Metastatic (stage 4) esophageal cancer

Diagnósticos

Esophageal cancer usually is diagnosed with an upper endoscopy and biopsy. During an upper endoscopy, a thin, flexible tube with a camera is used to look inside the esophagus. A tissue sample, called a biopsy, can be removed and tested for cancer.

After esophageal cancer is diagnosed, more tests may be used to find out how far it has spread and to help plan treatment.

Tests may include:

• Imaging tests. CT and PET/CT scans can help show where the cancer has spread. Other imaging tests, such as MRI, may be used in some situations.
• Endoscopic ultrasound. This test uses sound waves to make detailed images of the esophagus and nearby lymph nodes. It may be used when the healthcare team needs more information about how far the cancer has spread.
• Biopsy of an area where cancer has spread. A tissue sample from another part of the body may be tested when needed to confirm that the cancer has spread.

Tumor tissue also may be tested for certain features that can help guide treatment. These features, called biomarkers, may help show whether targeted therapy or immunotherapy is likely to help.

Tratamientos

Treatment for metastatic esophageal cancer focuses on slowing or controlling the cancer, helping people live longer and relieving symptoms. The treatment plan depends on the type of esophageal cancer, where it has spread, a person's overall health and results of tests on the tumor.

Treatment for metastatic esophageal cancer has changed in recent years. Immunotherapy now is used for some people, either with chemotherapy or with another immunotherapy medicine. Testing the tumor also can identify features that may be treated with targeted medicines. These treatment options and test results can help the healthcare team choose treatment based on the type of cancer and its test results.

Chemotherapy

Chemotherapy uses medicines to kill cancer cells or slow their growth. It may be used alone or as part of a combination treatment for metastatic esophageal cancer.

Immunotherapy

Immunotherapy helps the immune system recognize and attack cancer cells. Some medicines that fall into this class include pembrolizumab (Keytruda), nivolumab (Opdivo) and ipilimumab (Yervoy). Which immunotherapy is used depends on the type of esophageal cancer and results of tumor testing. When a person has the right markers for these medicines, these treatments have improved survival compared with chemotherapy alone in large studies.

Targeted therapy

Targeted therapy uses medicines that attack specific features of cancer cells.

Some esophageal adenocarcinomas have high levels of a protein called HER2, which can help cancer cells grow. These cancers are called HER2 positive. HER2-positive cancers may be treated with a HER2-targeted medicine along with chemotherapy and, in some cases, immunotherapy.

Radiation therapy

Radiation therapy may be used to shrink tumors, relieve pain or make swallowing easier. It also may be used to treat selected areas where the cancer has spread.

Proton beam therapy is one type of radiation therapy. It can reduce radiation exposure to some nearby healthy tissues compared with traditional photon radiation. Most studies of proton beam therapy for esophageal cancer have involved localized or locally advanced disease, so its role in metastatic esophageal cancer is less clear.

Treatments to help with swallowing

If a tumor narrows the esophagus, treatment may be needed to make swallowing easier. Options may include radiation therapy, an esophageal stent or other procedures performed through an endoscope.

Palliative care

Palliative care is specialized care that focuses on easing symptoms and improving quality of life. It can be given at the same time as treatments intended to control the cancer. Early palliative care may help with symptoms, nutrition, emotional distress and decisions about treatment.

If you have metastatic esophageal cancer, you may need help managing issues such as pain, nausea, trouble eating, weight loss or bleeding. Palliative care specialists work with the cancer care team to help manage these issues and support you and your family throughout treatment.

Surgery

Surgery usually is not used to treat widespread metastatic esophageal cancer. For some people whose cancer has spread to only a few areas, surgery or another treatment such as radiation to those areas may be an option after treatment with medicines. Ask your healthcare team if surgery has a role in your care.

Clinical trials

Clinical trials are studies of new treatments. They can be an important part of care for people with metastatic esophageal cancer. Trials may study new medicines, new treatment combinations or treatments aimed at specific features of cancer cells. Ask your healthcare team whether a clinical trial may be an option for you.

Estudios clínicos

Explora los estudios de Mayo Clinic que ensayan nuevos tratamientos, intervenciones y pruebas para prevenir, detectar, tratar o controlar esta afección.

Self-care

Living with metastatic esophageal cancer can make eating and drinking difficult. Trouble swallowing can lead to weight loss and malnutrition.

These steps may help:

• Choose foods and drinks that are easier to swallow.
• Eat smaller meals more often if large meals are difficult.
• Tell your healthcare team if swallowing becomes harder or if you are losing weight.
• Ask whether a dietitian can help you find foods and drinks that provide enough calories and protein.
• Report new or worsening pain, shortness of breath, vomiting, or other symptoms so they can be treated.

Estrategias de afrontamiento y apoyo

Living with metastatic esophageal cancer can be difficult for both the people with cancer and those close to them. Support can help with emotional concerns, practical needs and decisions about care.

Palliative care can help manage symptoms and support quality of life at any point during treatment. It also can help with communication about treatment goals and care preferences.

Support also may come from family, friends, social workers, counselors, spiritual care professionals and cancer support groups.

Mayo Clinic Connect offers an online community where people affected by esophageal cancer can share experiences and support one another. Hearing from others living with esophageal cancer may help you feel less alone. You also can learn how others have handled treatment and day-to-day challenges.

Preparación para la consulta

Before an appointment, write down your questions and any changes you have noticed. Consider bringing someone with you to listen and take notes.

What you can do

Bring information that may help your healthcare team understand how you are doing. This may include:

• A list of medicines, vitamins and supplements you take.
• A list of new or worsening symptoms.
• Notes about side effects from treatment.
• Changes in your weight or ability to eat and drink.
• Results of tumor or genetic testing done elsewhere.
• Your most important questions.

Questions you may want to ask include:

• Where has my cancer spread?
• What is the goal of treatment?
• What treatments are reasonable for me?
• What benefit might I expect from treatment?
• What side effects are most important to know about?
• How will we know whether treatment is working?
• What do my tumor test results mean for treatment?

Additional questions may include:

• Could targeted therapy or immunotherapy be an option for me?
• Is there a clinical trial I could consider?
• What can be done if swallowing becomes more difficult?
• Who should I call if my symptoms get worse?
• Can palliative care help me now?
• Can you help me understand my prognosis based on my health and how the cancer is responding?

What to expect from your doctor

Your healthcare team may ask about:

• Trouble swallowing and how much you are able to eat and drink.
• Weight loss.
• Pain or other symptoms.
• Side effects from treatment.
• Your ability to carry out daily activities.
• Your priorities and goals for care.

Tell your healthcare team what matters most to you. Your goals and preferences can help guide treatment decisions.