Treatments for stage 3 esophageal cancer

The following are treatment options for stage 3 esophageal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

You may have a feeding tube put in, so that you can gain weight and maintain good nutrition during treatment.

Chemotherapy is usually combined with radiation therapy to treat stage 3 esophageal cancer. This is called chemoradiation. The 2 treatments are given during the same time period.

Chemoradiation may be offered for stage 3 esophageal cancer:

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

People with stage 3 esophageal cancer that aren't healthy enough to have surgery, or don't want to have surgery, may be offered chemoradiation as the main treatment.

Chemotherapy may also be offered without radiation therapy before surgery for stage 3 esophageal tumours.

The most common chemotherapy drugs used to treat stage 3 esophageal cancer are:

• capecitabine (Xeloda)
• cisplatin and capecitabine
• cisplatin and etoposide (Vepesid)
• cisplatin and fluorouracil
• cisplatin and irinotecan
• carboplatin and fluorouracil
• carboplatin and irinotecan
• carboplatin and paclitaxel
• epirubicin, carboplatin and fluorouracil
• epirubicin, carboplatin and capecitabine
• epirubicin, cisplatin and capecitabine
• epirubicin, cisplatin and fluorouracil
• fluorouracil and leucovorin
• docetaxel (Taxotere), oxaliplatin, fluorouracil and leucovorin
• oxaliplatin, fluorouracil and leucovorin
• oxaliplatin and capecitabine

Targeted therapy drugs may be used to treat stage 3 adenocarcinoma tumours at the gastroesophageal (GE) junction. They are usually combined with chemotherapy.

Trastuzumab is used with chemotherapy drugs to treat HER2-positive tumours. The most common combinations are:

• trastuzumab, cisplatin and fluorouracil
• trastuzumab, cisplatin and capecitabine

Ramucirumab (Cyramza) is a monoclonal antibody that stops cells from using a substance called vascular endothelial growth factor (VEGF), which helps cells form new blood vessels. Without new blood vessels the cells don't get the oxygen and nutrients that they need to grow. Ramucirumab is given in combination with paclitaxel.

Immunotherapy may be used for stage 3 esophageal cancer.

Pembrolizumab (Keytruda) may be offered in combination with cisplatin and fluorouracil as the first treatment for:

• squamous cell carcinoma of the esophagus
• HER-2 negative adenocarcinoma tumours found at the gastroesophageal (GE) junction

Pembrolizumab can also be used as a first treatment in combination with cisplatin, fluorouracil and trastuzumab for HER-2 positive adenocarcinoma tumours found at the gastroesophageal junction.

Nivolumab (Opdivo) may be offered:

• if there is cancer left after neoadjuvant therapy with chemoradiation and surgery
• in combination with either cisplatin and fluorouracil or carboplatin and fluorouracil for tumours at the gastroesophageal (GE) junction or adenocarcinoma tumours

Ipilimumab (Yervoy) may be offered in combination with nivolumab to treat squamous cell carcinoma tumours of the esophagus.

Esophagectomy is surgery to remove all or part of the esophagus and lymph nodes around it. Part of the stomach may be removed as well. Before you are offered surgery, your healthcare team will do tests to make sure that you are healthy enough to have it done.

Esophagectomy is the type of surgery offered for stage 3 esophageal cancer when the person is healthy enough to have surgery. You may be offered surgery after chemoradiation.

External radiation therapy is the most common type of radiation therapy used to treat esophageal cancer.

Radiation therapy is combined with chemotherapy to treat stage 3 esophageal cancer. This is called chemoradiation. The 2 treatments are given during the same time period. Chemotherapy can make radiation therapy more effective in treating esophageal cancer.

Chemoradiation may be offered for stage 3 esophageal cancer:

• before surgery (neoadjuvant therapy)
• by itself as the main treatment

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.