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Esophageal cancer

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Treatments for recurrent esophageal cancer

The following are treatment options for recurrent esophageal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. They will usually do a nutritional assessment before treatment starts. You may need a feeding tube to make sure you get enough nutrition during treatment.

The types of treatment offered will depend on where the cancer comes back, if it has spread (metastasized) to distant sites and what treatments you’ve already had.

Surgery

You may be offered surgery to treat cancer that comes back in the esophagus after endoscopic mucosal resection (EMR) or photodynamic therapy (PDT). The most common surgery used is esophagectomy, which removes the esophagus, nearby lymph nodes and part of the stomach.

Chemoradiation

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.

You may be offered chemoradiation if esophageal cancer comes back after surgery, and it comes back near where the original tumour started. Chemoradiation is offered if you haven’t already had radiation therapy.

The most common chemotherapy drugs used in chemoradiation for recurrent esophageal cancer are:

  • cisplatin (Platinol AQ) and 5-fluorouracil (Adrucil, 5-FU)
  • cisplatin and capecitabine (Xeloda)
  • oxaliplatin (Eloxatin) and 5-fluorouracil
  • oxaliplatin and capecitabine
  • paclitaxel (Taxol) and carboplatin (Paraplatin, Paraplatin AQ)

Other combinations of drugs that may be used include:

  • paclitaxel and cisplatin
  • docetaxel (Taxotere) and cisplatin
  • irinotecan (Camptosar) and cisplatin
  • paclitaxel and 5-fluorouracil
  • paclitaxel and capecitabine
  • docetaxel and 5-fluorouracil
  • docetaxel and capecitabine

Chemotherapy

You may be offered chemotherapy alone for recurrent esophageal cancer that comes back after surgery. Chemotherapy is offered if you have already had radiation therapy, or if you can’t have chemoradiation or more surgery.

Chemotherapy is also used to treat esophageal cancer that recurs in a distant part of the body (called metastatic esophageal cancer).

The most common chemotherapy drugs used to treat recurrent esophageal cancer are:

  • cisplatin and 5-fluorouracil
  • ECF – epirubicin (Pharmorubicin), cisplatin and 5-fluorouracil
  • ECX – epirubicin, cisplatin and capecitabine
  • EOX – epirubicin, oxaliplatin and capecitabine
  • DCF – docetaxel, cisplatin and 5-fluorouracil
  • 5-fluouracil and irinotecan

Radiation therapy

You may be offered radiation therapy alone to relieve symptoms of recurrent esophageal cancer, such as pain and difficulty swallowing. This is called palliative radiation therapy. External beam radiation therapy or brachytherapy (internal radiation therapy) may be used.

Endoscopic treatments

You may be offered endoscopic treatments for recurrent esophageal cancer. Endoscopic treatments are used to relieve the symptoms of advanced esophageal cancer, such as difficulty swallowing. This is 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.

Laser surgery uses an intense, narrow beam of light to destroy cancer cells.

Photodynamic therapy (PDT) uses drugs that make cells sensitive to light (called photosensitizers) to destroy cancer cells.

Radiofrequency ablation (RFA) is a procedure that uses a high-frequency electrical current to destroy cancer cells.

Electrocoagulation or argon plasma coagulation uses an electrical current to destroy cancer cells.

Targeted therapy

Targeted therapy uses drugs or other substances to target specific molecules (usually proteins) involved in cancer cell growth while limiting harm to normal cells.

You may be offered targeted therapy if you have recurrent adenocarcinoma of the esophagus that is HER2 positive (which means it overexpresses, or makes too much, HER2 protein) and you aren’t having radiation therapy. The targeted therapy drug used is trastuzumab (Herceptin).

Trastuzumab is given along with chemotherapy. The most common chemotherapy drugs used with trastuzumab are:

  • cisplatin and 5-fluorouracil
  • cisplatin and capecitabine

Trastuzumab may be continued alone after chemotherapy is completed. It is given until the cancer starts to grow or spreads.

Clinical trials

You may be asked if you want to join a clinical trial for esophageal cancer. Find out more about clinical trials.

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