Endoscopic Treatments for Esophageal Cancer

Some types of treatment for esophageal (esophagus) cancer can be done by passing an endoscope (a long, flexible tube) down the throat and into the esophagus.

Some of these treatments may be used to try to cure very early-stage cancers, or even to prevent them from developing by treating Barrett’s esophagus or dysplasia.

Some treatments are used mainly to help relieve symptoms from more advanced esophageal cancers that can’t be removed completely with surgery.

Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD)

These treatments can be used for dysplasia (precancer) and some small, very early-stage esophageal cancers.

In these techniques, part of the inner lining of the esophagus is removed with instruments passed down the endoscope.

• Endoscopic mucosal resection (EMR) can be used to remove small areas of esophagus tissue.
• Endoscopic submucosal dissection (ESD) is used to remove larger abnormal areas. This is a more complex technique that takes longer to do, and not all doctors have experience with it.

After the abnormal tissue is removed, people typically take medicines called proton pump inhibitors to suppress acid production in the stomach. This can help keep the disease from returning.

Possible side effects of EMR and ESD

The most common side effect of these techniques is bleeding in the esophagus, which is usually not serious.

Less common but more serious side effects can include:

• Esophageal strictures (areas of narrowing) that might need to be treated with dilation
• Perforation (puncture) of the wall of the esophagus, which might require surgery to repair

Radiofrequency ablation (RFA)

This procedure can be used to treat dysplasia in areas of Barrett’s esophagus, and it may lower the chance of cancer developing in that area. It might also be used to help treat some very early-stage esophageal cancers, typically after EMR or ESD (see above).

A balloon containing many small electrodes is passed into the abnormal area of the esophagus through an endoscope. The balloon is then inflated so that the electrodes are in contact with the inner lining of the esophagus. Then an electrical current is passed through it, which kills the cells in the lining by heating them. Over time, normal cells will grow to replace the abnormal cells.

People getting this treatment need to stay on medicines to block stomach acid production after the procedure. Endoscopy (with biopsies) is then done regularly to watch for any further changes in the lining of the esophagus.

Possible side effects of RFA

Possible side effects of RFA include strictures (narrowing) or bleeding in the esophagus.

Photodynamic therapy (PDT)

PDT might sometimes be an option to treat Barrett’s esophagus, esophageal precancers (dysplasia), and some very early-stage esophageal cancers.

It might also be used to treat large cancers that are blocking the esophagus. In this situation, PDT is not meant to destroy all the cancer, but to kill enough of the cancer to improve a person’s ability to swallow.

For this technique, a light-activated drug called porfimer sodium (Photofrin) is injected into a vein. Over the next couple of days, the drug is more likely to collect in cancer (or precancer) cells than in normal cells.

A special type of laser light is then focused on the abnormal area through an endoscope. This light changes the drug into a new chemical that can kill the abnormal cells. The dead cells may then be removed a few days later during an upper endoscopy. This process can be repeated if needed.

An advantage of PDT is that it can kill cancer cells with very little harm to normal cells. But because the chemical must be activated by light, it can only kill cancer cells near the inner surface of the esophagus – those that can be reached by the light. While this can help for some very early-stage esophageal cancers, the light can’t reach cancers that have grown deeper into the esophagus wall.

People who’ve had this treatment need to have follow-up endoscopies to make sure the cancer isn’t growing back. They also need to stay on a drug called a proton pump inhibitor to limit stomach acid production.

Possible side effects of PDT

PDT can cause swelling in the esophagus for a few days, which may lead to problems swallowing. Strictures (narrowing of the esophagus) can also occur, which might need to be treated by dilation. Other possible side effects include bleeding or holes (perforations) in the esophagus.

Some of this drug also collects in normal cells in the body, such as skin and eye cells. This can make you very sensitive to sunlight or strong indoor lights. Too much exposure can cause serious skin reactions, so doctors typically recommend staying out of any strong light for 4 to 6 weeks after the injection.

For more on this technique, see Photodynamic Therapy.

Endoscopic cryotherapy

Cryotherapy, also known as cryoablation, is the use of extreme cold to freeze and destroy abnormal cells.

This type of treatment might be an option to treat Barrett’s esophagus, dysplasia, or very early esophageal cancer in some people. It might also be used to help relieve symptoms such as pain or trouble swallowing in people with more advanced esophageal cancer.

For this treatment, an endoscope is passed down into the esophagus, and very cold gases or liquids are passed down through the endoscope and sprayed onto the abnormal area to freeze and kill the cells.

The treatment might need to be repeated every few weeks if not all of the abnormal area is destroyed.

Possible side effects of endoscopic cryotherapy

This treatment can have some of the same side effects as other endoscopic treatments, such as trouble swallowing, bleeding, or strictures (narrowing) in the esophagus, although the risks might be lower than with other procedures.

Treatments to help keep the esophagus open

Along with some of the treatments above, other types of endoscopic treatments might be used to help keep the esophagus open.