Esophageal cancer

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Treatments for stage 2 or stage 3 esophageal cancer

The following are treatment options for stage 2 or stage 3 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 begins. You may need a feeding tube to make sure you get enough nutrition during treatment.

You may be offered one or more of the following treatments.

Surgery

Surgery is the primary treatment for stage 2 or stage 3 esophageal cancer. The most common surgery used is esophagectomy, which removes the esophagus and nearby lymph nodes. Sometimes part of the stomach is also removed.

Chemoradiation is usually given before surgery. This is called neoadjuvant chemoradiation.

Surgery may be used alone to treat esophageal tumours that are smaller than 2 cm. If surgery is the first treatment, chemoradiation may be given after surgery. This is called adjuvant chemoradiation.

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.

Chemoradiation is usually given before surgery for stage 2 or stage 3 esophageal cancer. This is called neoadjuvant chemoradiation.

Chemoradiation may be used as the primary treatment for stage 2 or stage 3 cancer in the part of the esophagus that is in the neck or upper part of the esophagus. It may be the primary treatment for squamous cell carcinomas. You may also be offered chemoradiation as the primary treatment if you are not healthy enough to have, or choose not to have, surgery. If chemoradiation is used as the primary treatment, your healthcare team will do close follow-up by using an endoscope to check that the cancer has not come back.

The most common chemotherapy combinations used for either neoadjuvant or primary chemoradiation are:

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

Chemoradiation may be given after surgery (called adjuvant chemoradiation) for adenocarcinoma that has spread to lymph nodes. It may also be used to kill any cancer cells left behind after surgery.

The most common chemotherapy drugs used for adjuvant chemoradiation are:

  • 5-fluorouracil and leucovorin (folinic acid)
  • 5-fluorouracil
  • capecitabine

Chemotherapy

You may be offered chemotherapy before and after surgery for adenocarcinoma of the lower part of the esophagus if the cancer is resectable (can be removed with surgery). You may also be offered chemotherapy alone as the primary treatment for stage 2 or stage 3 esophageal cancer if you are not healthy enough to have, or choose not to have, surgery or chemoradiation.

The most common combinations used in chemotherapy for stage 2 or stage 3 esophageal cancer are:

  • ECF – epirubicin (Pharmorubicin), cisplatin and 5-fluorouracil
  • ECX – epirubicin, cisplatin and capecitabine
  • epirubicin, oxaliplatin (Eloxatin) and 5-fluorouracil
  • epirubicin, oxaliplatin and capecitabine

Radiation therapy

You may be offered radiation therapy alone as the primary treatment if the tumour is in the upper third of the esophagus. It may also be offered as the primary treatment if you are not healthy enough to have, or choose not to have, surgery or chemoradiation.

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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