Treating cancer of the esophagus by stage

Most of the time, the initial treatment of esophagus cancer is based on its stage – how far it has spread in the body. But other factors, such as a person's overall health, may also affect treatment options. Talk to your doctor if you have any questions about the treatment plan he or she recommends.

Stage 0

A stage 0 tumor is not true cancer. It contains abnormal cells called high-grade dysplasia and is really a type of pre-cancer. The abnormal cells look like cancer cells, but they are only found in the inner layer of cells lining the esophagus (the epithelium). They have not grown into deeper layers of the esophagus. This stage is often diagnosed when a routine biopsy is done in someone with Barrett's esophagus.

Options for treatment may include endoscopic treatments such as photodynamic therapy, radiofrequency ablation, or endoscopic mucosal resection (EMR). Still, many doctors feel that surgery is the best treatment.

Stage I

In this stage the cancer has grown into some of the deeper layers of the esophagus (past the innermost layer of cells) but has not reached the lymph nodes or other organs.

T1 cancers:

Some very early stage I cancers that involve only a small area of the mucosa and haven't grown into the submucosa (T1a tumors) may be treated with EMR. This may be followed by some type of endoscopic procedure to destroy any remaining abnormal areas in the esophagus lining.

But most patients with T1 cancers who are healthy enough have surgery (esophagectomy) to remove the part of their esophagus that contains the cancer. Some doctors may recommend treatment with chemotherapy (chemo) and radiation therapy (chemoradiation) after surgery, especially if there are signs that all of the cancer may not have been removed.

T2 cancers:

For patients with cancers that have invaded the muscularis propia (T2 tumors), treatment with chemoradiation is often given before surgery. Surgery alone may be an option for smaller tumors (less than 2 cm). If the cancer is in the part of the esophagus near the stomach, chemo without radiation may be given before surgery. The targeted drug trastuzumab (Herceptin) may be given with chemo if the cancer is HER2 positive and no radiation is given.

If the cancer is in the upper part of the esophagus (in the neck), chemoradiation may be recommended as the main treatment instead of surgery. This may cure the cancer in some patients. Close follow-up with endoscopy is very important to look for possible signs of cancer returning.

Patients who cannot have surgery because they have other serious health problems may be treated with chemo, radiation therapy, or both together (chemoradiation).

Stage II

Stage II includes cancers that have grown into the main muscle layer of the esophagus or through the muscle layer and into the connective tissue on the outside of the esophagus. This stage also includes some cancers that have spread to 1 or 2 nearby lymph nodes.

For people who are healthy enough, treatment is most often chemoradiation followed by surgery. Patients with adenocarcinoma at the place where the stomach and esophagus meet (the gastroesophageal junction) are sometimes treated with chemo (without radiation) followed by surgery. The targeted drug trastuzumab may be given with chemo if the cancer is HER2 positive and no radiation is given. Surgery alone may be an option for small tumors (less than 2 cm).

If surgery is the initial treatment, chemoradiation may be recommended afterward, especially if the cancer is an adenocarcinoma or if there are signs that some cancer may have been left behind.

In some instances (especially for squamous cell cancers in the upper part of the esophagus), chemoradiation may be recommended as the main treatment instead of surgery. Patients who do not have surgery need close follow-up with endoscopy to look for possible signs of remaining cancer. Unfortunately, even when cancer cannot be seen, it can still be present below the inner lining of the esophagus, so close follow-up is very important.

Patients who cannot have surgery because they have other serious health problems are usually treated with chemoradiation.

Stage III

Stage III includes some cancers that have grown through the wall of the esophagus to the outer layer, as well as cancers that have grown into nearby organs or tissues. It also includes most cancers that have spread to nearby lymph nodes.

These cancers are treated much like stage II cancers.

For people who are healthy enough, the treatment most often used is chemoradiation followed by surgery. Patients with adenocarcinoma at the place where the stomach and esophagus meet (the gastroesophageal junction) are sometimes treated with chemo (without radiation) followed by surgery. The targeted drug trastuzumab may be given with chemo if the cancer is HER2 positive and no radiation is given. Surgery alone may be an option for small tumors (less than 2 cm).

If surgery is the initial treatment, chemoradiation may be recommended afterward, especially if the cancer is an adenocarcinoma or if there are signs that some cancer may have been left behind.

In some instances (especially for cancers in the upper part of the esophagus), chemoradiation may be recommended as the main treatment instead of surgery. Patients who do not have surgery need close follow-up with endoscopy to look for possible signs of remaining cancer. Unfortunately, even when cancer cannot be seen, it can still be present below the inner lining of the esophagus, so close follow-up is very important.

Patients who cannot have surgery because they have other serious health problems are usually treated with chemo and radiation therapy.

Stage IV

Stage IV esophageal cancer has spread to distant lymph nodes or to other distant organs.

In general, these cancers are very hard to get rid of completely, so surgery to try to cure the cancer is usually not a good option. Treatment is used mainly to help keep the cancer under control for as long as possible and to relieve any symptoms it is causing.

Chemo may be given to try to help patients feel better and live longer, but the benefit of giving chemo is not clear. Radiation therapy or other treatments may be used to help with pain or trouble swallowing. Some people prefer not to have treatments that have serious side effects and choose to receive only those treatments that will keep them comfortable and add to their quality of life. For more information on treatments that may be helpful, see the section, "Palliative therapy for cancer of the esophagus."