Esophageal Cancer Treatment and Survival Rate

May 25, 2025

This page was reviewed under our medical and editorial policy by Jae Y. Kim, M.D., associate professor, Division of Thoracic Surgery, Department of Surgery; and Terence Williams, M.D., Ph.D., professor and chair, Department of Radiation Oncology, City of Hope^® Cancer Center Duarte

Each patient’s treatment plan for esophageal cancer is personalized by his or her health care team. Several factors are taken into consideration, including:

• The type of esophageal cancer
• The esophageal cancer stage, or how far it has metastasized (grown and spread)
• Whether the cancer tumor is resectable (able to be completely removed by surgery) or unresectable (not completely removable using surgery)
• The patient’s general health
• Potential side effects
• The patient’s goals for treatment, such as symptom relief or slowing and stopping the cancer’s growth

Treatment for Esophageal Cancer

Esophageal cancer may be treated with one or a combination of therapies, including surgery, endoscopic procedures, radiation therapy, chemotherapy and drug therapy. These therapies and procedures sometimes change based on how well they are working and the patient’s goals.

Esophageal Cancer Surgery

The most common esophageal cancer treatment is surgery. It is used on resectable (removable) cancer, often when it is in the earlier stages.

Imaging tests like an ultrasound or computed tomography (CT) scan will be performed on the patient to determine whether they are a candidate for surgery.

Surgeons use different surgical techniques to remove esophageal cancer:

• Open surgery using a large chest incision called a thoracotomy
• Open surgery using a large abdominal (belly) incision called a laparotomy
• Thoracoscopic or laparoscopic surgery, using small cuts (keyholes) in the chest or belly, along with an instrument with attached cameras to guide the surgeon
• Robotic surgery, which is a type of thoracoscopic or laparoscopic surgery in which the surgeon uses a computer control panel to guide a robotic arm that holds the surgical tools
• Endoscopic surgery, which uses a long, tube-like tool with an attached camera (an endoscope) that is inserted into the esophagus and sends pictures to a monitor to guide the surgeon

Thoracoscopic and laparoscopic surgical techniques are sometimes called minimally invasive surgeries because they use smaller cuts affecting less body tissue, which may speed patients’ healing time.

Esophagectomy

The surgical removal of part or all of the esophagus is called an esophagectomy. Nearby lymph nodes are also removed, and sometimes part of the stomach. To reconstruct the esophagus so that the patient is able to swallow, the surgeon creates a conduit, usually out of the stomach. Sometimes, a part of the small intestine, large intestine (colon) or a plastic tube is used in the reconstruction. These are typically performed robotically.

There are a few different types of open esophagectomy, and the type chosen depends on where the tumor is located.

Transhiatal esophagectomy: For this procedure, the surgeon makes an incision in the neck and abdomen, which is performed for cancer in the lower esophagus. This procedure requires a bigger incision than the transthoracic esophagectomy.

Transthoracic esophagectomy: For this procedure, the surgeon makes an incision in the chest and abdomen (and sometimes the neck), which is performed for cancer in the mid-to-upper esophagus.

Both open and minimally invasive surgical techniques are used to perform an esophagectomy. Potential side effects and complications include:

• Bleeding
• Increased risk of infection
• Blood clots
• Lung issues, such as pneumonia
• Pain
• Voice changes
• Issues swallowing due to the esophagus narrowing (stricture)
• Heartburn
• Nausea and vomiting
• Leaks where connections are made between the esophagus and stomach

Longer-term, patients may need to eat smaller, frequent meals and may experience increased permanent reflux after surgery.

The health care team may recommend certain medications to help relieve these side effects, such as antacids to treat heartburn. Additionally, open or minimally invasive esophageal operations or endoscopic procedures may be performed to fix leaks and issues with swallowing.

Other Surgical Options

Lymphadenectomy is the surgical removal of nearby lymph nodes. It is performed during esophagectomy surgery to help ensure that cancer that may have spread to the lymph nodes is removed. After surgery, these lymph nodes are examined under a microscope to determine if cancer is present, which helps doctors understand the stage of the disease and the appropriate treatments to use.

In addition, certain endoscopic surgeries may be performed for precancerous tumors or early-stage cancer that has not spread beyond the first layer of the esophagus wall.

Endoscopic mucosal resection (EMR): For this procedure, an endoscope is placed down the esophagus and surgical tools inserted through it are used to cut or suction out the tumor or precancerous cells.

Endoscopic submucosal dissection (ESD): This procedure is performed in much the same way as an EMR, except a surgical tool injects fluid between the esophagus wall and the tumor to help loosen it before it is cut away and taken out.

Side effects of the endoscopic procedures may include:

• Bleeding
• Issues swallowing due to the esophagus narrowing (stricture)
• Puncture of the esophagus

Palliative care: If the esophagus narrows or becomes blocked, a surgery called esophageal dilation may be performed, typically using a local anesthetic (medication) that numbs the area. A pipe or balloon-shaped device is inserted into the esophagus to temporarily stretch it out for a few weeks.

A patient may also need a procedure to assist with eating if he or she is undergoing treatments like chemotherapy or radiation therapy, which sometimes leaves painful sores on the esophagus. For a feeding tube insertion, a jejunostomy tube (J-tube) is inserted into the small intestine through a small opening that the surgeon creates in the abdomen. Nutritional liquid is inserted into the tube. Less commonly, the tube is inserted directly into the stomach using a gastrostomy tube (G-tube).

Radiation Therapy

Radiation therapy uses beams of high-energy particles like X-rays, electrons, protons and photons, to destroy cancer cells. Most often, this is delivered as external beam radiation therapy (EBRT).

With EBRT, beams are aimed at the site of the cancer from a machine that is outside the body, similar to an X-ray. EBRT is the type of radiation therapy most often used to treat esophageal cancer.

One type of EBRT is called intensity modulated radiation therapy (IMRT). It’s commonly used for esophageal cancer. This therapy uses radiation waves of varying intensities (beamlets) to target the esophageal tumor and reduce damage to healthy tissue. It can be targeted very precisely at the tumor to protect and minimize damage to healthy tissue.

The potential short-term side effects of radiation therapy include:

• Fatigue
• Nausea
• Vomiting
• Skin redness and blistering
• Sores in the mouth or throat
• Dry mouth
• Thick saliva
• Painful swallowing
• Difficulty swallowing
• Weight loss
• Inflammation of the lung causing dry cough

After radiation therapy is complete, the potential long-term side effects of radiation therapy include:

• Stricture (narrowing of the esophagus)
• Lung damage, including lung scarring and/or radiation pneumonitis
• Heart damage

Radiation therapy short-term side effects usually only continue while patients undergo treatment, and the doctor may recommend medications or procedures (usually for long-term toxicities) to address these issues.

Radiation therapy is often given alongside chemotherapy (chemoradiation):

• Before surgery to help shrink the cancer and improve surgical outcomes
• As the main esophageal treatment for people who either prefer not to have surgery or are unable to due to health problems
• After surgery to ensure any remaining cancer cells are destroyed (more rarely)
• To improve symptoms caused by the cancer, such as pain and difficulty swallowing

Endoscopic Procedures

In addition to endoscopic mucosal resection and endoscopic submucosal dissection, other endoscopic procedures may be used to treat esophageal cancer. These include procedures to keep the esophagus open and make it easier to swallow. They include the following.

Laser ablation: A laser beam is aimed at the cancer through an endoscope inserted into the esophagus. This is done to help shrink the tumor. The procedure is usually used for advanced-stage esophageal cancer to help people with swallowing.

Argon plasma coagulation: This is similar to laser ablation, except an electric spark and argon gas are sent through the tip of the endoscope to shrink the tumor and make it easier for the patient to swallow.

Electrocoagulation: A probe is sent through the endoscope and into the esophagus. An electric current passes through the probe to burn the tumor and reduce the size of the blockage.

Cryotherapy: Cancer cells are destroyed by freezing them using a probe that is sent through the endoscope. The probe is cooled with liquid nitrogen, liquid nitrous oxide or other substances. This may help relieve swallowing issues in people with certain advanced esophageal cancers and help delay the need for an esophageal stent or a feeding tube.

Esophageal stent: A mesh, tube-like device made of metal or plastic is inserted into the esophagus over the tumor blockage to expand the area. This procedure is typically used after trying other procedures to unblock and expand the esophagus.

Two additional endoscopic procedures may help treat esophageal cancer or precancerous cells.

Photodynamic therapy: A drug activated by light is inserted into a vein, and a few days later, a laser is inserted into the esophagus through an endoscope. The light from the laser changes the properties of the drug so that it destroys the cancer cells. This is used to treat precancerous cells or early-stage cancers that have not spread beyond the inner surface of the esophagus.

Radiofrequency ablation: A balloon containing electrodes is passed through an endoscope. The balloon is inflated so that the electrodes come in contact with the lining of the esophagus. An electric current is passed through the electrodes to destroy the cancer cells. This procedure is used to treat a condition called Barrett's esophagus, a risk factor for developing esophageal cancer. The treatment may lower a person’s risk of developing the disease.

Chemotherapy

Chemotherapy is a medication that destroys fast-growing cancer cells. Patients are given chemotherapy pills, capsules or intravenous (IV) injections that travel throughout the body (systemic chemotherapy). The treatment is usually administered along with radiation therapy to improve success rates. Like radiation therapy, it may be given before, after or instead of surgery.

Because chemotherapy sometimes destroys some normal cells, people taking the therapy may experience the following side effects:

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Fatigue
• Bruising or bleeding
• Increased infection risk
• Hair loss
• Nerve damage
• Skin reactions
• Weight loss
• Mouth sores
• Hand-foot syndrome (redness, blistering or pain in the feet and hands)

To help reduce the impact of chemotherapy treatment, it is usually given in cycles of two to three weeks, and each cycle includes a period of rest (no treatment) and a period of treatment.

Drug Therapy

Two key categories of drugs are also used to help treat esophageal cancer, either alone or in combination with other therapies.

Targeted drug therapy: This treatment uses drugs that target molecules on cancer cells that help the cancer grow and thrive. For instance, some esophageal cancer cells have too much of the HER2 protein, which is a growth-stimulating protein. Targeted drugs like Herceptin® (trastuzumab) help block HER2 from working so that cancer cell growth is reduced.

Immunotherapy: This type of therapy uses drugs to help the body’s immune system identify and fight cancer cells. The immune system has checkpoints that stop it from destroying normal cells — but also some cancer cells. Immune checkpoint inhibitors target these checkpoints and turn them back “on” so they are able to fight and destroy esophageal cancer cells.

Who Treats Esophageal Cancer?

A number of experts may be part of a patient’s esophageal cancer treatment team, including:

• A thoracic surgical oncologist, who performs surgery on cancers of the thoracic cavity (chest) where the esophagus is located
• A surgical oncologist, who performs surgery on cancer
• A gastroenterologist, a specialist in treating health issues affecting the digestive tract
• A medical oncologist, who administers cancer therapies like chemotherapy, targeted drug therapy and immunotherapy
• A radiation oncologist, who directs radiation therapy treatments for cancer
• Palliative care specialists, who provide care focused on the patient’s comfort and quality of life, such as dietitians and registered nutritionists to help the patient get the nutrients they need.

Esophageal Cancer Survival Rate

The five-year relative survival rate for people diagnosed with esophageal cancer was 21.9% between 2015 and 2021, according to the National Cancer Institute (NCI). This means that approximately 22% of esophageal cancer patients were alive five years or more after diagnosis, compared to people without that cancer type.

Esophageal cancer prognosis (the odds of recovery or the cancer returning) varies significantly based on the stage of the disease, response to treatment, cancer subtype and other factors. Patients should always talk to the care team for an individualized prognosis.

In general, the NCI shares the esophageal cancer survival rates as follows:

Localized cancer (only located in the esophagus): 48.7%

Regional (grown into nearby lymph nodes, cavities or organs): 28.4%

Distant (spread to distant organs or structures): 5.4%

Treatment advances in many types of cancer are becoming new standards of care. Clinicians and scientists are continuing to research appropriate treatments to slow and stop the spread of the disease.

Esophageal Cancer Treatment at City of Hope^®

At City of Hope, a multidisciplinary team of medical experts across different fields, like thoracic surgery, radiation oncology, medical oncology and supportive care medicine, work together to plan and carry out an esophageal cancer treatment plan that is individually tailored to ensure each patient gets optimal results.