There are a variety of treatments for esophageal cancer, a form of cancer that affects your esophagus, or food pipe (the organ that connects your stomach to your throat).
If you’ve recently been diagnosed with esophageal cancer, your healthcare team will help you choose from the best treatment options available and decide on a path that works for you. Always speak with your healthcare professional before starting a new treatment, combining treatments, taking a new medication, or taking supplements as part of your treatment plan.
Doctors often recommend surgery to treat esophageal cancer that hasn’t spread to other parts of your body (early-stage esophageal cancer).
Depending on how invasive the procedure is, there are two main types of surgery for esophageal cancer.
Open Esophagectomy
Esophagectomy is the main type of surgery that’s used in early-stage esophageal cancer. During the operation, depending on where the cancer tumor is and how much of your esophagus is affected, the surgeon may remove:
The affected part of the esophagus
The nearby lymph nodes, if the cancer has spread there
Part of the stomach
Esophagectomy is usually done as an open, invasive surgery, which involves making several incisions (cuts) in the neck, chest, or belly. You’ll likely need to be hospitalized for a few weeks after the surgery.
Keyhole Esophagectomy
Esophagectomy can also be done as laparoscopy (keyhole surgery), which is a minimally invasive surgery.This involves making small incisions as opposed to the larger ones done in open surgery. Then, the surgeon will insert a small laparoscope (a thin tube with a light and a camera at the end of it) and small surgical instruments through these small incisions.
Minimally invasive surgery can mean faster recovery and less time spent in the hospital.
But esophageal cancer must be detected very early for this surgery to be effective.
Endoscopic Mucosal Resection (EMR)
In order to perform an endoscopic mucosal resection (EMR), specialists use an endoscope (a long, thin, flexible tube with a camera at the end of it, similar to a laparoscope).
During the procedure, the endoscope is passed down through your esophagus. Small surgical instruments are attached to it, and doctors use these instruments to remove the parts of your inner mucosa (the lining of the esophagus) that have been affected by cancer.
EMR is used for treating precancerous cells in your esophagus (a condition called dysplasia or Barrett’s esophagus). It’s also used for treating early stages of esophageal cancer.
Chemotherapy works by killing off cancer cells or stopping them from dividing and spreading. They are usually given as a combination of two or more drugs.
Chemotherapy drugs can be taken either by mouth or intravenously. Common chemo agents used for esophageal cancer include:
capecitabine (Xeloda)
carboplatin (Paraplatin)
cisplatin (Platinol)
docetaxel (Taxotere)
epirubicin (Ellence)
luorouracil (5FU)
oxaliplatin (Eloxatin)
paclitaxel (Taxol)
Common side effects include fatigue, nausea, vomiting, loss of appetite, diarrhea or constipation, mouth sores, hair loss, and an increased risk of infections.
There are two main types of radiation therapy, or radiotherapy, used for treating esophageal cancer: internal and external.
Internal radiation therapy may use needles or catheters to deliver a radioactive substance that can kill off localized cancer cells. External radiation uses a machine, called a linear accelerator, to deliver a beam of radiation to the affected area.
Your healthcare team may also recommend a combination of radiotherapy and chemotherapy (also known as radiochemotherapy or chemoradiotherapy), depending on your unique circumstances. This is particularly helpful in more advanced cases — and, depending on where the cancer is found, radiochemotherapy may also be recommended alongside surgery.
The chemotherapy drugs that are most commonly combined with radiotherapy for esophageal cancer include:
5-fluorouracil, or 5-FU (Adrucil)
carboplatin (Paraplatin)
cisplatin (Platinol)
paclitaxel (Taxol)
Targeted therapies are cutting-edge treatments that can help some forms of esophageal cancer, says Wasif Saif, MD, MBBS, a medical oncologist at Karmanos Cancer Institute in Detroit. Targeted therapy options for esophageal cancer include monoclonal antibodies, antibody-drug conjugates, and TRK inhibitors.
Monoclonal Antibodies
Monoclonal antibodies are lab-produced proteins that act like the antibodies in our bodies. They seek out certain targets on cells and stimulate the immune system to destroy them.
Trastuzumab (Herceptin, Herzuma, Kanjinti) is a monoclonal antibody that targets the HER2 protein. It’s given as an IV infusion once every three weeks, along with chemo. Side effects include fever, chills, cough, and headache.
Ramucirumab (Cyramza) blocks the process of making new blood vessels, which can help slow or stop the growth of cancer. It’s given as an IV infusion every two weeks. Side effects include fatigue, high blood pressure, swelling of the arms or legs, and protein in the urine. Serious side effects include blood clots, severe bleeding, and perforations in the stomach or intestines.
Zolbetuximab (Vyloy) targets claudin 18.2, a protein that sits on the surface of some epithelial cells that have transformed into cancer cells. The medicine is given as an IV infusion every two to three weeks, along with chemotherapy. Common side effects include nausea, vomiting, diarrhea or constipation, fatigue, stomach pain, weight loss, and decreased sensation in your fingers and toes. Serious side effects include liver problems, increased risk of infections and bleeding, and changes in electrolyte levels.
Antibody-Drug Conjugates
Antibody-drug conjugates (ADC) are monoclonal antibodies that are paired with chemotherapy drugs to target cancer cells.
Fam-trastuzumab deruxtecan (Enhertu) is an antibody-drug conjugate that targets the HER2 protein on cancer cells and delivers the chemo drug directly to the cancer. It’s given as an IV infusion once every three weeks.
Side effects include increased risk of infections and bleeding, nausea, vomiting, diarrhea or constipation, loss of appetite, fever, fatigue, and hair loss. Serious side effects include lung disease or heart damage.
TRK Inhibitors
Some cancerous cells fuse genes together. When one type of gene, neurotrophic tyrosine receptor kinase (NTRK), fuses with another gene, it can cause abnormal cell growth.
TRK inhibitors target these abnormal gene fusions. They may be given if the cancer can’t be removed through surgery or if it has spread to other parts of the body.
These TRK inhibitors are commonly used with esophageal cancers:
entrectinib (Rozlytrek)
larotrectinib (Vitrakvi)
They are given as pills taken daily. Common side effects include fatigue, dizziness, nausea, vomiting, cough, and diarrhea or constipation. Serious complications include liver problems and confusion.
Immunotherapy works by using a person’s own immune system, helping it to find and destroy cancer cells. It’s a promising treatment option for some people with more advanced stages of esophageal cancer.
A type of immunotherapy drug called checkpoint inhibitors targets “checkpoint” proteins that act as a switch to turn on or off an immune response. Cancer cells use these checkpoint inhibitors to hide from the immune system. But with the help of checkpoint inhibitors, the immune system can mount an attack against those cells.
“Immunotherapy, particularly checkpoint inhibitors like pembrolizumab and nivolumab, [...] are cutting edge treatments that have revolutionized outcomes for esophageal cancer,” says Dr. Saif.
Checkpoint inhibitors used for esophageal cancer include:
ipilimumab (Yervoy)
nivolumab (Opdivo)
pembrolizumab (Keytruda)
tislelizumab (Tevimbra)
Common side effects of these drugs include fatigue, nausea, poor appetite, cough, diarrhea or constipation, skin rash or itching, muscle or joint pain, and fever.
Every year, there are advances in treatments for esophageal cancer, says Daniel Boffa, MD, a clinical director of the center for thoracic cancers at Yale Cancer Center and the division chief of thoracic surgery at Yale School of Medicine. Though it’s best when a tumor is found early, recent advances make treatment safer and more effective, improving patient outcomes.
“We have learned that many patients can avoid radiation prior to surgery, and that immunotherapy, which has been so powerful in lung cancer, has a prominent role in many esophageal cancer patients,” says Dr. Boffa.
“There are also novel treatments that focus on proteins that the esophageal cancers are making, such as Claudin-18, which are showing good results [in clinical trials],” Boffa adds.
Following esophageal cancer treatment, there are many lifestyle changes that can help recovery, says Saif. These include:
Eat a balanced diet including fruits, whole grains, vegetables, and less processed meat.
Engage in regular physical activity.
Maintain a healthy weight.
Limit alcohol consumption.
Quit smoking.
Get ample sleep.
Reduce stress.
Engage in support groups.
Such healthy habits “tend to make people live longer, whether or not they have cancer,” says Boffa.
“One of the most powerful changes someone with cancer can make is to stop smoking,” he adds.
Various forms of therapies and rehabilitation programs help patients recover after they’ve received cancer treatment, says Saif. Such therapies and programs may include:
Nutrition support
Physical therapy to help with swallowing difficulties
Exercise programs to regain endurance and strength impacted by treatment
Pulmonary rehabilitation, such as breathing exercises to improve lung function and any similar problems resulting from the treatment
Social work support
The therapies and rehab recommended will depend on the type of treatment you receive, says Boffa. “If the patient had surgery, then on occasion, physical therapy or even short stay rehabilitation [in the hospital] can help some patients, but most leave the hospital and recover fully at home.”
Currently, there are no complementary or integrative health approaches that are used to treat esophageal cancer, says Saif.
But people may wish to try integrative approaches to treat their cancer symptoms and improve their quality of life. Such approaches may include:
Dietary and herbal supplements
Massage
Acupuncture
Stress management and relaxation techniques
It’s important that you discuss these with your oncology team beforehand, says Saif. Supplements, in particular, can interact with some cancer treatments. Consult a healthcare professional before you start taking any supplements.
Palliative care for esophageal cancer could mean relieving cancer symptoms, easing side effects from chemo or surgery, or improving quality of life to ensure patients live well with cancer for as long as possible.
“High-quality palliative care must address the patient's quality of life by managing symptoms and side effects of treatment, providing psychosocial support to both the patient and their caregivers throughout the illness, and [where necessary] helping them in end-of-life wishes and goals of care,” says Saif.
A palliative care plan for esophageal cancer may include interventions and lifestyle changes such as:
Eat smaller meals and softer foods to ease symptoms like esophageal pain.
Drink fluids when you eat to make it easier to swallow.
Adopt a liquid diet and use nutritional supplement drinks to stay well-nourished when you can’t eat due to chemo or pain.
Take medications such as anti-emetics (anti-nausea or anti-sickness medication), promotility or prokinetic drugs (drugs that help move food along your intestines), and anti-spasmodic drugs that help relieve cramps to improve cancer symptoms or chemo side effects.
Take opioids as prescribed to relieve pain.
Undergo palliative radiation for cases where the cancer has spread, causing localized pain.
Have meaningful and important conversations with your healthcare provider about end-of-life care planning, should the situation require it.
With any type of cancer, mental health challenges arise, says Saif. These can include:
“Cancer intrudes on just about every aspect of a person’s life, including mental health,” says Boffa. But support groups, or patients talking to other patients, is a key way to manage these mental health challenges, he says.
The primary care clinician also plays a crucial role. “The most important point is for clinicians to remember that we don’t treat cancer, we treat patients who have cancer,” Boffa says. “Just as we follow tumors on CT scans and treatments with blood tests, we need to check in with patients and support their mental health,” Boffa adds.
Esophageal cancer treatment options include surgery, chemotherapy, radiation, immunotherapy, and targeted therapies.
Palliative and mental health care are key for helping you live as well as possible and supporting you throughout your cancer treatment journey.
Esophageal cancer has the best outcomes when it’s diagnosed early. A healthcare team should discuss the best treatment options for you based on your individual circumstances.
Remember that new treatments emerge every day. Ask a healthcare professional about ongoing clinical trials you can enroll in.
