Esophageal cancer

You are here: 

Treatments for stage 4 esophageal cancer

The following are treatment options for stage 4 esophageal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Treatment for stage 4 esophageal cancer focuses on relieving symptoms, such as difficulty swallowing and pain, and improving your quality of life.

Endoscopic treatments

Endoscopic treatments for stage 4 esophageal cancer are offered to relieve pain or remove a blockage. You may be offered the following endoscopic treatments.

  • radiofrequency ablation (RFA)
  • laser surgery
  • photodynamic therapy (PDT)
  • esophageal dilation
  • esophageal stent
  • electrocoagulation or argon plasma coagulation (may not be available in all Canadian treatment centres)
  • placement of a feeding tube

Chemotherapy and chemoradiation

Chemotherapy is sometimes offered for stage 4 esophageal cancer. Adenocarcinoma tumours of the esophagus respond better to chemotherapy than squamous cell carcinoma (SCC) tumours.

Chemoradiation is chemotherapy combined with radiation therapy. The 2 treatments are given during the same time period. It may be used before surgery for stage 4 esophageal cancer. Unfortunately, surgery is not usually an option at this stage.

The most common chemotherapy drug combinations used to treat stage 4 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

Targeted therapy drugs may be used to treat stage 4 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.

Radiation therapy

Radiation therapy may be offered to shrink stage 4 esophageal cancer to help with swallowing and relive pain.

External radiation therapy directs radiation at the tumour from a machine outside of the body. It may be offered either alone or as part of chemoradiation.

Intraluminal brachytherapy uses a radioactive implant placed into the esophagus near the tumour.

Surgery

Esophagectomy is surgery to remove all or part of the esophagus, as well as lymph nodes around it. In rare cases it may be offered for some people with stage 4A esophageal cancer, if the cancer has spread only to the nearby lymph nodes.

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.

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.


monoclonal antibody

A substance that can find and bind to a particular target molecule (antigen) on a cancer cell.

Monoclonal antibodies can interfere with a cell’s function or can be used to carry drugs, toxins or radioactive material directly to a tumour.

Stories

A teenaged girl sitting on her bed I was in total shock when I heard the diagnosis of cancer. Cancer to me was an adult’s disease. Being a 13-year-old teenager, it certainly wasn’t even on my radar.

Read Sabrina's story

How can you stop cancer before it starts?

It's My Life! icon

Discover how 16 factors affect your cancer risk and how you can take action with our interactive tool – It’s My Life! Presented in partnership with Desjardins.

Learn more