Esophageal Cancer

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Questions to Ask Your Doctor About Your Cancer
(Free Handout)

Treatment

Treatment depends on the stage of the cancer and the overall health of the patient. Surgery, radiation, and chemotherapy may be used alone or in combination to treat cancer of the esophagus. Chemotherapy and/or radiation often are used as adjuvant treatments (i.e., in addition to surgery) and may be used to reduce symptoms (called palliative treatment).

Surgery
Esophagectomy (removal of all or part of the esophagus) is the treatment of choice for esophageal cancer. This procedure also includes removal of nearby lymph nodes and surrounding tissue. Transhiatal esophagectomy is performed through incisions in the upper abdomen and the lower neck and standard transthoracic esophagectomy is performed through an incision between the ribs that opens one side of the chest. In some cases, the surgeon attaches the healthy remaining portion of the esophagus to the stomach (anastomosis), and in other cases, a section of the intestine is used.

Contraindications for surgery include metastatic disease, tumor invasion of nearby structures (e.g., trachea, bronchi, aorta, pericardium), and severe cardiovascular or pulmonary disease.

After surgery, most patients are discharged from the hospital within 14 days. Side effects of the procedure include pain and tenderness, which usually can be controlled with medication. Patients are instructed to use special breathing and coughing exercises to help keep their lungs clear. Most patients are able to resume normal activities within 2 months.

Complications may be severe and occur in about 40% of patients. They include the following:

• Anastomotic leakage
• Bleeding
• Cardiac complications (e.g., arrhythmia, heart attack)
• Infection at the incision site or throughout the body (sepsis)
• Nerve injury
• Pulmonary complications (e.g., chylothorax, pneumonia, pleural effusion)

Radiation Therapy
Radiation involves using high-energy x-rays to destroy cancer cells. This treatment often is combined with chemotherapy to reduce dysphagia (difficulty swallowing) in patients with advanced or metastatic esophageal cancer. It also may be used to shrink the tumor before surgery (neoadjuvant therapy) or after surgery to destroy remaining cancer cells (adjuvant therapy).

Radiation therapy is performed in a hospital or outpatient center. Each treatment lasts a few minutes and treatment is usually given 5 days per week, for 6 weeks. Side effects include the following:

• Dental cavities
• Difficulty swallowing
• Dry, sore mouth and throat
• Fatigue
• Loss of appetite
• Reddening of the skin
• Swelling of the mouth and gums

Chemotherapy
Chemotherapy uses a combination of drugs to destroy cancer cells. It is a systemic treatment (i.e., affects cells throughout the body) and may be used in combination with radiation to relieve symptoms. It is not used as a primary treatment for esophageal cancer. Common side effects include the following:

• Diarrhea
• Fatigue
• Hair loss
• Loss of appetite
• Mouth and lip sores
• Nausea and vomiting
• Skin rash and itching

Prognosis

Prognosis for esophageal cancer depends on the stage of the disease. Advanced disease (i.e., penetrates the muscular wall of the organ) and metastatic esophageal cancer have a poor prognosis. The overall 5-year survival rate for esophageal cancer is 20-25%.

Prevention

Avoiding heavy alcohol consumption and tobacco use may help prevent squamous cell carcinoma of the esophagus. In developed countries, these factors contribute to as many as 90% of cases.

Patients with frequent heartburn should undergo regular endoscopic screening to detect precancerous changes in the lining of the esophagus, which are the primary risk factor for adenocarcinoma of the esophagus. Dietary and lifestyle changes and medication may help prevent progression of Barrett's esophagus.

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