Esophageal Cancer Treatment Options

Esophageal cancer treatment depends on three things: the stage, the cell type, and where the tumor sits. Squamous cell carcinoma and adenocarcinoma are treated somewhat differently. Your team also weighs your overall health. Some of these treatments are demanding.

Some esophageal cancers are found very early. At this point, the cancer is still confined to the inner lining. Doctors can sometimes remove these through an endoscope. That is a thin tube passed down the throat. No open surgery is needed. This is called endoscopic mucosal resection, or endoscopic submucosal dissection for a deeper cut. Another tool, radiofrequency ablation, uses heat to destroy abnormal tissue in the lining. These options avoid a major operation. They only work when cancer has not grown deep or spread.

Surgery is often central to the plan for cancer that has grown deeper but has not spread far. The operation is called an esophagectomy. A surgeon removes the part of the esophagus with the tumor. Nearby lymph nodes come out too. The remaining esophagus is then reconnected. NCI says the doctor connects the remaining healthy part of the esophagus to the stomach so you can still swallow. This is a major operation. Your team will explain what to expect for eating, digestion, and daily life afterward.

Sometimes cancer has grown into deeper layers or reached nearby lymph nodes, but has not spread to distant organs. Doctors usually treat this with more than surgery alone. Chemotherapy and radiation are often given together first. This is called chemoradiation. NCI says it combines the two to increase the effects of both. Because it comes before the main treatment, doctors call this step neoadjuvant treatment. Surgery can follow.

Sometimes a small amount of cancer remains in the tissue removed during surgery. When that happens, NCI lists nivolumab, an immunotherapy drug, as a treatment for people who had chemoradiation and then surgery, but cancer cells were found in the removed tumor or lymph nodes. Ask your team whether it applies to you and how long it would last.

Some tumors cannot be safely removed by surgery. This can be due to their location or size. It can also be due to a person's overall health. In that situation, chemoradiation alone can become the main treatment. The goal shifts to controlling the cancer for as long as possible, rather than removing it.

Once esophageal cancer has spread to distant organs, removing the tumor is no longer the goal. Treatment shifts to drugs that travel through the bloodstream. These drugs reach cancer cells wherever they are.

NCI lists chemotherapy, immunotherapy and chemotherapy with immunotherapy as options for advanced disease. Nivolumab is a type of PD-1 inhibitor, a kind of immune checkpoint inhibitor. These drugs help the immune system fight cancer.

Tumor testing also guides treatment. Some gastroesophageal cancers make too much of a protein called HER2. NCI's clinician summary describes HER2-targeted drugs, including trastuzumab, in this setting. The FDA has approved pembrolizumab with trastuzumab and chemotherapy as first-line treatment for adults with locally advanced unresectable or metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma whose tumors also make the protein PD-L1. Ask your team which tumor tests apply to you.

Treatment can still ease symptoms and improve daily life, even when a cure is not possible. NCI says an expandable metal stent (tube) may be placed inside the esophagus to help keep it open. This helps when a tumor is narrowing it and making swallowing hard. ACS notes radiation can help when the cancer makes it hard to swallow or eat. NCI says some people may need a feeding tube. This is not a lesser form of care. It is care aimed at comfort and function. It can be combined with cancer-directed treatment too.

• What is the stage and cell type of my cancer, and how does that shape my plan?
• Will I have chemotherapy or radiation before surgery, after it, or both?
• Has my tumor been tested for HER2, and would that change my options?
• If a cure is not the goal, what can be done to help me eat and feel better?
• What does recovery from surgery actually look like, day to day?
• Is a clinical trial a reasonable option for me?

• National Cancer Institute — Esophageal Cancer Treatment (PDQ) Patient Version
• American Cancer Society — Treatment of Esophagus Cancer
• NCI — Nivolumab
• NCI — Esophageal Cancer Treatment (PDQ) Health Professional Version
• FDA — Pembrolizumab with trastuzumab and chemotherapy for HER2-positive gastric or gastroesophageal junction adenocarcinoma