This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

After the cancer is found and staged, your doctor will talk to you about a treatment plan. There is a lot for you to think about when choosing the best way to treat or manage your cancer. There may be more than one treatment to choose from. Give yourself time to absorb the information you have learned.

You may want to get a second opinion. A second opinion can give you more information and help you feel good about the treatment you choose. Some insurance companies require you to get a second opinion before they will agree to pay for treatments.

Surgery, chemotherapy, and radiation are used to treat early cancer of the esophagus. Other treatments may be used for early cancers and pre-cancers of the esophagus. There are also treatments to help relieve symptoms such as pain and blockage.

Surgery

How much surgery is done depends on the stage of the cancer. Surgery can also be used along with other treatments such as chemotherapy and radiation treatment.

Esophagectomy

Surgery to remove all or part of the esophagus is called an esophagectomy. Often a small amount of the stomach is removed, too. When the esophagus is removed as treatment for cancer, lymph nodes near the esophagus are also removed. The top of the esophagus is then reattached to the stomach, or the surgeon may replace the removed part of the esophagus with a piece of the small or large intestine.

While surgery can cure some patients whose cancer has not spread beyond the esophagus, often these cancers are not found early enough. So it's important to know whether the goal of surgery is it to try to cure the cancer or to ease symptoms.

Different methods of esophagectomy

There are several different ways to do surgery for esophagus cancer. All of these surgeries are complex. Surgeons who do this surgery must be experts. You should feel free to ask your surgeon about his or her experience with these operations and how many were successful. The success rate is higher when the surgery is done in a hospital where it is done often.

Open esophagectomy: The main cut (incision) is in either the chest or the belly (abdomen). Some methods involve incisions in the neck, chest, and abdomen. You and your surgeon should discuss in detail the operation planned for you and what you can expect. The surgeon may use pictures to describe how the operation will be done. No matter what approach is used, this is not a simple operation and it may require a long hospital stay.

Minimally invasive esophagectomy: Sometimes surgeons are able to do the operation using a laparoscopic approach. This means that small cuts are made through which the doctor uses tiny tools, something like a telescope, to look inside the body. The surgery itself is done through even smaller cuts.

In order to do this type of surgery well, the surgeon needs to be highly skilled and have a great deal of experience removing the esophagus this way. When successful, this surgery allows the patient to leave the hospital sooner and recover faster. This approach is used most often for early (small) cancers.

Risks and side effects

Like most serious operations, surgery of the esophagus has some risks. A heart attack or a blood clot in the lungs or the brain can happen during or after surgery. There may be a leak at the place where the stomach is reconnected to the esophagus. After surgery, the stomach may empty too slowly. This can, in a few cases, lead to frequent nausea and vomiting.

Infection is a risk with any surgery. And some patients have trouble swallowing after surgery. To relieve this symptom, these narrow places can be stretched during an upper endoscopy. After surgery, bile and stomach contents can enter the esophagus because the lower esophageal sphincter is often removed or changed by the surgery. This can cause symptoms such as heartburn. Sometimes antacids or other drugs can help relieve these symptoms.

Some complications from surgery can be very serious, even fatal. It is important to have a surgeon with experience and a hospital where these operations are done often. Don't be afraid to ask the surgeon about his or her experience and about the survival rates at the hospital.

Radiation therapy

Radiation therapy is treatment with high energy rays (such as x-rays) to kill cancer cells or shrink tumors. External radiation uses a beam from outside the body. This is the kind most often used for cancer of the esophagus. For internal or implant radiation, radioactive "seeds" are placed directly inside the tumor.

Radiation therapy by itself will not cure esophagus cancer. Often it is used along with surgery and/or chemotherapy. It is also used to relieve problems with swallowing, pain, or other symptoms of this cancer.

Side effects of radiation treatment may include:

• skin changes -- ranging from something like a sunburn to blistering and open sores
• nausea and vomiting
• diarrhea
• extreme tiredness (fatigue)
• painful sores in the mouth and throat

These side effects may be worse if chemo and radiation are given at the same time. And often these side effects go away when treatment ends. Radiation to the chest may cause lung damage and lead to trouble breathing and shortness of breath. If you have these or other side effects, talk with your doctor since there are often ways to relieve them.

Chemotherapy

Chemotherapy (often called simply "chemo) refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body.

Chemo by itself rarely cures esophageal cancer. Often it is combined with radiation or surgery.

Chemo is used in 3 ways:

• It can be used to ease the symptoms of advanced cancer.
• It can be given along with radiation to shrink the cancer.
• It can be used before surgery to shrink a tumor and make it easier to remove.

Chemo can have some side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. The most common side effects can include:

• nausea and vomiting
• loss of appetite
• hair loss
• mouth sores
• increased chance of infection (from a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (from a shortage of blood platelets)
• tiredness or shortness of breath (from a shortage of red blood cells)

Most side effects go away once treatment is over. Anyone who has problems with side effects should talk with their doctor or nurse as there are often ways to help.

People with esophageal cancer often have problems with weight loss before the cancer is even found. Treatment like chemo and radiation can cause painful sores in the mouth and throat, which can make it hard to eat and get good nutrition. Some people with esophagus cancer need to have a feeding tube put in before treatment. This allows liquid "food" to be put right into the intestine. A feeding tube can help prevent further weight loss. It may help make treatment easier to tolerate.

Other types of treatments

PDT (photodynamic therapy)

This method may be used when the cancer has been found very early or has come back after other treatment. 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 changes the chemical collected there into a new chemical that 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 reach only 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 redness or discoloration 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 6 weeks.

At this time, the main use of PDT is to relieve symptoms of advanced cancer that are blocking the esophagus. It is also being used to treat Barrett esophagus and very early cancers found in Barrett esophagus. Researchers are looking at the use of PDT in comparison to other treatments such as surgery or the use of lasers.

Laser ablation

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 help improve problems with swallowing.

Radiofrequency ablation (RFA)

In this method, a balloon is passed into an area of Barrett 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. Normal cells grow in to replace the Barrett cells. The patient needs to stay on drugs to block acid production after the procedure. Endoscopy (with biopsies) then is done to watch for any further changes in the lining of the esophagus.

Argon plasma coagulation

This is a method something like laser ablation. It is also used to unblock the esophagus when the patient has trouble swallowing.

Electrocoagulation

This method involves burning the tumor off with electric current. In some cases, this treatment can help relieve esophageal blockage.

Survival rates by stage

Because this cancer is usually found at an advanced stage, many people will die of the disease. But survival rates have been getting better. Talk with your cancer care team if you have questions about your own chances of a cure, or how long you might survive your cancer. They know your situation best.

The 5-year survival rate is the percentage of patients who are alive 5 years after diagnosis (leaving out those who die of other causes). Of course, patients might live more than 5 years after diagnosis.

These numbers describe the outcomes of patients whose cancer was found and treated several years ago (before 2000). Treatment and care has improved since that time, and people diagnosed today may have better outcomes.

Last Medical Review: 05/28/2009
Last Revised: 05/28/2009