How Is Esophageal Cancer Treated?

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

Specific treatment for esophageal cancer will be determined by your doctor based on:

• Your age, overall health, and medical history
• The extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of this disease
• Your opinion or preference

Different types of treatment may be used to control esophageal cancer and to reduce symptoms. Sometimes, your doctor may combine several of these methods to treat your esophageal cancer. Treatment may include:

• Surgery - Two types of surgery are commonly performed for esophageal cancer. In one type of surgery, the surgeon removes part of the esophagus and the nearby lymph nodes and reconnects the remaining portion of the esophagus to the stomach. In the other surgery, the doctor removes part of the esophagus, the nearby lymph nodes, and the top of the stomach. The doctor then reconnects the remaining portion of the esophagus to the stomach. Your doctor may perform this operation after he or she completes other treatments.
• Chemotherapy - the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways. The oncologist will recommend a treatment plan. Your doctor may use chemotherapy along with radiation therapy as the primary treatment. Or your doctor may use chemotherapy to shrink your tumor prior to surgery.
• Radiation therapy - the use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation:
  • External radiation (external beam therapy) - precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
  • Internal radiation (brachytherapy, implant radiation) - given inside the body as close to the cancer as possible. Substances that produce radiation, called radioisotopes, may be swallowed, injected, or implanted directly into the tumor. Some of the radioactive implants are called “seeds” or “capsules.” Internal radiation uses a higher dose of radiation in a shorter time span than with external radiation. Some internal radiation treatments stay in the body temporarily. Others stay in the body permanently, although the radioactive substance looses its radiation within a short period of time. In some cases, both internal and external radiation therapies are used.

  • Photodynamic therapy (PDT) - Photodynamic therapy 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 can be focused directly on the tumor. As the cells absorb the light, a chemical reaction destroys the cancer cells. The light is delivered through a small, flexible tube called an endoscope, which is inserted through the mouth or nose. Photodynamic therapy may be used to relieve or reduce symptoms of esophageal cancer, such as difficulty swallowing.
  • Biologic therapy - Biologic therapy uses the body’s own immune system to fight cancer.