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. You may feel that you need to make a decision quickly. But give yourself time to absorb the information you have learned. Talk to your doctor. Look at the list of questions at the end of this piece to get some ideas. Then add your own.

You may want to get a second opinion. A second opinion can provide 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. There are also treatments to help relieve pain and help with symptoms.

The best choice for you will depend on the stage of the cancer as well as your general health. Each kind of treatment might have side effects. Your cancer care team will be glad to discuss the side effects with you.

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.

There are 2 common types of operations for this cancer. In one, esophagectomy (ee-sof-uh-JEK-tuh-me), the part of the esophagus with cancer and nearby lymph nodes are removed. The esophagus is attached either to the stomach or the surgeon may replace the removed part of the esophagus with a piece of the small or large intestine.

The other surgery, esophagogastrectomy (ee-sof-uh-go-gas-TREK-tuh-me), is done to remove part of the lower esophagus, nearby lymph nodes, and the upper part of the stomach. The esophagus is again connected to the remaining part of the stomach.

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 the goal of surgery: is it to try to cure the cancer or to ease symptoms?

Both of these operations are complex. Some surgeons are able to do the operation using a laparoscopic approach. This means that small cuts are made through which the doctor uses a tiny instrument something like a telescope to look inside the body. The surgery itself is done through even smaller incisions.

Surgeons who do this surgery must be quite expert. You should feel free to ask your surgeon about his or her experience with these operations and what percent were successful. The success rate is greater when the surgery is done in a hospital where it is done more often.

Most people stay in the hospital for 2 weeks after surgery. And there can be risks and side effects. For example, after the operation the stomach may empty very slowly, causing nausea and vomiting. The place where the esophagus connects to the stomach can become more narrow, making it hard for the person to swallow. Also, acid from the stomach can enter the esophagus causing heartburn. Anyone who has problems with side effects should talk with their doctor or nurse as there are often ways to help.

Some complications from surgery can be very serious, even fatal. It is important to have a surgeon with experience in a hospital where these operations are done more 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 or shrink cancer cells. 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 body near the cancer.

Radiation therapy by itself will not cure esophageal cancer. Often it is combined 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 problems, upset stomach, diarrhea, and fatigue. 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 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.

Chemotherapy alone cannot cure cancer of the esophagus unless radiation treatment (and in some cases surgery) are also used. Chemotherapy 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. This use is still being studied.

Chemotherapy 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.

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 injected 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 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 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.

Survival Rates by Stage (from the National Cancer Data Base; based on 11,154 patients diagnosed in 1998)

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.

Stage	5-year relative survival rate
0	52%
I	41%
II	26%
III	13%
IV	3%

Revised: 11/17/2005