Esophageal Cancer

Treatment

Tremendous advances have occurred in esophageal cancer treatment over the past decade. Mayo Clinic offers an exceptionally comprehensive treatment program that makes full use of the latest therapies. You and your family are actively involved in all treatment decisions and work with an integrated team of specialists who have expertise in every aspect of cancer care.

Endoscopic therapies

At Mayo Clinic, early esophageal cancer is often treated with endoscopic therapies rather than with surgery. Mayo Clinic physicians are among the world's most experienced in the use of these techniques, which preserve the esophagus, cause minimal trauma and have a low risk of complications. Most people need a minimum of three endoscopic treatments, spaced eight to twelve weeks apart, to remove abnormal cells and allow healthy, new cells to grow in their place.

Specialists at all three Mayo Clinic sites offer advanced endoscopic treatments and precisely tailor them to meet the needs of each patient. These therapies include:

• Endoscopic mucosal resection: Mayo Clinic was one of the first institutions in the United States to use endoscopic mucosal resection to both diagnose and treat early esophageal cancer and Barrett's esophagus Barrett's esophagus, a condition that can lead to esophageal cancer in some people. During EMR, a saline solution is injected under a nodule or lesion in the esophagus. The solution forms a blister that allows doctors to cut or suction away the lesion, while leaving the rest of the esophagus intact. Patients who undergo this procedure at Mayo have the same outcomes as people who undergo surgery to remove the entire esophagus. Mayo Clinic also has the lowest EMR complication rates of any medical center in the world.
• Radiofrequency ablation (RFA): In this outpatient procedure, controlled bursts of radiofrequency energy burn away thin layers of abnormal tissue on the surface of the esophagus, leaving healthy tissue intact. Radiofrequency ablation takes about 45 minutes, and you can usually return to your normal activities the next day, though you may experience some chest pain and difficulty swallowing for about a week.
• Cryotherapy: In this therapy, your doctor uses liquid nitrogen or carbon dioxide to freeze cancer cells in your esophagus. The frozen tissue thaws and ultimately sloughs off, allowing healthy, new tissue to grow in its place. Depending on the extent of disease and your response to treatment, sessions are repeated every two to six weeks. Most people need at least three sessions to remove all the abnormal tissue. Mayo Clinic is one of a handful of institutions in the United States offering cryotherapy as a treatment for early esophageal cancer.
• Photodynamic Therapy (PDT): Photodynamic therapy uses a light-sensitive drug and laser light to destroy cancer cells in the esophagus. Mayo Clinic physicians were the first to use PDT in humans in the 1960s, and the clinic remains a pioneer in researching and using this therapy. At the start of treatment, you're given an intravenous drug called porfimer sodium that makes cancer cells sensitive to light. A few days later, your doctor activates the drug inside your esophagus with a laser light inserted through an endoscope. The laser destroys the targeted cells without harming healthy ones. Photodynamic therapy may also be used to treat cancer that recurs after surgery, radiation or chemotherapy or in conjunction with endoscopic mucosal resection. PDT produces the deepest tissue destruction of any ablative method, but also carries a higher risk of complications.

Surgery

When cancer is more advanced, surgery to remove the esophagus (esophagectomy) is usually necessary. Mayo Clinic is one of the world's largest and most experienced medical centers for esophageal surgery, performing more than 150 esophagectomies each year. During the procedure, surgeons remove the damaged portion of the esophagus and sometimes nearby lymph nodes and the upper part of the stomach (fundus).

To re-establish the continuity of the digestive tract, the stomach is formed into a tube and pulled upward to join the remaining portion of the esophagus. Mayo Clinic surgeons offer both transhiatal esophagectomy, which is performed through the neck and abdomen and is usually effective for cancer higher in the esophagus, and transthoracic esophagectomy, which uses incisions in the abdomen and chest.

When possible, Mayo Clinic surgeons perform esophageal surgery using laparoscopic techniques. Unlike traditional open surgery, which requires long abdominal and chest or neck incisions, minimally invasive esophagectomy uses four or five small incisions that require just a stitch or two to close. This approach causes less trauma to the body, and usually leads to shorter hospital stays, reduced postoperative pain and a faster recovery. Minimally invasive esophagectomy is a complex surgery, but it can produce excellent results in the hands of a skilled surgeon. Mayo Clinic has one of the largest and most experienced minimally invasive surgery practices in the United States, performing thousands of procedures every year.

Combined-modality treatments

Depending on the extent of the cancer, Mayo Clinic physicians may recommend radiation combined with chemotherapy (chemoradiation) before or after surgery. For patients with more advanced disease, chemotherapy and radiation may be the primary treatment.

Palliative care

When cancer is so widespread that treatment options are limited, Mayo Clinic offers palliative care to ease symptoms and improve quality of life. In every case, an experienced, integrated team of care providers serves the social, psychological and spiritual needs of patients and their families. Your care team may include physicians from a number of fields as well as dietitians, medical social workers, chaplains, psychologists, pharmacists and pain management specialists. If you are facing a serious illness, your primary treatment team will consult with a Mayo Clinic palliative care expert who then works with your primary Mayo physicians to address your needs and those of your family. Mayo Clinic is committed to providing every patient with compassionate end-of-life care.