Esophageal Cancer Treatment Options
Various treatment options exist for patients diagnosed with esophagus cancer, a type of gastrointestinal cancer. These options can include participation in clinical trials. The right treatment plan for each patient will be created based on the stage and location of the cancer by our gastrointestinal (GI) cancer doctors. Most patients receive a combination of therapies.
How the Stage of Esophageal Cancer Affects Treatment
Esophageal cancer is often found at a later stage because it rarely shows symptoms at earlier stages. However, if it’s diagnosed at stage 0 or stage I, surgery is usually the first treatment option.
For stage II or III esophageal cancers, radiation therapy and chemotherapy are included in the treatment plan along with surgery. Chemotherapy and radiation can be done before or after surgery.
If the cancer has spread to distant areas, treatment will focus on chemotherapy (with or without radiation) as well as targeted therapies and immunotherapy. The goals of Stage IV cancer are to slow the cancer’s growth and help manage symptoms.
If surgery is not possible, treatments are still used based on the stage. Earlier stages will still use chemotherapy and radiation therapy. Later stages (III and IV) will use systemic therapies, including chemo, immunotherapy, and targeted therapies, to kill cancer cells. In most cases, a combination of these drugs is used.
The Compass Oncology GI cancer team works together to review each patient’s needs and create a personalized treatment plan for you based on the stage of esophageal cancer.
Esophageal Cancer Treatments
The main treatment options for esophageal cancer include:
Surgery for Esophageal Cancer
Surgically removing the cancer and some healthy nearby tissue is a common treatment approach for early-stage esophageal cancers. This surgery, called an esophagectomy, removes part or most of the esophagus, nearby lymph nodes, and a small section of the stomach. The upper part of the esophagus is then connected to the remaining stomach, with part of the stomach moved into the chest or neck to act as a new esophagus.
The location of the tumor and its stage will determine how much of the esophagus should be removed. Only a small part of the esophagus will be taken out if the cancer is contained in the lower section. If the tumor is in the upper or middle section, most of the esophagus will likely need to be removed.
Doctors typically prefer to perform esophagectomies using a minimally invasive, laparoscopic approach involving fewer and smaller cuts. If necessary, they will use a traditional open technique, which requires one or more large incisions in the neck, chest, or abdomen.
Radiation Therapy for Esophageal Cancer
Radiation therapy uses high-energy radiation to kill cancer cells. It is often used together with other treatments like chemotherapy and surgery for esophageal cancer.
Radiation therapy may be used in the following ways:
- Main treatment: For patients who cannot have surgery due to health issues or personal choice, radiation therapy may be given with chemotherapy (known as chemoradiation).
- Before surgery (neoadjuvant treatment): Radiation therapy, often with chemotherapy, can be given before surgery to shrink the tumor, making it easier to remove.
- After surgery (adjuvant treatment): After surgery, radiation therapy may be used with chemotherapy to kill any leftover cancer cells that are too small to see on scans.
- For advanced cancers: If cancer has spread to organs like the liver, radiation can help relieve symptoms and may improve the patient’s quality of life (palliative treatment).
Most of the time, radiation for esophagus cancer is given from outside the body using a machine called a linear accelerator. However, some individuals may benefit more from internal radiation (brachytherapy). Brachytherapy involves placing radioactive material close to the cancer using an endoscope.
The radiation oncologist works with your medical oncologist to determine the best time for radiation treatments and how many are needed. They will also decide if radiation should be used before or after surgery – or both.
Chemotherapy for Esophageal Cancer
Chemotherapy uses anti-cancer drugs that travel through the bloodstream to reach cancer cells throughout the body. These drugs can be injected into a vein or taken by mouth.
Chemotherapy alone usually cannot cure esophageal cancer. It is often used with radiation therapy before surgery to shrink the tumor, after surgery to eliminate any remaining cancer cells, or for palliative care.
Targeted Therapy Drugs for Esophageal Cancer
Targeted therapy uses drugs that specifically attack certain cancer cells. These drugs work differently than standard chemotherapy.
To see how well you might respond to targeted therapies, your doctor may suggest biomarker testing to find any unusual proteins or genetic mutations. This testing helps your treatment team choose drugs that target the genetic mutations in the tumor.
Monoclonal antibody therapy is a type of targeted therapy used in the treatment of esophageal cancer. These drugs target the HER2 protein, which can fuel the growth of cancer cells. Cancers with increased levels of HER2 are called HER2-positive.
Immunotherapy for Esophageal Cancer
Immunotherapy uses medications to boost your immune system’s ability to find and destroy cancer cells more effectively. Some patients with esophageal cancer can benefit from immune checkpoint inhibitors, an immunotherapy that can help restore the immune response against esophageal cancer cells.
Checkpoint inhibitors are a type of immunotherapy that has been shown to be effective in treating advanced or recurrent esophageal cancer.
The immune system uses "checkpoint" proteins on immune cells, such as T cells, to help regulate immune responses. Cancer cells sometimes use these checkpoints to trick the immune system into thinking they are healthy cells. Immune checkpoint inhibitors block these proteins, allowing the T cells to better target and kill cancer cells.
Checkpoint inhibitor immunotherapies can block proteins including the PD-1 protein and the CTLA-4 protein.
Immunotherapy drugs are typically administered intravenously. They are often used in combination with one another or with other esophageal cancer treatments, such as chemotherapy.
Endoscopic Treatments
Some patients with esophageal cancer may be able to have endoscopic treatments. These procedures use an endoscope, a thin tube with a light and camera, placed down the throat into the esophagus. Different types of endoscopic treatments may be used to try to treat early-stage cancer, help prevent cancer from developing, or relieve symptoms from advanced esophageal cancers that can't be surgically removed.
- Endoscopic mucosal resection (EMR): This procedure removes a section of the inner lining of the esophagus. After removing abnormal tissue, doctors prescribe proton pump inhibitors to reduce stomach acid and help prevent the disease from returning.
- Photodynamic therapy (PDT): This treatment uses a drug activated by light, called a photosensitizer, to kill cancer cells.
- Radiofrequency ablation (RFA): This procedure uses radio waves to heat and destroy abnormal cells via electrodes that carry electricity.
Endoscopic treatments can also help keep the esophagus open:
- Laser ablation: A laser beam targets the cancer through the endoscope and destroys cancerous tissue.
- Argon plasma coagulation: This method uses ionized argon gas and an electrical current to remove growths.
- Electrocoagulation: An electric current is used to burn off the tumor, and a probe is inserted through the endoscope into the esophagus.
- Esophageal stent: A stent, which is a small, expandable tube, may be placed in the esophagus across the tumor to keep it open.
Advances in Esophageal Cancer Treatments and Clinical Trials
The doctors at Compass Oncology are dedicated to exploring new therapies by offering access to clinical research trials at our cancer centers. This commitment includes participation in research and clinical trials.
Clinical trials are an essential part of paving the way for advancements in treating esophagus cancer. By participating in clinical trials, patients help researchers determine whether new cancer treatments are safe and effective or better than the current standard protocols.
Compass Oncology is a leading referral source for cancer-specific clinical trials in the pacific northwest region. We offer clinical trials that are not available anywhere else in the Portland and Vancouver area through Sarah Cannon Research Institute (SCRI), one of the world’s leading oncology research organizations conducting community-based clinical trials. SCRI has contributed to pivotal research that has led to the majority of new cancer therapies approved by the FDA today.
These treatments may include:
- Personalized vaccine approaches
- Novel immunotherapy combinations
- Targeted therapies based on specific genetic mutations
If you are interested in participating in a clinical trial, be sure to talk to a member of your cancer care team to see if you are eligible.
Support Services For Patients Undergoing Treatment for Esophageal Cancer
At Compass Oncology, we are committed to ensuring that our esophageal cancer patients receive the support they need along the way. We offer a range of multidisciplinary care and support services so you can better manage the physical and emotional challenges associated with esophageal cancer:
Nutritional Counseling
Our registered dietitian at Compass Oncology helps our patients undergoing esophageal cancer treatment understand how to get the nutrition they need, especially when that patient is experiencing difficulty with swallowing.
Speech and Swallowing Therapy
Our specialists are available to help you manage speech and swallowing difficulties caused by the nature of the disease and how it's treated. Finding better ways to manage these challenges can improve your overall quality of life.
Palliative Care
Our palliative care team collaborates with your oncologist and other healthcare providers to focus on preventing, managing, and relieving cancer symptoms and the side effects of treatment.
Psychological Support
Patients have access to counseling services that address emotional and spiritual needs. We also provide resources regarding support groups that help patients and families cope with the emotional impact of cancer diagnosis and its treatment.
Financial Counseling
Financial specialists at Compass Oncology are here to assist you with questions about treatment costs and to manage insurance inquiries, verifications, and claims processing.
The Latest Esophageal Cancer Treatments are Available in Portland & Vancouver
If you or a loved one has recently been diagnosed with GI cancer, such as esophageal cancer, the GI oncologists at Compass Oncology are here to help you understand your unique diagnosis. We care for patients with GI cancers in the Portland, OR, and Vancouver, WA, areas. Find a cancer center near you to schedule a consultation.
