Esophageal Cancer Recurrence: What to Ask

This page is for people whose esophageal cancer may have come back, and their families. It covers the symptoms, where the cancer tends to return, what NCI lists for treatment, and questions to bring to clinic.

Trouble swallowing is a symptom to report right away. ACS says it can mean the cancer is coming back, or it can be a late side effect of treatment.

Some people have a later narrowing of the esophagus, called a stricture. ACS says it can be helped with procedures that open the area, such as dilation or a stent. The cancer coming back can also cause it.

Follow-up can include a physical exam, imaging, blood tests, and endoscopy (a thin camera passed down the throat). Ask which one is being ordered and what result would change the plan.

ACS says a recurrence may be local, near the first tumor, or in distant organs. After surgery, it can come back in nearby lymph nodes.

Treatment depends on where it comes back and what treatment you have already had. Ask your team to say it plainly.

Be prepared for a short list. For recurrent esophageal cancer, NCI names three things. Certain treatments used to ease symptoms. Nivolumab and chemoimmunotherapy for squamous cell disease (cancer that starts in the flat cells lining the esophagus). And clinical trials. NCI says everyone with recurrent disease should think about a trial.

That is narrower than many people expect, and it is worth knowing why. A patient summary lists what applies broadly. It does not rule out what is not printed. ACS says options depend on where the cancer returns, what you had before, and your health and wishes. For example, ACS says that if the cancer returns nearby after surgery, radiation may not be an option if you already had it. More chemotherapy is usually still possible if you had it before. Other options might include more surgery. Those are specialist judgments, not something a summary can settle.

NCI also describes treatments to relieve symptoms. These are an esophageal stent, laser therapy or an electric current (electrocoagulation) to destroy tumor, radiation with a tube to keep the esophagus open, and esophageal brachytherapy, where a radiation source is placed inside the esophagus. They are aimed at swallowing and quality of life.

NCI's clinician summary describes CheckMate 577. In that trial, a year of nivolumab after surgery improved disease-free survival in people whose removed tissue did not show a complete response. It also notes that overall survival results were not published.

If your cancer returned while you were taking it, say so early. It is part of your treatment history.

• Is my swallowing worse from a narrowing or from cancer?
• Which test will settle that, and when can I have it?
• Is the recurrence near the first tumor, in nodes, or elsewhere?
• Is my cancer squamous cell or adenocarcinoma?
• Does that make immunotherapy an option now?
• What can be done this month for swallowing: a stent, dilation, or radiation?
• Should the new tissue be biopsied and tested again?

Ask what the goal of the next treatment is. Comfort, control and cure are different goals, and the answer should be said out loud.

• Call 911 or go to an emergency department if you are gasping, choking, or cannot get words out. Do not drive yourself.
• Call 911 or go to an emergency department if you vomit blood, or you vomit something that looks like coffee grounds (MedlinePlus). Do not drive yourself.
• Call 911 or go to an emergency department if your stools turn black and tarry, or you pass a lot of blood in your stool. These can be signs of bleeding in the gut (MedlinePlus). Do not drive yourself.
• Call 911 or go to an emergency department if nothing will go down at all, including your own saliva. Do not drive yourself.
• Call your care team right away if you see any blood in your stool or a change in its color, including dark red (MedlinePlus).
• Call your care team right away if swallowing is getting harder again, you cough or choke while eating or drinking, or food feels stuck after meals. ACS says to report trouble swallowing right away.
• Call your care team right away if you have been vomiting for more than two days or cannot keep fluids down.
• Call your care team within a day or two if you are losing weight without trying.

If you are on chemotherapy, have had a stem cell transplant or CAR T, or have low white cells, call right away, day or night, for a temperature of 100.4°F (38°C) or higher, chills, a sore throat, mouth sores, or any other sign of infection. A normal temperature is not a reason to wait (CDC).

Cancer Staging and Biomarker Testing explain the terms that come up most when esophageal cancer comes back. Clinical Trial vs Standard Treatment, Palliative Care, and Questions to Ask Your Doctor cover the decisions that follow an esophageal cancer recurrence.

These questions were drawn from current patient guidance for esophageal cancer:

• NCI — Esophageal Cancer Treatment (PDQ) Patient Version
• NCI — Esophageal Cancer Treatment by Stage, including recurrent disease
• NCI — Esophageal Cancer Treatment (PDQ) Health Professional Version
• ACS — Treating Esophageal Cancer
• ACS — Living as an Esophageal Cancer Survivor (Follow-up Care)
• MedlinePlus — Gastrointestinal bleeding
• MedlinePlus — Black or tarry stools
• CDC — Signs and Symptoms of Infection (Preventing Infections in People With Cancer)