Esophageal Cancer Treatment

MD Anderson has one of the most active esophageal cancer programs in the nation.

We offer many innovative treatments for esophageal cancer, including minimally invasive surgeries and targeted therapies. Additionally, our status as a major research site allows us to offer a full range of clinical trials for esophageal cancer.

If you are diagnosed with esophageal cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health. Your treatment for esophageal cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Preventative treatment

The following treatments may be recommended for patients with very early stage Barrett’s esophagus that has a high risk of developing into esophageal cancer (dysplasia.)

Radiofrequency ablation (RFA): An endoscopic device uses heat to kill precancerous tissue.

Cryotherapy: A technique that uses chemicals at a very low temperature to rapidly freeze precancerous tissue in the esophagus. After the tissue has thawed, the cells die. The area heals, replacing precancerous tissue with normal esophageal cells.

Treatment for early esophageal cancer

Endoscopic mucosal resection (EMR) / Endoscopic submucosal dissection (ESD): Doctors use an endoscope to remove early-stage esophageal cancer that has only invaded the surface of the esophagus. Though these are complex procedures, they are also minimally invasive techniques that do not require any incisions or the removal of the esophagus.

Treatment for locally advanced and advanced cancers

If your cancer has spread to the surrounding tissue or beyond, the following treatments may be used to slow the disease and ease symptoms:

Surgery

Surgery is the most common treatment for esophageal cancer. To treat more advanced stages of esophageal cancer, surgery may be combined with chemotherapy and/or radiation therapy.

Esophagectomy: The most common surgery for esophageal cancer is an esophagectomy. Generally, the surgery involves removing all or part of the esophagus, part of the stomach, and nearby lymph nodes. The remaining stomach is then moved up into the chest or neck and connected to the remaining esophagus. If the stomach cannot be moved up to join the remaining esophagus, your surgeon may join the two using a section of your intestine.

There are several ways to perform an esophagectomy. Your doctor will recommend the best technique for you based on the location of the tumor and if it has spread.

Life after esophageal cancer surgery

After recovering from an esophagectomy, our surgeons expect your quality of life will be excellent. Optimally, you should be able to eat all types of food, return to work and carry on your normal activities.

After an esophagectomy, you will need to alter the way you eat and the way you sleep. Smaller, more frequent meals are necessary due to a smaller sized stomach after surgery. Additionally, sleeping with the head of the bed elevated helps prevent infection of the lungs and heartburn.

While you recover from an esophagectomy, you may temporarily use a feeding tube (a small tube that can be inserted at the time of surgery into the small bowel) to get nutrients. Your doctor removes this tube several weeks after surgery.

Chemotherapy

Chemotherapy works by killing fast-growing cells, including cancer cells. It can be used to treat esophageal cancer before or after surgery and helps treat cancer that has metastasized. MD Anderson offers the most up-to-date and advanced chemotherapy options for esophageal cancer.

Radiation therapy

Radiation therapy uses focused, high-energy photon beams to destroy cancer cells. New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

MD Anderson provides the most advanced radiation treatments for esophageal cancer, including:

Intensity-modulated radiotherapy (IMRT): Radiation beams are delivered at different angles, which are tailored to the specific shape of the tumor.

Proton therapy: High radiation particles are aimed directly at the tumor site. For some patients, this therapy may result in fewer side effects because of lower doses to surrounding normal tissue. MD Anderson's Proton Therapy Center treats some esophageal cancers.

Immunotherapy

Immunotherapy recruits the patient’s own immune system in the fight against cancer. For esophageal cancer, patients may be given an immunotherapy known as immune checkpoint inhibitors, which causes the immune system to attack the tumor. Immunotherapy is most commonly used to treat advanced stages of esophageal cancer. It is still being explored in early stages.

Targeted therapies

While many treatments directly kill cancer cells, targeted therapy works by stopping or slowing the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them.

Other surgical procedures for esophageal cancer may include:

Esophageal stents

Small, expandable metal tubes are placed inside the esophagus with the aid of an endoscope. Once placed, the stent can expand and open up the blocked part of the esophagus, allowing food and liquids to pass through more easily.