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Esophageal cancer treatments

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

At Cancer Treatment Centers of America® (CTCA), our esophageal cancer program offers radiation, surgery, chemotherapy and a number of other treatment options. Which would be appropriate for you depends on several factors, including the stage and extent of your disease. Your multidisciplinary team of esophageal cancer experts will answer your questions and recommend treatment options based on your unique diagnosis and needs.

The following types of doctors may be a part of your multidisciplinary team for esophageal cancer:

  • Surgical oncologist, who uses surgery to treat cancer
  • Medical oncologist, who uses drug therapies (chemotherapy, targeted therapy, immunotherapy, etc.) to treat cancer
  • Radiation oncologist, who uses radiation therapy to treat cancer
  • Thoracic surgeon, who performs surgery to treat problems in the chest
  • Gastroenterologist, who is an expert in handling diseases and issues of the digestive system

Other medical professionals, such as nurses, counselors and oncology dietitians, may also play a role in caring for you during treatment for esophageal cancer.

Together, your team of doctors can create a treatment plan based on the following factors:

  • Cancer stage (determined by the cancer’s location within the esophagus, how much of the esophagus is affected, and whether the cancer has spread to other areas of your body)
  • Whether surgery can remove the tumor completely
  • Overall health and personal preferences

Common treatments for esophageal cancer include:

Immunotherapy

Immunotherapy drugs are designed to allow the immune system to better recognize and attack cancer cells.

Checkpoint inhibitors work by blocking specific protein receptors on the surface of cancer cells and/or immune cells. Blocking these receptors may prevent cancer cells from sending signals that allow them to hide from the immune system.

Checkpoint inhibitors and other immunotherapy treatments may be used on esophageal tumors in combination with other treatments, such as surgery or chemotherapy. Immunotherapy isn’t recommended for all patients, and responses to the treatment may vary.

Most often, the immunotherapy drugs used to treat esophageal cancer may come with side effects such as:

  • Fatigue
  • Poor appetite
  • Pain in muscles or joints
  • Weakness
  • Breathing difficulties
  • Itchy skin or rashes
  • Fever
  • Upset stomach (nausea, constipation, diarrhea)
  • Cough

Autoimmune reactions and infusion reactions are examples of the more severe side effects of immunotherapy that can occur, although they are rare.

  • An autoimmune reaction is a sign that the drugs have stimulated your immune system to the point that it’s attacking healthy cells in your body, potentially causing severe and life-threatening damage to organs, including the liver, kidneys, lungs, skin and intestines.
  • An infusion reaction resembles an allergic reaction and comes with symptoms such as breathing difficulties, facial flushing, fever, rashes, chills and dizziness. It’s a sign that your body may be experiencing an adverse reaction to the immunotherapy drugs. If you experience these types of symptoms while undergoing immunotherapy, tell your doctor immediately.

Chemotherapy

Treatment with chemotherapy involves different types of drugs that kill off cancer or stop its growth by destroying cells or preventing them from replicating.

For esophageal cancer, chemotherapy is rarely used as a standalone treatment, as it tends to be ineffective when used in this way. Instead, doctors typically use chemoradiation to treat esophageal cancer, which involves simultaneously giving chemotherapy drugs and radiation therapy.

Chemoradiation or chemotherapy may be a treatment option for esophageal cancer under the following circumstances:

  • After surgery has been performed, doctors may use chemotherapy or chemoradiation to reduce the chance that any cancer cells are left behind.
  • Before surgery has been performed, doctors may use chemotherapy or chemoradiation to reduce the size of the tumor. Shrinking the tumor may make it easier for the surgeon to remove it and lower the chance that cancer may spread or recur (come back) after surgery.
  • For advanced esophageal cancers that have spread to other parts of the body (metastasized), your care team may recommend chemotherapy or chemoradiation to reduce the size of metastatic tumors and relieve symptoms caused by these large tumors. In this case, chemotherapy is considered a palliative therapy, as it may extend and improve quality of life but is unlikely to treat cancer.

Chemotherapy may cause many different side effects, depending on the drug used and its dose. Among the most common side effects are:

  • Upset stomach (nausea, vomiting, diarrhea, constipation)
  • Poor appetite
  • Loss of hair
  • Sores in the mouth

Chemotherapy drugs may also lead to reduced blood cell counts, which may cause symptoms such as:

  • Fatigue (due to low red blood cell counts)
  • Easy bleeding or bruising (due to low blood platelet counts)
  • Frequent infections (due to low white blood cell counts)

Chemotherapy and other cancer treatments may also result in weight loss, exacerbating the weight loss that often has already occurred in an esophageal cancer patient. If weight loss or nutritional deficiencies are an issue, your doctor or an oncology dietitian can help ensure you’re well-fed and take in the proper nutrients to maintain your overall health.

After treatment with chemotherapy has concluded, the side effects tend to subside. It’s important that you’re open and communicative with your care team about any symptoms or problems you experience during and after treatments. Side effects should be kept under control for your overall health and well-being and so that your body is well-prepared to fight off cancer.

Depending on your side effects and their severity, your doctor may alter the dose or type of chemotherapy drug or prescribe additional medications to relieve any problematic side effects.

Targeted therapy

Targeted therapy drugs may be recommended for certain esophageal cancer patients to target specific proteins that help the cancer thrive. These treatments may be used as an alternative to surgery, or in some cases, to treat advanced esophageal cancers that haven’t responded to other treatments.

Some targeted drugs are an option for patients with esophageal cancers that are HER2 positive. When cancer is HER2 positive, it means you have too many copies of the HER2 gene. Too many copies of the HER2 gene causes elevated levels of the HER2 protein on the surface of cancer cells, which helps fuel the cancer’s growth.

Targeted drugs such as trastuzumab may help treat HER2-positive esophageal cancers by targeting the HER2 protein and slowing the cancer’s growth. Trastuzumab is an artificially produced protein designed to mimic proteins that are naturally produced by the immune system. It isn’t used on patients who are HER2 negative, as its mechanism of action only affects cancers that are fueled by elevated levels of the HER2 protein. Eligible patients typically receive trastuzumab intravenously (into a vein) at three-week intervals, in addition to chemotherapy. This drug may cause mild, flu-like symptoms, including fever, headache and cough. It also comes with a risk of heart damage, so your care team may wish to test your heart health before treatment.

Ramucirumab is another example of a targeted drug that may be a treatment option for some esophageal cancers. This drug prevents tumors from creating new blood vessels, which is how they receive the blood and nutrients necessary to continue growing and spreading. It does this by blocking the action of a specific protein called VEGF, which tells the body to form new blood vessels. Ramucirumab can stop these signals by blocking VEGF from attaching to cancer cells and potentially preventing the cancer’s growth. It may be an option for advanced esophageal cancers that have been unsuccessfully treated by other therapies. Increased blood pressure, tiredness and swelling in the arms or legs are among the more common side effects of ramucirumab. In rarer cases, the drug may cause more severe problems, including blood clots, excessive bleeding and perforations (holes) in the digestive system.

Gastroenterology

Common gastrointestinal procedures for esophageal cancer include:

Endoscopic ultrasound (EUS): An EUS allows us to view high-quality images of the esophagus and deliver treatment directly to a mass.

Endoscopic mucosal resection (EMR): This procedure is used to remove very early-stage cancer in the esophagus. In some cases, it may be used during the diagnosis process. During an EMR, a thin tube (endoscope) is inserted down the throat. The endoscope has instruments attached to the end that are designed to remove the tumor.

Cryotherapy: This procedure uses liquid nitrogen to freeze and kill cancer cells in an effort to shrink the tumor. This may also help improve swallowing.

Balloon dilation: This technique may be used to remove an obstruction in the esophagus.

Stent placements: Placing a stent in the esophagus may be recommended to improve swallowing. Stents are inserted through the mouth and do not require surgery.

Photodynamic therapy (PDT): Photodynamic therapy may be used to treat stage 1 esophageal cancer, or to alleviate symptoms associated with esophageal obstruction. Before this procedure, you may be given an injection of Photofrin® (porfimer sodium), a drug that accumulates near cancer cells. After a couple of days (once the drug has had time to find and gather within cancer cells), a doctor focuses a specialized light on the area of cancer. When exposed to this light, porfimer sodium goes through a chemical change that enables it to kill nearby cancer cells.

Photodynamic therapy is highly targeted, meaning that it destroys cancer cells without causing much harm to healthy cells. However, the light used to activate the drug cannot travel through most parts of the body besides the inner lining of the esophagus. The light cannot get to cancers that have grown deeply into the esophagus or other body parts, and therefore cannot kill cancer cells in those areas. This is why it may be a beneficial option for very early-stage esophageal cancers within the esophagus’ inner surface.

Potential risks and side effects of photodynamic therapy include:

  • Difficulty swallowing due to swelling in the esophagus
  • Difficulty swallowing due to an extreme narrowing of the esophagus
  • Bleeding or holes in the esophagus
  • Skin or eye reactions if exposed to sunlight or strong indoor lights

Your doctor may advise you to avoid sunlight or powerful indoor lights for at least a month after receiving the injection. This is because strong lights can activate the drug and cause it to kill healthy cells (particularly in the skin and eyes) if it happens to accumulate there.

Radiation therapy

Radiation therapy may be an option in cases when esophageal cancer has advanced and is often performed in conjunction with chemotherapy. If radiation therapy helps shrink the tumor, surgery may be performed.

Radiation can be delivered externally (external beam radiation) or internally (internal radiation). External beam radiation involves a machine that sends beams of radiation toward the tumor from outside the body. When radiation therapy is used to treat esophageal cancer, it’s most often external beam radiation therapy.

Internal radiation therapy may be a treatment option for some cases of advanced esophageal cancer. For esophageal cancer, internal radiation therapy involves a doctor inserting a tube into the mouth and down the throat. Then, the doctor uses the tube to place radioactive material near the tumor. The material may contain a high dose of radiation, in which case it’s placed near the cancer for a short time (10 to 20 minutes) over multiple sessions. Other times, radioactive material containing a low radiation dose may be left in place for a few days and then removed. This option involves fewer treatments, but the patient may need to remain in the hospital until the radioactive material is removed.

Internal radiation therapy has the benefit of delivering radiation directly to the tumor, potentially resulting in less damage to healthy tissue and fewer side effects than external beam radiation therapy. Internal radiation therapy is often helpful for patients who have a large, advanced tumor in their esophagus that interferes with their ability to swallow. It’s usually ineffective at destroying a large area of cancer, but it may help relieve symptoms by shrinking a specific part of a tumor.

Side effects of radiation therapy, which may include difficulty swallowing, are also managed during cancer treatment. A stent may be placed in the esophagus before radiation therapy begins, and a temporary feeding tube may be used to help patients receive necessary nutrients during treatment.

Other side effects include:

  • Blistering
  • Redness or peeling at the treatment site
  • Upset stomach (nausea, vomiting, diarrhea)
  • Tiredness
  • Mouth or throat sores
  • Dry mouth

Surgery

Surgery is the preferred procedure to treat early-stage adenocarcinoma. Your surgical oncologist will perform surgery to treat stage 1 and stage 2 esophageal cancer. For later-stage esophageal cancer, we typically combine other forms of treatment, such as radiation therapy and chemotherapy. These treatments may be used to shrink the tumor before surgery can be reconsidered. If cancer is found in the esophagus, nearby lymph nodes are also removed during surgery to test for the presence of cancer.

Learn more about surgery for esophageal cancer

Interventional radiology

Treatment for esophageal cancer requires accuracy and precision. Interventional radiology is intended to allow doctors to visualize tumors in the esophagus and perform real-time image-guided interventional procedures.

Esophageal cancer clinical trials

Clinical trials are a critical testing ground for determining the effectiveness and safety of new and developing cancer drugs and other treatments. As part of our commitment to bringing esophageal cancer patients new and innovative treatment options, Cancer Treatment Centers of America® (CTCA) may offer clinical trials to qualifying patients. Talk to your doctor about whether a clinical trial is an option for you and ask about the risks and requirements involved.

Search our clinical trials

Metastatic esophageal cancer

Esophageal cancer may spread from its original location to other areas or organs in the body. When esophageal cancer spreads to distant organs or lymph nodes, it’s considered stage 4 or metastatic cancer. These cancers tend to be very difficult to treat, and treatment is generally focused on:

  • Extending the patient’s life
  • Preventing the cancer from spreading further
  • Improving symptoms and overall quality of life

Chemotherapy and radiation therapy are commonly used to shrink the tumor and relieve pain and difficulty swallowing in patients with metastatic esophageal cancer. Doctors may place a tube (stent) in the throat or use photodynamic therapy to keep the esophagus open. Some patients may receive chemotherapy along with targeted therapy or immunotherapy.

Recurrent esophageal cancer

After treatment has concluded and you have entered remission, cancer can sometimes come back. When cancer returns after treatment, it’s called recurrent cancer.

If esophageal cancer recurs, you will need to undergo another round of testing to determine where the cancer has spread. When esophageal cancer recurs in the esophagus (local recurrence), treatment options may include surgical removal of the esophagus, chemotherapy or radiation therapy. When esophageal cancer recurs in distant areas of the body, the treatment options are the same as those used for metastatic or stage 4 esophageal cancer, and generally involve some combination of chemotherapy, radiation therapy, immunotherapy and targeted therapy.

Before deciding on a plan, your care team may consider your overall health and past cancer treatments you underwent. Palliative treatments, which focus on relieving symptoms and improving quality of life rather than treating the cancer, are often an essential part of controlling recurrent esophageal cancer. Some patients with recurrent esophageal cancer may be eligible for clinical trials, which provide access to new and innovative treatments.

Treatment options by stage of esophageal cancer

Below are the standard treatment options for different stages of esophageal cancer, according to the National Cancer Institute.

  • Stage 0
    • Surgery
    • Endoscopic resection
  • Stage 1
    • Surgery performed after chemoradiation
    • Surgery alone
  • Stage 2
    • Surgery performed after chemoradiation
    • Surgery alone
    • Surgery performed after chemotherapy alone
    • Chemoradiation alone
  • Stage 3
    • Surgery performed after chemoradiation
    • Surgery performed after chemotherapy alone
    • Chemoradiation alone
  • Stage 4
    • Surgery performed after chemoradiation
    • Chemotherapy
    • Laser surgery to help ease symptoms and improve quality of life
    • Placement of a stent in the esophagus to keep the esophagus open and fix swallowing problems
    • Radiation therapy (given internally or externally) to shrink the tumor and relieve symptoms
    • Clinical trials testing new approaches to chemotherapy or targeted therapy
  • Recurrent
    • Palliative treatments, such as radiation therapy
    • Clinical trials

Next topic: How is esophageal cancer treated with surgery?

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