Treatment of Stage IV 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 IV esophageal cancer have metastatic cancer. This is cancer that has spread from the esophagus to distant areas in the body.

The following is a general overview of the treatment of stage IV 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.

Clinical Trials

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.

Optimal treatment of patients with stage IV esophageal cancer often requires more than one therapeutic approach. Thus, it is important for you to receive treatment at a medical center that can offer you a variety of specialists, including medical oncologists, radiation oncologists, surgeons, gastroenterologists, and nutritionists.

There are currently no standard curative therapies for treatment of stage IV esophageal cancer. The major symptom of esophageal cancer is dysphagia, which simply means difficulty in swallowing food and liquids.

Specific treatments can result in short-term benefit and can improve your nutrient intake. Current treatment approaches primarily control symptoms and prolong survival. There are a number of treatment options available to you. Your physician may use these options alone or in combination to achieve optimal results.

Palliative surgery - Palliative surgery is surgery that offers relief of symptoms but not a cure. Patients with stage IV esophageal cancer often have widespread cancer at the time of diagnosis. So surgery would not offer a cure. There is controversy over how best to treat patients who cannot undergo surgery with the intent of curing them.

Chemotherapy - Single chemotherapy drugs such as Platinol^® (cisplatin), fluorouracil, Mutamycin^® (mitomycin), Doxil^® (doxorubicin), and Ellence^® (epirubicin) may result in clinical remissions (inactive state of disease) in patients with esophageal cancer. Standard combination chemotherapy treatment regimens have often used cisplatin with fluorouracil and epirubicin or mitomycin. The overall response rate for these combination regimens is approximately 40 percent, and the average survival duration is 8 to 10 months.

Recent studies indicate that taxanes (Taxol^® [paclitaxel] and Taxotere^® [docetaxel]) may be the most active single chemotherapy drugs for the treatment of esophageal cancer, with complete remissions occurring in up to 15 percent of patients. Other agents that have been or are being evaluated include Camptosar^® (irinotecan) and Gemzar^® (gemcitabine).

Currently available combination chemotherapy treatment for stage IV cancer results in complete remission in up to 20 percent of patients, with average survival of 8 to 12 months. As newer drugs, such as the taxanes, irinotecan, and gemcitabine become part of regimens, this percentage may continue to improve.

Other Treatment Modalities

Physicians use many other treatment modalities to prolong survival and quality of life for patients with esophageal cancer.

Thermal laser treatment - Thermal laser destruction of cancer cells using endoscopy (a procedure allowing the physician to view the inside of the esophagus and to insert instruments to remove a tissue sample) may provide temporary relief of dysphagia, or difficulty swallowing.

Laser ablation (removing cancer cells with a laser) appears to be most helpful for treating polypoid cancers (polyps or growths that are malignant) that grow into the esophagus causing blockage. Laser treatment is less effective for upper esophageal cancers or cancers of the gastroesophageal junction (the lower part of the esophagus that connects to the stomach).

Photodynamic treatment - Photodynamic treatment is a type of laser treatment that involves injecting photosensitizing chemicals into the bloodstream. Cells throughout the body absorb the chemicals. The chemicals collect and stay longer in the cancer cells than in the healthy cells. At the right time, when the healthy cells surrounding the tumor may already be relatively free of the chemical, the light of a laser focuses directly on the tumor. As the cells absorb the light, a chemical reaction destroys the cancer cells. The light comes through a small, flexible tube called an endoscope, that enters through the mouth or nose. Photodynamic therapy may relieve or reduce some of the symptoms of esophageal cancer, such as difficulty swallowing.

Esophageal dilation - Often, after administering chemotherapy, radiation therapy, laser, or photodynamic treatment, the area of the esophagus with cancer may narrow. Narrowing of the esophagus may be due to recurrent cancer or to treatment-related strictures (areas of abnormal narrowing) or both. Relief of this constriction by dilation can temporarily improve swallowing.

During esophageal dilation, a physician uses endoscopic or fluoroscopic (instruments to help view the area) guidance to pass flexible dilators (mercury-filled rubber tubes) through the patient’s mouth. The physician then introduces increasing diameters of dilators, called bougies, until the swallowing difficulty resolves.

Esophageal stents or prostheses - Stents are rigid tubes that stay in the esophagus to keep it open.

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.