Surgery is the most common treatment for esophageal cancer. Usually, the surgeon removes the tumor along with all or a portion of the esophagus, nearby lymph nodes and other tissue in the area.
An operation to remove the esophagus is called an esophagectomy. The surgeon connects the remaining healthy part of the esophagus to the stomach so the patient is still able to swallow. Sometimes, a plastic tube or part of the intestine is used to make the connection. The surgeon may also widen the opening between the stomach and the small intestine to allow stomach contents to pass more easily into the small intestine. Sometimes surgery is done after other treatments are finished.
To help patients eat and relieve symptoms caused by the cancer, surgeons can create a bypass, or new pathway, to the stomach if a tumor blocks the esophagus but cannot be removed. The surgeon can put in a percutaneous gastrostomy or jejunostomy (also called a feeding tube), so the patient can receive nutrition directly into the stomach or intestine. This may be done before chemotherapy and radiation therapy is given to ensure that the patient can eat enough food to maintain his or her weight and strength during that phase of the treatment.
People who have trouble eating and drinking may need intravenous (IV) feedings and fluids for several days before and after the operation, as well as antibiotics to prevent or treat infection. Surgery for esophageal cancer may cause short-term pain and tenderness in the area of the operation, but this discomfort or pain can be controlled with medicine. Patients are taught special breathing and coughing exercises to keep their lungs clear.
Also called radiotherapy, involves high-energy rays to kill cancer cells. Radiation therapy affects cancer cells in the treated area only. Radiation may come from a machine outside the body, called external radiation, or from radioactive materials placed in or near the tumor, called internal radiation. A plastic tube may be inserted into the esophagus to keep it open during radiation therapy. This procedure is called intraluminal intubation and dilation.
Radiation therapy may be used alone or combined with chemotherapy as primary treatment instead of surgery, especially if the size or location of the tumor would make an operation difficult. Doctors may also combine radiation therapy with chemotherapy to shrink the tumor before surgery. Even if the tumor cannot be removed by surgery or destroyed entirely by radiation therapy, radiation therapy can often help relieve pain and make swallowing easier.
Radiation therapy affects normal as well as cancerous cells. Side effects of radiation therapy depend mainly on the dose and the part of the body that is treated. Common side effects of radiation therapy to the esophagus are a dry, sore mouth and throat; difficulty swallowing; swelling of the mouth and gums; dental cavities; fatigue; skin changes at the site of treatment; and loss of appetite.
Chemotherapy is the use of anticancer drugs to kill cancer cells. The anticancer drugs used to treat esophageal cancer travel throughout the body. Anticancer drugs used to treat esophageal cancer are usually given by injection into a vein (IV).
Chemotherapy may be combined with radiation therapy as primary treatment (instead of surgery) or to shrink the tumor before surgery. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy, like radiation therapy, affects normal as well as cancerous cells. Side effects depend largely on the specific drugs and the dose (amount of drug administered). Common side effects of chemotherapy include nausea and vomiting, poor appetite, hair loss, skin rash and itching, mouth and lip sores, diarrhea and fatigue. These side effects generally go away gradually during the recovery periods between treatments or after treatment is over.
Laser therapy is the use of high-intensity light to destroy tumor cells. Laser therapy affects the cells only in the treated area. The doctor may use laser therapy to destroy cancerous tissue and relieve a blockage in the esophagus when the cancer cannot be removed by surgery. The relief of a blockage can help to reduce symptoms, especially swallowing problems. Laser therapy can cause short-term pain where the treatment was given, but this discomfort can be controlled with medicine.
Photodynamic Therapy (PDT)
This is a type of laser therapy that involves the use of drugs that are absorbed by cancer cells; when exposed to a special light, the drugs become active and destroy the cancer cells. This is used to make swallowing easier, especially in people who cannot, or choose not, to receive surgery, radiation therapy or chemotherapy. The doctor may use PDT to relieve symptoms of esophageal cancer such as difficulty swallowing. Although photodynamic therapy may relieve swallowing problems for a brief period, it is not a curative therapy.
Photodynamic therapy makes the skin and eyes highly sensitive to light for 6 weeks or more after treatment. Other temporary side effects of PDT may include coughing, trouble swallowing, abdominal pain, and painful breathing or shortness of breath.