical trials look at new and better ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.