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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 health and specific information about the cancer. When deciding which treatments to offer for esophageal cancer, your healthcare team will consider:

  • the stage of the cancer
  • where the tumour is in the esophagus (location)
  • the type of esophageal cancer
  • your overall health
  • your personal preferences

Before your healthcare team decides which treatments to offer you, they will look at your overall health to see what types of treatment you can handle. They will check your lungs and heart to make sure they are working properly.

People diagnosed with esophageal cancer often have difficulty eating. Your healthcare team will check your weight and how well you have been eating. You may need nutritional supplements, a feeding tube or intravenous feeding for a few days before and after surgery to gain weight and improve your nutrition and health. You may also need antibiotics to prevent or treat infections if poor nutrition has weakened your immune system.

If you are a smoker, it’s very important to quit smoking before starting treatment. Smokers have a higher risk for side effects and complications during treatment for esophageal cancer. Treatment may not work as well in smokers as it does in non-smokers.

You may be offered one or a combination of the following treatments for esophageal cancer.

Surgery

If you are healthy, and the tumour can be completely removed, you will be offered surgery to treat esophageal cancer.

Esophagectomy removes all or part of the esophagus, as well as nearby lymph nodes. Sometimes part of the stomach is also removed.

Chemotherapy and chemoradiation

Chemotherapy may be used to treat esophageal cancer. While it may be given alone, it is more often given during the same time period as radiation therapy (called chemoradiation). Some chemotherapy drugs make radiation therapy more effective.

Chemoradiation may be given:

  • before surgery (neoadjuvant chemotherapy)
  • after surgery (adjuvant chemotherapy)

Chemotherapy may be used alone:

  • as the main (primary) treatment if you aren’t healthy enough to have surgery, or if you don’t want to have surgery or chemoradiation
  • to treat recurrent or advanced esophageal cancer that can’t be treated with surgery or radiation therapy

Radiation therapy

Radiation therapy may be used to treat esophageal cancer. It is usually given during the same time period as chemotherapy (chemoradiation).

Radiation therapy may be given alone to treat esophageal cancer if you aren’t healthy enough to have, or don’t want to have, surgery or chemoradiation.

It may also be used alone to treat the symptoms of advanced esophageal cancer, or to treat esophageal cancer that has come back (recurred) after treatment.

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.

Targeted therapy drugs are used to treat locally advanced or metastatic adenocarcinoma tumours found at the gastroesophageal (GE) junction. They are usually combined with chemotherapy.

Endoscopic treatments

Endoscopic treatments are done using an endoscope (a thin, tube-like instrument with a light and lens) placed in the esophagus. You may be offered endoscopic treatments to relieve the symptoms of advanced esophageal cancer, such as difficulty swallowing. Some endoscopic treatments may also be used to treat precancerous conditions and early stage cancers in the esophagus.

The types of endoscopic treatments used for esophageal cancer are:

  • endoscopic mucosal resection (EMR)
  • endoscopic submucosal dissection (ESD)
  • radiofrequency ablation (RFA)
  • laser surgery
  • electrocoagulation or argon plasma coagulation
  • photodynamic therapy (PDT)

An endoscope may also be used to:

  • put stent into the esophagus to help keep it open
  • widen, or dilate, the esophagus where it is blocked
  • place a feeding tube

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Follow-up care

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.

Clinical trials

Talk to your doctor about clinical trials open to people with esophageal cancer in Canada. Clinical trials look at new 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.


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