Treatments Treatment for Malignant Esophageal Disease

Surgery

Surgery to remove esophageal cancer can be used alone or in combination with other treatments. Operations used to treat esophageal carcinoma include:

  • Surgery to remove very small tumors. If your cancer is very small, confined to the superficial layers of your esophagus and hasn’t spread, your surgeon may recommend removing the cancer and margin of healthy tissue that surrounds it. Surgery for very early-stage cancers can be done using an endoscope passed down your throat and into your esophagus.
  • Surgery to remove a portion of the esophagus (esophagectomy). During esophagectomy, your surgeon removes the portion of your esophagus that contains the tumor and nearby lymph nodes. The remaining esophagus is reconnected to your stomach. Usually, this is done by pulling the stomach up through the diaphragm to meet the remaining esophagus.
  • Surgery to remove part of your esophagus and the upper portion of your stomach (esophagogastrectomy). During esophagogastrectomy, your surgeon removes part of your esophagus, nearby lymph nodes and the upper part of your stomach. The remainder of your stomach is then pulled up and reattached to your esophagus. If necessary, part of your colon is used to help join the two.
Doctor looking at images

Complications

As esophageal cancer advances, it can cause complications, such as:

  • Obstruction of the esophagus. Cancer may make it difficult or impossible for food and liquid to pass through your esophagus.
  • Pain. Advanced esophageal cancer can cause pain.
  • Bleeding in the esophagus. Esophageal cancer can cause bleeding. Though bleeding is usually gradual, it can be sudden and severe at times.

Treatments for Complications

Treatments for esophageal obstruction and difficulty eating can include:

  • Relieving esophageal obstruction. If your esophageal cancer has narrowed your esophagus, a surgeon may use an endoscope and special tools to place a metal tube (stent) to hold the esophagus open. Other options include surgery, radiation therapy, chemotherapy, laser therapy and photodynamic therapy.
  • Providing nutrition. Your doctor may recommend a feeding tube if you’re having trouble swallowing or if you’re having esophagus surgery. A feeding tube allows nutrition to be delivered directly to your stomach or small intestine, giving your esophagus time to heal after cancer treatment.

Chemotherapy and Radiation

  • Chemotherapy: Is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.
    • The chemotherapy side effects that you experience depend on which chemotherapy drugs you receive.
  • Radiation therapy: Uses high-powered energy beams to kill cancer cells. Radiation can come from a machine outside your body that aims the beams at your cancer (external beam radiation). Or radiation can be placed inside your body near the cancer (brachytherapy).Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It can be used before or after surgery.
    • Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to your stomach.
    • Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.

Preparing for Your Appointment

Preparing for Your Appointment

If your family doctor suspects you have esophageal cancer, you may be referred to a number of doctors who will help to evaluate your condition. Your health care team may include doctors who:

  • Evaluate the esophagus (gastroenterologists)
  • Treat cancer with chemotherapy and other medications (oncologists)
  • Perform surgery (surgeons)
  • Use radiation to treat cancer (radiation oncologists)
  • To get the most from your appointment, it’s a good idea to be well-prepared. Here’s some information to help you get ready, and to know what to expect from your doctor.

What You Can Do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there’s anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you’re taking.
  • Consider taking a family member or friend along. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor. Preparing a list of questions will help you make the most of your time with your doctor. For esophageal cancer, some basic questions to ask your doctor include:
  1. Where is my esophageal cancer?
  2. How advanced is my cancer?
  3. Can you explain the pathology report to me?
  4. What other tests do I need?
  5. What are my treatment options?
  6. What are the potential side effects of each treatment option?
  7. Is there one treatment option you feel is the best?
  8. What would you recommend to a friend or family member in my situation?
  9. Should I see a specialist?
  10. Are there any brochures or other printed material that I can take with me? What websites do you recommend?
  11. What will determine whether I should plan for a follow-up visit.
  • Don’t hesitate to ask any other questions that occur to you during your appointment.

Coping and Support

Coping with the shock, fear and sadness that come with a cancer diagnosis can take time. You may feel overwhelmed just when you need to make crucial decisions. With time, each person finds a way of coping and coming to terms with the diagnosis.

Until you find what brings you the most comfort, consider trying to:

Find out enough about esophageal cancer to make decisions about your care. Ask your doctor for the specifics about your cancer, such as its type and stage. And ask for recommended sources of information where you can learn more about your treatment options. The National Cancer Institute and the American Cancer Society are good places to start.

Stay connected to friends and family. Your friends and family can provide a crucial support network for you during your cancer treatment. As you begin telling people about your esophageal cancer diagnosis, you’ll likely get offers for help. Think ahead about things you may like help with, whether it’s having someone to talk to if you’re feeling low or getting help preparing meals.

Find someone to talk to. You might have a close friend or family member who’s a good listener. Or talk to a counselor, medical social worker, or pastoral or religious counselor. Consider joining a support group for people with cancer. You may find strength and encouragement in being with people who are facing the same challenges you are. Ask your doctor, nurse or social worker about groups in your area. Or try online message boards, such as those available through the American Cancer Society.

Doctors Who Treat Malignant Esophageal Disease

Dr. Robert McKenna, Director Minimally Invasive Chest Surgery and Thoracic Surgical Oncology - Saint John's Cancer Isntitute

Robert McKenna, M.D.

Professor and Chair of Thoracic Oncology
Meet Our Thoracic Experts

Esophageal Cancer Supportive Care

In addition to the expert medical care available from our team of cancer physicians, we offer a host of integrative and wellness services that aim to address the physical, emotional, social, mental, and spiritual needs of patients and their loved ones throughout the cancer journey.

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