Esophageal Cancer: Treatment Choices

There are many treatment choices for esophageal cancer. Which may work best for you? It depends on a number of factors. These include the type, size, location, and stage of your cancer. Factors also include your age, overall health, side effects, and your preferences.

Learning about your treatment choices

You may have questions and concerns about your treatment choices. You may also want to know how you’ll feel, how your body will look and work after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. Your provider can tell you what your treatment choices are, how well they’re expected to work, and what the risks and side effects are. Your healthcare provider may suggest a specific treatment. Or you may be offered more than one choice and have to decide on which you’d like to use. It can be hard to make this decision. It's important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your choices. You may want to get a second opinion before deciding on your treatment plan. And you may want to involve your family and friends in this process.

Understanding the goals of treatment for esophageal cancer

For some esophageal cancers, the goal of treatment is to cure the cancer. If a cure isn’t possible, you may get treatment to help shrink the tumor. Or treatment may keep it under control for as long as possible. Treatment can also improve your quality of life. It does this by helping to control the problems caused by the cancer, like bleeding or trouble swallowing. The goals of treatment include:

• Removing or destroying the cancer in the esophagus

• Removing or destroying tumors in other parts of your body

• Killing or stopping the growth or spread of esophageal cancer cells

• Preventing or delaying the cancer's return

• Easing symptoms from the cancer. These can include pain, trouble swallowing, or pressure on other organs.

Types of treatment for esophageal cancer

Many kinds of treatment can be used for esophageal cancer. You may get a combination of different treatments. The treatments used depend on a number of factors, such as: 

• The type of esophageal cancer

• Where the cancer is in the esophagus

• The stage (extent) of the cancer (how big it is and if it has spread)

• Your age

• Your overall health

• Your concerns and preferences

Some of the most common treatments used are listed below.

Surgery

This is the most common treatment for early stage esophageal cancer, especially if it's in the lower part of the esophagus. Surgery may cure the cancer at this stage because the cancer is small and only in the esophagus.

Even when the cancer can’t be cured, surgery might be used to help ease symptoms caused by the tumor, like pain or bleeding. It can also be done to put in a feeding tube if you're not able to swallow.

Radiation therapy 

This treatment is most often used along with chemotherapy, either before or after surgery. Radiation and chemotherapy before surgery can help shrink a tumor. This can make it easier to take out. After surgery, radiation and chemotherapy can kill cancer cells that might be left. It may also be used as part of the main treatment in people who can't have surgery. It may be used to help relieve symptoms in people with advanced cancer, too.  

Chemotherapy and targeted therapy

For esophageal cancer, chemotherapy is often used with radiation. It may be used before or after surgery. Or it may be part of the treatment for people who can't have surgery.

Targeted therapy medicines work differently from standard chemotherapy medicines. Targeted therapy may be useful for some people. These medicines target certain gene changes in the cancer cells. (Your cancer cells will be tested to see if they have these changes.)

Both of these treatments can be used to treat cancers that have spread beyond the esophagus.

Endoscopic treatments

These treatments are done using an endoscope. This is a thin, flexible, lighted tube that's put in your mouth and slid into your esophagus. Endoscopic treatments can be used to help relieve symptoms caused by the cancer. These include using photodynamic therapy, freezing (cryotherapy), a laser, or an electric current (electrocoagulation) to kill cancer cells in your esophagus. An endoscope can also be used to put in a stent. This is a small metal tube that's put in to keep your esophagus open.

Palliative treatment

Your healthcare provider may suggest treatments that help ease your symptoms, but don’t treat the cancer. This is called palliative care. It's often used with other treatments. For instance, pain medicine can be a palliative treatment.

Or your healthcare provider may suggest that you get only palliative care if they believe that treatments are likely to cause you more harm than good.

Immunotherapy

Immunotherapy medicines help your body's natural immune system find and kill cancer cells. Medicines called immune checkpoint inhibitors may be used to treat advanced esophageal cancer. These medicines are given through intravenous infusion. These medicines may be given alone or with chemotherapy or targeted therapy.

Clinical trials for new treatments

Researchers are always looking for new ways to treat esophageal cancer. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare provider

Thinking about treatment choices may seem overwhelming. Ask how you can learn more about your choices. Talk with your healthcare team and loved ones. Make a list of questions. Think about the benefits, risks, and side effects of each choice. Talk about your concerns with your healthcare provider before making a decision.