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Cancer of the Esophagus

  • Posted: 04/04/2013

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Treatment

People with cancer of the esophagus have many treatment options. Treatment options include...

You and your doctor will develop a treatment plan. The treatment that's right for you depends mainly on the type and stage of esophageal cancer. You'll probably receive more than one type of treatment. For example, radiation therapy and chemotherapy may be given before or after surgery.

At any stage of esophageal cancer, care is available to manage health problems caused by the disease or side effects from its treatment. You can get information about coping with symptoms and side effects on NCI's website at http://www.cancer.gov/cancertopics/coping.

Also, you can get information about coping from NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). Or, chat using NCI's instant messaging service, LiveHelp (https://livehelp.cancer.gov).

Doctors Who Treat Esophageal Cancer

Your health care team may include the following specialists:

You may want to find doctors who have a lot of experience with treating esophageal cancer.

Resources are available to help you find doctors who treat this disease:

  • Your doctor may be able to refer you to specialists.
  • You can ask a hospital, medical school, or medical society for names of specialists near you.
  • NCI's Cancer Information Service can give you information about treatment centers near you. Call 1-800-4-CANCER (1-800-422-6237). Or, chat using LiveHelp (https://livehelp.cancer.gov), NCI's instant messaging service.
  • Other sources can be found in the NCI fact sheet How To Find a Doctor or Treatment Facility If You Have Cancer.

Your health care team may also include an oncology nurse, a social worker, and a registered dietitian. If your airways are affected by the cancer, you may have a respiratory therapist as part of your team. If you have trouble swallowing, you may have a speech pathologist.

For help relieving or reducing pain, you may work with a specially trained doctor, a nurse, a palliative care team, or another pain control specialist.

Your health care team can describe your treatment options, the expected results of each option, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for everyone, and they may even change from one treatment session to the next.

Cancer of the esophagus is hard to control with current treatments. For that reason, many doctors encourage people with this disease to consider taking part in a research study (clinical trial) of new treatment methods. Research studies are an important option for people with any stage of esophageal cancer. See the Cancer Treatment Research section on page 30.

Questions you may want to ask your doctor about treatment options

  • What are my treatment options? Which do you recommend for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What are the risks and possible side effects of each treatment? How can side effects be managed?
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • What is the treatment likely to cost? Will my insurance cover it?
  • How will treatment affect my normal activities?
  • Would a treatment research study be right for me?

Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and your treatment options. You may even want to talk to several different doctors about all of the treatment options, their side effects, and the expected results.

Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some insurance companies actually require a second opinion.

If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment recommendation. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with cancer of the esophagus need treatment right away.

Surgery

Surgery may be an option for people with early-stage cancer of the esophagus. Usually, the surgeon removes the section of the esophagus with the cancer, a small amount of normal tissue around the cancer, and nearby lymph nodes. Sometimes, part or all of the stomach is also removed.

If only a very small part of the stomach is removed, the surgeon usually reshapes the remaining part of the stomach into a tube and joins the stomach tube to the remaining part of the esophagus in the neck or chest. Or, a piece of large intestine or small intestine may be used to connect the stomach to the remaining part of the esophagus.

If the entire stomach needs to be removed, the surgeon will use a piece of intestine to join the remaining part of the esophagus to the small intestine.

During surgery, the surgeon may place a feeding tube into your small intestine. This tube helps you get enough nutrition while you heal.

You may have pain from the surgery. However, your health care team will give you medicine to help control the pain. Before surgery, you may want to discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain relief.

Your health care team will watch for pneumonia or other infections, breathing problems, bleeding, food leaking into the chest, or other problems that may require treatment.

The time it takes to heal after surgery is different for everyone. Your hospital stay may be a week or longer, and your recovery will continue after you leave the hospital.

See the Nutrition section for information about eating after surgery.

Questions you may want to ask your doctor about surgery

Do you suggest surgery for me? If so, what type?

How will I feel after surgery?

If I have pain, how can we control it?

How long will I be in the hospital?

Am I likely to have eating problems? Will I need a special diet?

Will I need a feeding tube? If so, for how long? How do I take care of it? Who can help me if I have a problem?

Will I have any lasting side effects?

When can I get back to my normal activities?

Radiation Therapy

Radiation therapy is an option for people with any stage of esophageal cancer. The treatment affects cells only in the area being treated, such as the throat and chest area.

Radiation therapy may be given before, after, or instead of surgery. Chemotherapy is usually given along with radiation therapy.

Radiation therapy for esophageal cancer may be given to...

  • Destroy the cancer
  • Help shrink the tumor so that you can swallow more easily
  • Help relieve pain from cancer that has spread to bone or other tissues

Doctors use two types of radiation therapy to treat esophageal cancer. Some people receive both types:

  • Machine outside the body: The radiation comes from a large machine. This is called external radiation therapy. The machine aims radiation at your body to kill cancer cells. It doesn't hurt. You'll go to a hospital or clinic, and you'll lie down on a treatment table. Each treatment session usually lasts less than 20 minutes. Treatments are usually given 5 days a week for several weeks.
  • Radioactive material inside the body (brachytherapy): The doctor numbs your throat with an anesthetic spray and gives you medicine to help you relax. The doctor puts a tube into your esophagus. The radiation comes from the tube. After the tube is removed, no radioactivity is left in your body. Usually, one treatment session is needed. Because the treatment session lasts one to two days, you'll probably stay in a special room at the hospital.

The side effects of radiation therapy depend mainly on the type of radiation therapy, how much radiation is given, and the part of your body that is treated.

External radiation therapy aimed at the chest may cause a sore throat, cough, or shortness of breath. You may feel a lump in your throat or burning in your chest or throat when you swallow. After several weeks of treatment, it may be painful to swallow. Your health care team can suggest ways to manage these problems. The problems usually go away when treatment ends.

External radiation therapy can harm the skin. It's common for the skin in the chest area to become red and dry and to get darker. Sometimes the skin may feel tender or itchy. Check with your doctor before using lotion or cream on your chest. After treatment is over, the skin will heal.

You're likely to become tired during external radiation therapy, especially in the later weeks of treatment. Although getting enough rest is important, most people say they feel better when they exercise every day. Try to go for a short walk, do gentle stretches, or do yoga.

Years after either type of radiation therapy, the esophagus may become narrow. If this happens, it may feel like food is getting stuck in your chest. Usually, a gastroenterologist can treat this problem.

The NCI booklet Radiation Therapy and You has helpful ideas for coping with radiation therapy side effects.

Questions you may want to ask your doctor about radiation therapy

When will treatment start? When will it end? How often will I have treatments?

How will I feel during treatment? Will I be able to drive myself to and from treatment?

What can I do to take care of myself before, during, and after treatment?

How will we know the treatment is working?

What side effects should I expect? What should I tell you about?

Are there any lasting effects?

Chemotherapy

Most people with esophageal cancer get chemotherapy. It may be used alone or with radiation therapy.

Chemotherapy uses drugs to kill cancer cells. The drugs for cancer of the esophagus are usually given directly into a vein (intravenously) through a thin needle.

You'll probably receive chemotherapy in a clinic or at the doctor's office. People rarely need to stay in the hospital during treatment.

The side effects depend mainly on the drugs given and amount of chemotherapy that you get. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. They may also give you medicines that help your body to make new blood cells.
  • Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.

Other possible side effects include a skin rash, joint pain, tingling or numbness in your hands and feet, hearing problems, or swollen feet or legs.

When radiation therapy and chemotherapy are given at the same time, the side effects may be worse.

Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.

The NCI booklet Chemotherapy and You has helpful ideas for coping with chemotherapy side effects.

Targeted Therapy

People with esophageal cancer that has spread may receive a type of treatment called targeted therapy. This treatment can block the growth and spread of esophageal cancer cells.

Targeted therapy for cancer of the esophagus is usually given intravenously. The treatment enters the bloodstream and can affect cancer cells all over the body.

During treatment, your health care team will watch you for side effects. You may get diarrhea, belly pain, heartburn, joint pain, tingling arms and legs, or heart problems. Most side effects usually go away after treatment ends.

You may want to read the NCI fact sheet Targeted Cancer Therapies.

Questions you may want to ask your doctor about chemotherapy or targeted therapy

  • Which drug or drugs do you suggest for me? What will they do?
  • What are the possible side effects? What can we do about them?
  • When will treatment start? When will it end? How often will I have treatments?
  • How will we know the treatment is working?
  • Will there be lasting side effects?

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