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Esophageal cancer

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Treatments for stage IV esophageal cancer

The following are treatment options for stage IV 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 stent or feeding tube to make sure you get enough nutrition during treatment.

Treatment for stage IV esophageal cancer involves palliative therapy to relieve symptoms. The main goals of palliative therapy are to improve your quality of life.

Radiation therapy

You may be offered radiation therapy to relieve symptoms of stage IV esophageal cancer, such as pain and difficulty swallowing. You may also be given radiation therapy to treat cancer that has spread to other parts of the body (called metastases). External beam radiation therapy or brachytherapy (internal radiation therapy) may be used.

Endoscopic treatments

You may be offered endoscopic treatments to relieve the symptoms of stage IV esophageal cancer, such as difficulty swallowing.

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.

Chemotherapy

You may be offered chemotherapy to relieve pain or to control symptoms of stage IV esophageal cancer. Adenocarcinoma of the esophagus responds better to chemotherapy than squamous cell carcinoma (SCC).

The most common chemotherapy combinations used to treat stage IV esophageal cancer are:

  • DCF – docetaxel (Taxotere), cisplatin (Platinol AQ)  and 5-fluorouracil (Adrucil, 5-FU)
  • ECF – epirubicin (Pharmorubicin), cisplatin and 5-fluorouracil
  • epirubicin, oxaliplatin (Eloxatin) and 5-fluorouracil
  • ECX – epirubicin, cisplatin and capecitabine (Xeloda)
  • EOX – epirubicin, oxaliplatin (Eloxatin) and capecitabine
  • cisplatin and 5-fluorouracil
  • cisplatin, 5-fluorouracil and leucovorin (folinic acid)
  • cisplatin and capecitabine

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 stage IV adenocarcinoma of the esophagus that is HER2 positive (which means it overexpresses, or makes too much, HER2 protein).

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 again 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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