After the cancer is found and staged, your cancer care team will discuss treatment options with you. It is important that you take time to think about your choices. You will want to weigh the benefits of each treatment option against the possible risks and side effects. In choosing a treatment plan, 2 of the main factors to consider are your overall health and the stage (extent) of the cancer. The main options for treatment of cancer of the esophagus include:
• Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.
As explained above, chemotherapy and radiation therapy are often given at the same time to treat esophageal cancer, called chemoradiotherapy. Recent studies also show that chemotherapy without radiation therapy may work as well, but more research is needed to understand any benefits of chemotherapy without radiation therapy compared with chemoradiotherapy.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
• Cryotherapy
This is a type of palliative treatment that uses an endoscope with a probe attached that can freeze and remove tumor tissue. It can be used to reduce the size of a tumor to help a patient swallow better.
• Electrocoagulation
This type of palliative treatment helps kill cancer cells by heating them with an electric current. This is sometimes used to help relieve symptoms by removing a blockage caused by the tumor.
• Photodynamic therapy
Photodynamic therapy is a palliative or supportive option used to make swallowing easier, especially for people who cannot or choose not to have surgery, radiation therapy, or chemotherapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor and stays longer in cancer cells than in healthy cells. A laser is then aimed at the tumor, destroying the cancer cells. Although photodynamic therapy may relieve swallowing problems for a short period of time, it does not cure esophageal cancer. Esophagus Cancer Treatment.
• Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation treatment is given directly inside the body, it is called internal radiation therapy or brachytherapy. For esophageal cancer, this involves temporarily inserting a radioactive wire into the esophagus using an endoscope.
Side effects from radiation therapy may include fatigue, mild skin reactions, soreness in the throat and esophagus, difficulty or pain with swallowing, upset stomach, nausea, and loose bowel movements. Most side effects go away soon after treatment is finished.
• Surgery
Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery has traditionally been the most common treatment for esophageal cancer. However, currently, surgery is used as the primary (first) treatment only for patients with early-stage esophageal cancer.
For patients with locally-advanced esophageal cancer, a combination of chemotherapy and radiation therapy, or only chemotherapy in some situations, may be used before surgery to shrink the tumor. For people who cannot have surgery, the best treatment option is often a combination of chemotherapy and radiation therapy.
The most common surgery to treat esophageal cancer is called an esophagectomy, where the doctor removes the esophagus and then connects the remaining healthy part of the esophagus to the stomach so that the patient can swallow normally. The stomach or part of the intestine may sometimes be used to make the connection. The surgeon also removes lymph nodes around the esophagus.
• Targeted therapy
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells.
Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them.
Some of these treatments can also be used as palliative treatment when all the cancer cannot be removed. Palliative treatment is meant to relieve symptoms, such as pain and trouble swallowing, but it is not expected to cure the cancer.
Depending on the stage of the cancer and your general health, different treatment options may be used alone or in combination. Based on these options, you might have different types of doctors on your treatment team. These doctors could include:
- A gastroenterologist: a doctor who specializes in treatment of diseases of the digestive system
- A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy
- A radiation oncologist: a doctor who treats cancer with radiation therapy
- A thoracic surgeon: a doctor who treats diseases of the chest with surgery