Esophageal Cancer Treatment Options

For early-stage esophageal cancer, surgery is often an effective treatment approach. An esophagectomy, which involves removing part or most of the esophagus, nearby lymph nodes, and a small section of the stomach, is a common procedure. Depending on the location and stage of the tumor, varying amounts of the esophagus will be removed. If the cancer is contained to the lower part of the esophagus, only a small section will be taken out. Tumors located in the upper or middle sections of the esophagus may require more extensive removal.

Typically patients receive other treatments after surgery to ensure all the cancer cells are destroyed.

Radiation therapy uses high-energy radiation to kill cancer cells. Typically, it is used alongside other treatments, such as chemotherapy and surgery. For esophageal cancer it can be used in a few ways, including:

• After surgery (adjuvant treatment): to destroy any remaining cancer cells that imaging can’t detect. This reduces the likelihood of recurrence.
• Before surgery (neoadjuvant treatment): Radiation therapy, often with chemotherapy, can be given before surgery to shrink the tumor for easier removal.
• Main treatment: For patients unable to undergo surgery due to health concerns or personal choices, radiation therapy may be combined with chemotherapy (chemoradiation).
• For advanced cancers: If cancer has spread to organs like the liver, radiation can help manage symptoms and enhance quality of life (palliative treatment).

Most commonly, radiation for esophageal cancer is delivered externally using a machine called a linear accelerator. However, some patients may benefit more from internal radiation (brachytherapy), which places radioactive material close to the cancer using an endoscope.

Our radiation oncologists work closely with your medical oncologist to determine the best timing and number of radiation treatments, as well as whether radiation should be used before, after, or both before and after surgery.

Chemotherapy uses powerful anti-cancer drugs that travel through the bloodstream to reach cancer cells throughout the body. These medications can be injected into a vein or taken orally.

While chemotherapy alone is generally not a cure for esophageal cancer, it is often effective when combined with radiation therapy. It can be used before surgery to shrink the tumor, after surgery to eliminate any remaining cancer cells, or for palliative care.

Targeted therapy drugs hone in on specific cancer cells based on their characteristics. Unlike standard chemotherapy, these drugs are designed to attack cancer cells more precisely.

To determine how well you might respond to various targeted therapies, your doctor will recommend biomarker testing. This process identifies any unusual proteins or genetic mutations in the cancer cells, helping your treatment team identify the drugs that target these unique characteristics.

One such approach is monoclonal antibody therapy. These drugs target the HER2 protein, which can fuel the growth of cancer cells. Cancers with increased levels of HER2 are referred to as HER2-positive.

Immunotherapy uses medications to strengthen your immune system’s ability to recognize and destroy cancer cells more effectively. Some patients with esophageal cancer may benefit from immune checkpoint inhibitors—powerful treatments that can help restore the immune response against esophageal cancer cells.

Checkpoint inhibitors block specific proteins—such as PD-1 and CTLA-4—that cancer cells use to trick the immune system into thinking they are healthy cells. By blocking these proteins, your T cells can effectively target and kill cancer cells.

Immunotherapy drugs are typically administered intravenously. They are often used in combination with one another or with other esophageal cancer treatments, such as chemotherapy.

For some patients, endoscopic treatments provide a minimally invasive option for managing esophageal cancer. These procedures use an endoscope, a thin tube equipped with a light and a camera, to access the esophagus. Various endoscopic treatments can be used to treat early-stage cancer, help prevent cancer from progressing, or relieve symptoms from advanced esophageal cancers that can't be surgically removed.

• Endoscopic mucosal resection (EMR): This procedure removes abnormal tissue from the esophagus’ inner lining and is often followed by proton pump inhibitors to reduce stomach acid and help prevent the disease from returning.
• Endoscopic submucosal dissection (ESD): A more advanced technique that removes larger or deeper lesions from the mucosa and submucosa in one piece. It allows more precise removal than EMR.
• Photodynamic therapy (PDT): This treatment uses a light-activated drug, called a photosensitizer, to kill cancer cells.
• Radiofrequency ablation (RFA): Using radio waves, this procedure generates heat to eliminate abnormal cells via electrodes that carry electricity.

Other endoscopic procedures may be used depending on the patient’s specific need.