Esophageal Cancer Treatment
Treatment for esophageal cancer is individualized to each patient’s unique needs. Treatment options include:
- Radiation therapy: The use of X-rays, gamma rays, and charged particles to fight cancer
- Chemotherapy: The use of anticancer drugs to treat cancerous cells
- Surgery: The use of an operation to remove the cancerous tissue from the body
Combined Treatment for Esophageal Cancer
Most treatment plans for esophageal cancer involve a combined approach, which is when you receive a mix of radiation, chemotherapy, or surgical treatments, instead of just one type of treatment. Neoadjuvant therapy is a combination of therapy (usually radiation and chemotherapy) that aims to shrink tumors and prevent their reoccurrence before surgery. Treatment chemotherapy and radiation together halts the spread of microscopic tumors that have developed beyond the original tumor site.
Research also shows that patients recover more quickly from radiation and chemotherapy when they are performed before surgery rather than after. When developing the most effective treatment plan for your unique case, your doctors will consider many factors including:
- The stage of your cancer when it is discovered
- Your overall health and nutrition levels
- The location of the tumor site
- Your personal preferences for different treatment options
The type of treatments that your doctor can recommend will depend upon the stage of your cancer and your overall health. The following description sums up the treatment options for each stage of esophageal cancer:
Treatment of stage 0 esophagus cancer
A stage 0 esophageal tumor consists of abnormal cells known as high-grade dysplasia and is a pre-cancer category. The abnormal cells are similar in appearance to cancer cells but they are only present in the inner layer of the esophagus cell lining known as the epithelium. The cancerous cells do not yet grow into deeper layers of the esophagus. The treatment options typically involve endoscopic treatments such as radiofrequency ablation (RFA), endoscopic mucosal resection (EMR), and photodynamic therapy (PDT).
Long-term treatment along with frequent upper endoscopy is very crucial after endoscopic treatment to carry on to look for pre-cancer cells in the esophagus. Another treatment option is the removal of the abnormal cell growth portion of the esophagus with an esophagectomy. Esophagectomy is a major surgical procedure with one advantage that it does not need a lifelong follow-up check-up with endoscopy.
Treatment of stage 1 esophagus cancer
At stage 1, the esophagus cancer cells already grow into some of the deepest layers if the esophageal lining but does not reach other organs or the lymph nodes. Following is the detail of two sub-stages of stage 1 esophagus cancer:
- T1 cancer
Some early-stage 1 cancer patients that are only present in a tiny area of the mucosa and do not grow into the submucosa can get treatment with EMR along with another form of an endoscopic procedure such as ablation. Ablation helps to destruct any remaining abnormal portions in the esophageal lining. Sometimes, the ablation procedure alone is just enough to treat patients with T1 tumor cells. However, most people with T1 esophagus cancer are healthy enough to have surgery like esophagectomy to remove the area of their esophagus that carries cancer. Radiation and chemotherapy therapy together can be a recommendation after surgery if there are symptoms that there are some cancer cells still present.
- T2 cancer
For esophagus cancer patients who suffer from T2 tumor invasion in the muscular propia, a treatment involving chemoradiation is often a recommendation prior to surgery. Only surgery can be a treatment option for tumors smaller than 2 cm. however, if the cancer is in the area of the esophagus near the stomach, chemotherapy without radiation might be given prior to surgery. Despite that, if lab tests after surgery and chemoradiation indicate that some cancer might be left behind, then treatment through an immunotherapy drug such as nivolumab might be an option.
Treating stages 2 and 3 esophagus cancer
Stage 2 involves cancerous cells that grow into the major muscular layer of the esophagus or the connective tissue on the outer side of the esophagus. In addition, stage 2 also includes the spread of cancerous cells to the nearby lymph nodes. Stage 3 on the other hand involves cancer cells that are growing throughout the esophagus wall towards the outer layer as well as into the surrounding tissues and organs. The cancer cells at stage 3 esophagus cancer also affect the nearby lymph nodes.
In the case of people who are healthy enough, treatment involves chemoradiation along with surgery. However, in patients having adenocarcinoma at the area where the esophagus and the stomach meet, the gastroesophageal junction sometimes needs surgery along with chemotherapy. Even after surgery as the first option for treatment, some patients might also need chemoradiation afterward, particularly if the cancer is adenocarcinoma with signs of some leftover cancer.
Treating stage 4 of esophagus cancer
Stage 4 of esophagus cancer spreads to distant lymph nodes or organs. The cancerous cells at stage 4 esophageal cancer in general are very difficult to get rid of entirely. Therefore, surgery is usually not a good option to treat stage 4 cancer. The treatment typically aims to help keep the cancerous cells under control and to relieve any symptoms for as long as possible. Chemotherapy might be an option with targeted drug therapy to help patients live longer and feel better. Radiation therapy might also be helpful in providing relief against pain and troubled swallowing symptoms. A targeted drug like Larotrectinib or entrectinib might be an option if the cancerous cells have some gene changes.
Treating recurrent esophagus cancer
The recurrence of esophageal cancer might be local meaning near the initial tumor area, or it might be distant. Treatment for recurrent esophageal cancer depends on what previous treatments were in practice and the area of recurrence as well as a person’s wishes for further treatment and overall health. For local recurrence of esophageal cancer, surgery might be helpful to remove the cancerous parts of the esophagus. Esophageal cancer that recurs in the distant organs or tissues of the body needs a stage 4 esophageal cancer treatment.