Esophageal Cancer

Treatment

Treatment for esophageal cancer depends greatly on the extent of the disease — whether or how much the tumor has spread beyond the esophagus. If the tumor is confined to the wall of the esophagus and has not spread to lymph nodes, on the basis of preoperative imaging and endoscopic ultrasonography (EUS), surgery to remove the tumor (esophagectomy) is the usual initial treatment approach. Surgery is sufficient treatment for disease of this extent. If pathology review of the surgical specimen reveals the cancer has spread beyond the esophagus wall, involved nodes or both, postoperative radiation plus concurrent and maintenance chemotherapy may also be recommended.

If the tumor extends beyond the wall of the esophagus or has spread to local or regional lymph nodes, on the basis of preoperative imaging and EUS, with no evidence of blood-borne metastasis to other sites, treatment often consists of preoperative radiation plus concurrent chemotherapy followed by surgery to remove the tumor (esophagectomy) and additional cycles of postoperative chemotherapy. Radiation and chemotherapy may also be given without surgery (primary chemoradiation) for patients who are not candidates for surgery (extent of disease, medical condition, patient's preference). A typical course of treatment with radiation and concurrent chemotherapy (preoperative, postoperative, primary chemoradiation) consists of a series of 25-30 radiation treatments delivered five days per week over 5 to 6 weeks.

Several surgical approaches are possible based on the needs and condition of the patient. These options include both open resection (standard) and laparoscopic resection. Learn more about esophagectomy.

Radiation and chemotherapy may also be given without surgery. A typical course of treatment with radiation therapy and chemotherapy takes about six weeks, but it sometimes can take longer.

If the tumor has spread to the liver or other sites, treatment is aimed at prolonging life and controlling symptoms rather than curing the disease. Swallowing problems, if severe, can be treated either by placing a metallic stent into the esophagus to keep it open or by using radiation therapy or laser therapy to shrink the tumor. Chemotherapy or other systemic therapy is usually given in an attempt to shrink the metastatic cancer and may also help in relieving swallowing problems. Mayo Clinic is commited to testing new drugs and approaches for the treatment and palliation of esophageal cancer.

For patients with early stage cancer or those who are not candidates for surgery, alternatives to surgery are available. These include:

Photodynamic therapy, a treatment in which a drug is given to make cancerous and precancerous cells sensitive to light. A light is then inserted into the esophagus using an endoscope — a thin, lighted tube with a tiny camera on the end that sends images to a TV monitor. Tissues that the light touches are burned off. Photodynamic therapy is used to treat people with Barrett's esophagus at high risk for developing cancer and to open the passage for food and improve quality of life in people with advanced, inoperable esophageal cancer.

Photodynamic therapy combined with chromoendoscopy and endoscopic mucosal resection are endoscopic procedures. Photodynamic therapy uses stains to color the mucous tissue that lines the esophagus to make it easier to see fine details. Endoscopic mucosal resection is the removal of cancerous tissue from the lining of the esophagus using an endoscope.

Multipolar electrocautery involves the use of an electric wire that is inserted into the esophagus to burn away dysplasia (excess, abnormal tissue).

Laser therapy uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Additional supportive services available to esophageal cancer patients includes:

• Psychosocial care
• Pulmonary rehabilitation
• Nutritional assessment
• On-site patient education
• Award-winning pain management