Esophageal Cancer Treatments
Treatment Options for Esophageal Cancer
Esophageal cancer is often diagnosed at an advanced stage, so treatment should be rapid and aggressive, requiring the expertise of specialists in the disease.
Because esophageal cancer rarely shows symptoms in early stages, it is often advisable to treat precancerous conditions — such as Barrett’s esophagus.
At City of Hope, a multidisciplinary team of medical experts across different fields — including thoracic surgery, radiation oncology, medical oncology and supportive care medicine — work together to plan and implement a treatment plan that is individually tailored to you so that you get the best results.
Therapies we use to treat cancer and precancer of the esophagus may include:
Surgery is often the primary treatment for esophageal cancer, as well as precancerous esophageal conditions such as Barrett’s esophagus. Surgery may also be used to alleviate esophageal cancer symptoms, including difficulty swallowing and speaking.
Chronic heartburn (gastroesophageal reflux disease) can lead to irritation of the lining of the esophagus. Over time, this irritation can cause the cells to become precancerous, a condition known as Barrett’s esophagus. Through an endoscope (small, flexible camera that enters through the mouth), experts at City of Hope can destroy (ablate) this precancerous tissue, allowing the body to lay down a new layer of more normal cells.
We can also remove very early stage cancers with the endoscope, in a technique known as endoscopic mucosal resection. These endoscopic treatments are outpatient procedures and, in most cases, do not require an overnight stay. Patients recover quickly and usually resume normal activities by the next day.
For Barrett’s esophagus and early stage esophageal tumors, these endoscopic treatments are highly effective and have cure rates equivalent to traditional surgery.
Minimally Invasive Surgery and Its Benefits
Unfortunately, most esophageal cancers are found at a more advanced stage than can be treated with endoscopic therapies. For these aggressive tumors, we recommend a radical esophagectomy, which involves removal of most of the esophagus, as well as some of the stomach.
Many patients receive a combination of treatments with chemotherapy and radiation before surgery. In most cases, City of Hope surgeons perform radical esophagectomy using minimally invasive, robotic techniques.
Compared to traditional esophagectomy which requires a large abdominal incision, a large chest incision with rib spreading, and sometimes a neck incision, minimally invasive esophagectomy has been shown to cause less pain, less blood loss, a faster recovery and fewer complications. There is no difference in the risk of cancer recurrence.
Radiation is often combined with other therapies to treat esophageal cancer. For cancers of the esophagus, radiation may be applied externally, using one or more beams focused on the tumor or internally, using radioactive seeds that are implanted into or near the tumor site (brachytherapy).
City of Hope also offers helical TomoTherapy, a technology combining radiation delivery with advanced imaging that results in more focused beams of radiation focused on the tumor, while minimizing exposure to adjacent tissues and organs, including the heart, lungs and spine.
Chemotherapy — the use of anti-cancer medicines — includes a wide range of drugs to treat primary and metastatic esophageal cancer. City of Hope provides both standard chemotherapies and access to newly developed drugs (or drug combinations) through an extensive program of clinical trials.
Chemotherapy can also enhance the effectiveness of surgery or radiation therapy, by shrinking the tumor before the procedure and making it easier to remove (neoadjuvant chemotherapy), or given after the procedure to minimize the chance of recurrence (adjuvant chemotherapy.)
As part of the treatment team, a medical oncologist will evaluate the patient’s cancer, health and other factors, so that the chemotherapy, if appropriate, can be tailored to the patient throughout the continuum of care.