Treatment of Stage II Esophageal Cancer

This content has been reviewed and approved by

Chandra P. Belani, MD
Deputy Director, Penn State Cancer Institute
Miriam Beckner Professor of Medicine
Penn State University School of Medicine

Patients with stage II esophageal cancer have cancer that penetrates into or through the muscular wall of the esophagus but not into nearby local structures (stage IIA). When there is nearby lymph node involvement but no invasion of local structures, this is called stage IIB. Physicians sometimes call stage II cancer “locally advanced.”

The following is a general overview of the treatment of stage II esophageal cancer. Circumstances unique to your situation and prognostic factors (factors that help your physician estimate your chance of recovery or the chance that your cancer will come back) may ultimately influence how your physician applies these general treatment principles to your situation. The information on this website is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments come about through clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Developing more effective cancer treatments requires cancer patients to help evaluate these new and innovative therapies.

Participating in a clinical trial may offer you access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. If you’re interested in participating in a clinical trial, you should discuss the risks and benefits of clinical trials with your physician. To ensure that you’re receiving the optimal treatment for your cancer, it’s important to stay informed and follow the cancer news to learn about new treatments and clinical trial results.

Types of Treatment

Optimal treatment of patients with stage II esophageal cancer often requires more than one therapeutic approach. So it’s important to receive treatment at a medical center that can offer multimodality treatment. This is treatment that involves specialists in a variety of fields: medical oncologists, radiation oncologists, surgeons, medical gastroenterologists, and nutritionists.

Physicians treat patients with stage II esophageal cancer with the intent of curing them, using either a primary surgical approach or a primary combined chemotherapy and radiation therapy approach. However, physicians usually reserve combined chemotherapy and radiation therapy for patients who are not able or do not wish to undergo major surgery.

There have been no clinical studies directly comparing combined chemotherapy and radiation therapy with surgery alone for the treatment of patients with stage II esophageal cancer. However, the American Society of Radiology guidelines for the treatment of stages I through III esophageal cancer currently recommend surgery alone as the best treatment for patients with stage II esophageal cancer.

Generally, patients with stage IIB cancer involving the lymph nodes have a worse outlook for survival (prognosis) than patients with stage IIA cancer without lymph node involvement. Survival of patients with stage IIB also depends on the number of lymph nodes involved with cancer. In stage IIA cancer, the primary tumor is between 2 and 5 centimeters in diameter and has not spread to the lymph nodes. In stage IIB, the primary tumor is between 2 and 5 centimeters in diameter and has spread to nearby lymph nodes; or the primary tumor is over 5 centimeters and has not spread to the lymph nodes.

• Primary treatment with surgery alone - It is difficult to get accurate information about outcomes for patients with stage II esophageal cancer because most published clinical studies have pooled together the results of patients with stage I through III cancer.
• Neoadjuvant therapy (treatment before surgery) - Chemotherapy and/or radiation therapy administered before surgery is referred to as neoadjuvant therapy. In theory, neoadjuvant therapy can decrease the size of the cancer, making it easier to remove with surgery. The major problems with this approach are the higher mortality rates that occur when radiation therapy and/or chemotherapy are administered before surgery and the delay of surgery for some patients who do not respond to therapy.

In most but not all studies, chemotherapy alone, radiation therapy alone, or both therapies delivered before surgery have not consistently improved survival following surgery in patients with stage II esophageal cancer. Many current clinical trials are directed at improving outcomes of patients with stage II esophageal cancer by administering newer neoadjuvant treatment regimens containing taxane-based chemotherapy and/or radiation therapy.

With new chemotherapy regimens constantly emerging, there will continue to be new clinical trials of neoadjuvant therapy in patients with stage II esophageal cancer undergoing esophagectomy (removing the esophagus completely). The goal of these trials is to develop an effective regimen of chemotherapy and radiation therapy that increases survival.

• Neoadjuvant and adjuvant treatment - Researchers are also evaluating the combination of neoadjuvant low-dose chemotherapy before surgery followed by additional adjuvant chemotherapy after surgery.
• Radiation therapy and chemotherapy as primary treatment - Patients with stage II esophageal cancer may be unable or unwilling to undergo surgery. So physicians may choose treatment with combined chemotherapy and radiation therapy instead. Chemotherapy consists of anticancer drugs that have the ability to kill cancer cells. Chemotherapy and radiation therapy may act together to destroy more cancer cells than either therapy alone.

Research is in progress to refine existing treatments and develop new ones. For information on some of the techniques currently under investigation, see Strategies to Improve Treatment.