Esophageal Cancer: Treatment Choices

There are many treatment choices for esophageal cancer. Which may work best for you? It depends on a number of factors. These include the type, size, location, and stage of your cancer. Factors also include your age, overall health, and what side effects you can stand.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may require a second opinion. In addition, you may want to involve your family and friends in this process.

Understanding the goals of treatment for esophageal cancer

For some esophageal cancers, the goal of treatment is to cure the cancer. If a cure isn’t possible, you may receive treatment to shrink the cancer. Or treatment may keep it under control for as long as possible. Treatment can also improve your quality of life. It does this by helping to control the symptoms of your cancer. The goals of treatment can include the following:

• Remove or destroy the cancer in the esophagus

• Remove or destroy tumors in other parts of your body

• Kill or stop the growth or spread of esophageal cancer cells

• Prevent or delay the cancer's return

• Ease symptoms from the cancer. These can include pain or pressure on organs.

Types of treatment for esophageal cancer

Several types of treatment can be used for esophageal cancer. You may receive combinations of treatments. These depend on a number of factors. These can include: 

• The type and location of the cancer 

• The stage (extent) of the cancer

• Your age and overall health

• Your concerns and preferences

Each treatment has its own goals.

Surgery

This is the most common treatment for early stage esophageal cancer, especially cancer in the lower part of the esophagus. It may cure the cancer if it’s caught in an early stage. Even when cancer can’t be cured, your healthcare provider may suggest surgery to ease your symptoms.

Radiation therapy 

This treatment is often used with chemotherapy, either before or after surgery. Radiation and chemotherapy before surgery can help shrink a tumor. This can make it easier to take out. After surgery, radiation and chemotherapy can try to kill cancer cells that are left. It may also be used as part of the main treatment in people who can't have surgery. Or it may be used to help relieve symptoms in people with advanced cancer.  

Chemotherapy and targeted therapy

For esophageal cancer, chemotherapy is often used with radiation. It may be used before or after surgery. Or it may be part of the treatment for people who can't have surgery. Targeted therapy medicines work differently from standard chemotherapy medicines. Targeted therapy may be useful for some people.

Photodynamic therapy (PDT) and other endoscopic treatments

PDT uses a special light-activated medicine and laser to kill cancer cells. It can be used to treat some very early stage cancers. But it’s most often used to help relieve symptoms, such as trouble swallowing, in people with advanced cancer. Other endoscopic treatments can also be used to help relieve symptoms in advanced cancer. These include using a laser or electric current to destroy cancer cells in your esophagus. 

Supportive care

Your healthcare provider may suggest treatments that help ease your symptoms, but don’t treat the cancer. These can sometimes be used with other treatments. Or your healthcare provider may suggest supportive care if he or she believes that treatments are more likely to cause more harm than good.

Clinical trials for new treatments

Researchers are always looking for new ways to treat esophageal cancer. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare provider

Thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Think about the benefits and side effects of each option. Talk about your concerns with your healthcare provider before making a decision.