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Treatment for Esophageal Cancer

People with esophageal cancer have several treatment options. The options are surgery, radiation therapy, chemotherapy, or a combination of these treatments. For example, radiation therapy and chemotherapy may be given before or after surgery.

The treatment that's right for you depends mainly on the following:

where the cancer is located within the esophagus
whether the cancer has invaded nearby structures
whether the cancer has spread to lymph nodes or other organs
your symptoms
your general health

Esophageal cancer is hard to control with current treatments. For that reason, many doctors encourage people with this disease to consider taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for people with all stages of esophageal cancer. See the Taking Part in Cancer Research section.

You may have a team of specialists to help plan your treatment. Your doctor may refer you to specialists, or you may ask for a referral. You may want to see a gastroenterologist, a doctor who specializes in treating problems of the digestive organs. Other specialists who treat esophageal cancer include thoracic (chest) surgeons, thoracic surgical oncologists, medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian. If your airways are affected by the cancer, you may have a respiratory therapist as part of your team. If you have trouble swallowing, you may see a speech pathologist.

Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.

You may want to ask your Doctor these Questions before your Treatment begins

What is the stage of the disease? Has the cancer spread? Do any lymph nodes show signs of cancer?
What is the goal of treatment? What are my treatment choices? Which do you recommend for me? Why?
Will I have more than one kind of treatment?
What can I do to prepare for treatment?
Will I need to stay in the hospital? If so, for how long?
What are the risks and possible side effects of each treatment? For example, am I likely to have eating problems during or after treatment? How can side effects be managed?
What will the treatment cost? Will my insurance cover it?
Would a research study (clinical trial) be appropriate for me?
Can you recommend other doctors who could give me a second opinion about my treatment options?
How often should I have checkups?

Surgery for Esophageal Cancer

There are several types of surgery for esophageal cancer. The type depends mainly on where the cancer is located. The surgeon may remove the whole esophagus or only the part that has the cancer. Usually, the surgeon removes the section of the esophagus with the cancer, lymph nodes, and nearby soft tissues. Part or all of the stomach may also be removed. You and your surgeon can talk about the types of surgery and which may be right for you.

The surgeon makes incisions into your chest and abdomen to remove the cancer. In most cases, the surgeon pulls up the stomach and joins it to the remaining part of the esophagus. Or a piece of intestine may be used to connect the stomach to the remaining part of the esophagus. The surgeon may use either a piece of small intestine or large intestine. If the stomach was removed, a piece of intestine is used to join the remaining part of the esophagus to the small intestine.

During surgery, the surgeon may place a feeding tube into your small intestine. This tube helps you get enough nutrition while you heal. Information about eating after surgery is in the Nutrition section.

You may have pain for the first few days after surgery. However, medicine will help control the pain. Before surgery, you should discuss the plan for pain relief with your health care team. After surgery, your team can adjust the plan if you need more relief.

Your health care team will watch for signs of food leaking from the newly joined parts of your digestive tract. They will also watch for pneumonia or other infections, breathing problems, bleeding, or other problems that may require treatment.

The time it takes to heal after surgery is different for everyone and depends on the type of surgery. You may be in the hospital for at least one week.

You may want to ask your Doctor these Questions about Surgery

Do you suggest surgery for me? If so, which type?
Will you remove lymph nodes and other tissue? Will you remove part or all of the stomach? Why?
What are the risks of surgery?
How will I feel after surgery?
How will pain be controlled after surgery?
How long will I be in the hospital?
Am I likely to have eating problems? Will I need a special diet?
Will I need a feeding tube? If so, for how long? How do I take care of it? Who can help me if I have a problem?
Will I have any lasting side effects?

Radiation Therapy for Esophageal Cancer

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Radiation therapy may be used before or after surgery. Or it may be used instead of surgery. Radiation therapy is usually given with chemotherapy to treat esophageal cancer.

Doctors use two types of radiation therapy to treat esophageal cancer. Some people receive both types:

External radiation therapy: The radiation comes from a large machine outside the body. The machine aims radiation at your cancer. You may go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks.

Internal radiation therapy (brachytherapy): The doctor numbs your throat with an anesthetic spray and gives you medicine to help you relax. The doctor puts a tube into your esophagus. The radiation comes from the tube. Once the tube is removed, no radioactivity is left in your body. Usually, only a single treatment is done.

Side effects depend mainly on the dose and type of radiation. External radiation therapy to the chest and abdomen may cause a sore throat, pain similar to heartburn, or pain in the stomach or the intestine. You may have nausea and diarrhea. Your health care team can give you medicines to prevent or control these problems.

Also, your skin in the treated area may become red, dry, and tender. You may lose hair in the treated area. A much less common side effect of radiation therapy aimed at the chest is harm to the lung, heart, or spinal cord.

You are likely to be very tired during radiation therapy, especially in the later weeks of external radiation therapy. You may also continue to feel very tired for a few weeks after radiation therapy is completed. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Radiation therapy can lead to problems with swallowing. For example, sometimes radiation therapy can harm the esophagus and make it painful for you to swallow. Or, the radiation may cause the esophagus to narrow. Before radiation therapy, a plastic tube may be inserted into the esophagus to keep it open. If radiation therapy leads to a problem with swallowing, it may be hard to eat well. Ask your health care team for help getting good nutrition.

You may want to ask your Doctor these Questions before having Radiation Therapy:

Which type of radiation therapy can I consider? Are both types an option for me?
When will treatment start? When will it end? How often will I have treatments?
Will I need to stay in the hospital?
What can I do to take care of myself before, during, and after treatment?
How will I feel during treatment? Will I be able to drive myself to and from treatment?
How will we know the treatment is working?
How will I feel after the radiation therapy?
Are there any lasting effects?

Chemotherapy for Esophageal Cancer

Most people with esophageal cancer get chemotherapy. Chemotherapy uses drugs to destroy cancer cells. The drugs for esophageal cancer are usually given through a vein (intravenous). You may have your treatment in a clinic, at the doctor's office, or at home. Some people need to stay in the hospital for treatment.

Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drug can also harm normal cells that divide rapidly:

Blood cells: When chemotherapy lowers the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of drug. There also are medicines that can help your body make new blood cells.

Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may change in color and texture.

Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.

Other possible side effects include a skin rash, joint pain, tingling or numbness in your hands and feet, hearing problems, or swollen feet or legs. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.

You may want to ask your Doctor these Questions before having Chemotherapy

Which drugs will I get?
When will treatment start? When will it end? How often will I have treatments?
Where will I go for treatment? Will I have to stay in the hospital?
What can I do to take care of myself during treatment?
How will we know the treatment is working?
Will I have side effects during treatment? What side effects should I tell you about? Can I prevent or treat any of these side effects?
Can these drugs cause side effects later on?

Second Opinion for Esophageal Cancer

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. You may want to find a medical center that has a lot of experience with treating esophageal cancer. You may even want to talk to several different doctors about all of the treatment options, their side effects, and the expected results.

Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it.

If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.

There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists. NCI's Cancer Information Service at 1-800-4-CANCER can tell you about nearby treatment centers. Other sources can be found in the NCI fact sheet How To Find a Doctor or Treatment Facility If You Have Cancer.

Supportive Care of Esophageal Cancer

Esophageal cancer and its treatment can lead to other health problems. You can have supportive care before, during, or after cancer treatment.

Supportive care is treatment to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment.

You can get information about supportive care on NCI's Web site at https://www.cancer.gov/cancerinfo/coping and from NCI's Cancer Information Service at 1-800-4-CANCER or LiveHelp (https://www.cancer.gov/help).

Cancer Blocks the Esophagus

You may have trouble swallowing because the cancer blocks the esophagus. Not being able to swallow makes it hard or impossible to eat. It also increases the risk of food getting in your airways. This can lead to a lung infection like pneumonia. Also, not being able to swallow liquids or saliva can be very distressing.

Your health care team may suggest one or more of the following options:

Stent: You get an injection of a medicine to help you relax. The doctor places a stent (a tube made of metal mesh or plastic) in your esophagus. Food and liquid can pass through the center of the tube. However, solid foods need to be chewed well before swallowing. A large swallow of food could get stuck in the stent.
Laser therapy: A laser is a concentrated beam of intense light that kills tissue with heat. The doctor uses the laser to destroy the cancer cells blocking the esophagus. Laser therapy may make swallowing easier for a while, but you may need to repeat the treatment several weeks later.
Photodynamic therapy: You get an injection, and the drug collects in the esophageal cancer cells. Two days after the injection, the doctor uses an endoscope to shine a special light (such as a laser) on the cancer. The drug becomes active when exposed to light. Two or three days later, the doctor may check to see if the cancer cells have been killed. People getting this drug must avoid sunlight for one month or longer. Also, you may need to repeat the treatment several weeks later. You may want to read the NCI fact sheet Photodynamic Therapy for Cancer: Questions and Answers.
Radiation therapy: Radiation therapy helps shrink the tumor. If the tumor blocks the esophagus, internal radiation therapy or sometimes external radiation therapy can be used to help make swallowing easier.
Balloon dilation: The doctor inserts a tube through the blocked part of the esophagus. A balloon helps widen the opening. This method helps improve swallowing for a few days.
Other ways to get nutrition: See the Nutrition section for ways to get food when eating becomes difficult.

Pain of Esophageal Cancer

Cancer and its treatments may cause pain. It may be painful to swallow, or you may have pain in your chest from the cancer or from a stent. Your health care team or a pain control specialist can suggest ways to relieve or reduce pain. More information about pain control can be found in the NCI booklet Pain Control.

Sadness and Other Feelings

It's normal to feel sad, anxious, or confused after a diagnosis of a serious illness. Some people find it helpful to talk about their feelings. See the Sources of Support section.

Nutrition for Esophageal Cancer

It's important to meet your nutrition needs before, during, and after cancer treatment. You need the right amount of calories, protein, vitamins, and minerals. Getting the right nutrition can help you feel better and have more energy.

However, when you have esophageal cancer, it may be hard to eat for many reasons. You may be uncomfortable or tired, and you may not feel like eating. Also, the cancer may make it hard to swallow food. If you're getting chemotherapy, you may find that foods don't taste as good as they used to. You also may have side effects of treatment such as poor appetite, nausea, vomiting, or diarrhea.

If you develop problems with eating, there are a number of ways to meet your nutrition needs. A registered dietitian can help you figure out a way to get enough calories, protein, vitamins, and minerals:

A dietitian may suggest a change in the types of foods you eat. Sometimes changing the texture, fiber, and fat content of your foods can lessen your discomfort. A dietitian may also suggest a change in the portion size and meal times.
A dietitian may recommend liquid meals, such as canned nutrition beverages, milk shakes, or smoothies.
If swallowing becomes too difficult, your dietitian and your doctor may recommend that you receive nutrition through a feeding tube.
Sometimes, nutrition is provided directly into the bloodstream with intravenous nutrition.

Nutrition After Surgery of Esophageal Cancer

A registered dietitian can help you plan a diet that will meet your nutrition needs. A plan that describes the type and amount of food to eat after surgery can help you prevent weight loss and discomfort with eating.

If your stomach is removed during surgery, you may develop a problem afterward known as the dumping syndrome. This problem occurs when food or liquid enters the small intestine too fast. It can cause cramps, nausea, bloating, diarrhea, and dizziness. There are steps you can take to help control dumping syndrome:

Eat smaller meals.
Drink liquids before or after eating solid meals.
Limit very sweet foods and drinks, such as cookies, candy, soda, and juices.

Also, your health care team may suggest medicine to control the symptoms.

After surgery, you may need to take daily supplements of vitamins and minerals, such as calcium, and you may need injections of vitamin B12.

You may want to ask a registered dietitian these questions about nutrition:

How do I keep from losing too much weight? How do I know whether I'm getting enough calories and protein?
What are some sample meals that would meet my needs?
How can I include my favorite foods without causing or worsening digestive problems?
Are there foods or drinks that I should avoid?
What vitamins and minerals might I need to take?

Follow-Up Care for Esophageal Cancer

You'll need checkups after treatment for esophageal cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor.

Checkups may include a physical exam, blood tests, chest x-ray, CT scans, endoscopy, or other tests.

You may want to ask your doctor these questions after you have finished treatment:

How often will I need checkups?
Which follow-up tests do you suggest for me?
Between checkups, what health problems or symptoms should I tell you about?

Sources of Support for Esophageal Cancer

Learning you have esophageal cancer can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to need help coping with the feelings that a diagnosis of cancer can bring.

Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities. Here's where you can go for support:

Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities.

Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.

Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.

Information specialists at 1-800-4-CANCER and at LiveHelp (https://www.cancer.gov/help) can help you locate programs, services, and publications. They can send you a list of organizations that offer services to people with cancer.
For tips on coping, you may want to read the NCI booklet Taking Time: Support for People With Cancer.

Taking Part in Esophageal Cancer Research

Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective.

Research already has led to advances that have helped people live longer, and research continues. Doctors are trying to find better ways to care for people with esophageal cancer:

Surgery: Surgeons are studying whether small cuts can be used instead of long incisions. The surgeon makes small cuts in the neck, chest, and abdomen. The surgeon sees inside the chest with a laparoscope, and the cancer-containing esophagus is removed.
Chemotherapy and biological therapy: NCI is sponsoring a study of biological therapy (a monoclonal antibody) combined with chemotherapy.
Supportive care: Doctors are also testing ways to manage the problems caused by cancer and its treatment.

Even if the people in a trial do not benefit directly, they may still make an important contribution by helping doctors learn more about cancer and how to control it. Although clinical trials may pose some risks, doctors do all they can to protect their patients.

If you're interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It describes how treatment studies are carried out and explains their possible benefits and risks.

NCI's Web site includes a section on clinical trials at https://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of cancer. NCI's Information Specialists at 1-800-4-CANCER or at LiveHelp at https://www.cancer.gov/help can answer questions and provide information about clinical trials.