Other treatments for cancer of the esophagus
Other types of treatment can also be used to help treat cancer of the esophagus. Many of these treatments are done by passing an endoscope (a long, flexible tube) down the throat and into the esophagus. Some of these can be used to try to cure or even prevent very early-stage cancers. Others are used mainly to help relieve symptoms from more advanced cancers that can’t be removed.
Endoscopic mucosal resection (EMR)
In EMR, the doctor removes part of the inner lining of the esophagus using instruments passed down the endoscope. EMR can be used for dysplasia (pre-cancer or cell changes that have not yet become cancer) and some small, very early-stage cancers of the esophagus. After the abnormal tissue is removed, the patient will be given drugs to reduce stomach acid. This can help keep the disease from coming back.
The most common side effect of EMR is bleeding in the esophagus, which is usually not serious. Less often it might cause narrowing or holes in the esophagus.
Radiofrequency ablation (RFA)
RFA may be used to treat areas of abnormal cells (called dysplasia) in Barrett’s esophagus. A balloon with many small electrodes is passed into an area of Barrett’s esophagus. It is inflated so that the surface of the balloon is in contact with the inner lining. Then high-power energy is passed through the balloon to kill the cells in the lining by heating them. Over time, normal cells grow in to replace the Barrett’s cells.
The patient will need to stay on drugs to block the stomach from making too much acid after the treatment. Endoscopies (with biopsies) are then done to watch for any further changes in the lining of the esophagus.
Photodynamic therapy (PDT)
This method may be used to treat Barrett’s esophagus, esophageal pre-cancers (dysplasia), and some very early stage cancers.
PDT is also often used to treat large cancers that are blocking the esophagus. Here, PDT is not meant to destroy all of the cancer, but to kill enough of the cancer to help a person swallow.
First, a harmless chemical is put into the bloodstream. It collects in the tumor for a few days. Then a special type of laser light is focused on the cancer through an endoscope. The light “turns on” the chemical in the tumor so that it can kill cancer cells.
PDT is useful because it can kill cancer cells with very little harm to normal cells. But because the light must be used, it can only reach cancers near the surface of the esophagus. It doesn’t work for cancers that have spread deeper or into other organs.
Side effects of PDT include swelling in the esophagus for a few days, which may lead to some problems swallowing. Some patients also develop scar tissue that narrows the esophagus. Other side effects could include bleeding or holes in the esophagus. PDT can also cause redness of the skin and sensitivity to the sun or other light sources. Because of this, people having this treatment may be told to stay indoors for about 4 to 6 weeks.
People getting this treatment need to have follow-up endoscopies to make sure the cancer hasn’t grown back. They also need to stay on drugs to stop the stomach from making too much acid.
To find out more, see Photodynamic Therapy.
This method uses a laser that is aimed through the endoscope to kill cancer cells. It is used to open up the esophagus when it is blocked. This can make swallowing problems better. The cancer often grows back, so the treatment may need to be done again every month or two.
Argon plasma coagulation
This method is something like laser ablation, but it uses argon gas to burn the tumor. It is used to unblock the esophagus when the patient has trouble swallowing.
This treatment burns the tumor off with electric current. In some cases, it can help relieve esophageal blockage.
This procedure is used to stretch out an area of the esophagus that is narrowed or blocked to help a person swallow.
A small balloon-like device or a device shaped like a cylinder is passed down the throat and pushed through the narrowed area to stretch it out. This can be repeated if needed. Before the procedure, your doctor might give you a sedative to help you relax and may spray your throat to numb it.
There is a small risk of bleeding or tearing a hole in the esophagus with this procedure, which could require surgery or other treatments to fix. The esophagus typically stays open only a few weeks after dilation, so this is often followed by other treatments (such as placing a stent) to help keep the esophagus open.
A stent is a small tube that helps hold the esophagus open. Most often stents are made out of metal, but they can also be made out of plastic. Using endoscopy, a stent can be placed into the esophagus across the length of the tumor.
The success of the stent depends on the type of stent that is used and where it is placed. Stents will relieve trouble swallowing in most patients. They are often used after some of the other treatments above to help keep the esophagus open.
Last Medical Review: 05/21/2014
Last Revised: 02/04/2016