Esophageal Cancer Treatment

This information is an interpretation of various studies that have been published in medical journals. The information below represents various views of nurses and doctors who serve on the American Cancer Society’s Cancer Information Database Editorial Board. Keep in mind that the information provided in this article is not designed to be taken as medical advice or to replace the opinion and judgment of your personal cancer care team. It is simply designed to help you make informed decisions together with your doctor. The general treatment options that will be discussed may not be what your doctor recommends, and there may be various reasons why. You should take the time to find out what specific treatments doctors recommend for you.

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There are local and systemic treatments for esophageal cancer. Local treatments are used when cancer is still in the earlier stages and hasn’t spread yet. They are less likely to have major effects on other parts of the body. Systemic treatments, on the other hand, can reach further into different parts of the body and are used when cancer has already spread.

Local Treatments for Esophageal Cancer

Surgery for Esophageal Cancer

The surgery for esophageal cancer is called esophagectomy. It includes removing part or most of the esophagus, depending on the extent of the cancer. If esophageal cancer is found early, removing only part of the esophagus near the infected lymph nodes may be enough to treat it. But most of the time, esophageal cancer is found in the later stages, and surgery alone may not be sufficient. A part of the stomach is also usually removed along with the esophagus and is pulled up into the neck or chest to replace the esophagus that has been cut off.

Esophagectomy is a complicated process that requires a long hospitalization. Different techniques are used, and preparation needs to be carefully planned. The standard technique is open esophagectomy, where the surgeon uses one or more large cuts in the abdomen, chest, or neck. A minimally invasive esophagectomy is used for smaller cancers and allows for the removal of infected parts of the esophagus through smaller cuts. A laparoscope may be inserted into the small cuts, and using the instruments that can be attached to a laparoscope, the doctor may be able to remove the tumors.

The doctor may also remove lymph nodes near the infected area to prevent further cancer spread. Surgery is usually followed by radiation or chemotherapy to make sure that the cancer does not immediately come back.

Some of the risks included in esophagectomy include:

  • Bleeding
  • Blood clots
  • Infections
  • Lung complications
  • Voice changes
  • Stomach leaks
  • Strictures that make swallowing difficult
  • Frequent nausea and vomiting due to slowed stomach movement
  • Heartburn due to sphincter damage

This surgery requires an experienced team of surgeons. Many complications from the surgery can be life-threatening, and it is important to have a well-equipped hospital and well-versed doctors for better chances of success.

Radiation Therapy for Esophageal Cancer

Radiation therapy is a staple of cancer treatment and uses X-rays to kill cancer cells. There are two primary types of radiation therapy used for esophageal cancer treatment. These are External Beam Radiation Therapy and Brachytherapy.

Radiation may be used as the main treatment along with chemo if surgery is not an option, before surgery to shrink tumors, after surgery to kill remaining cells, or to relieve advanced cancer symptoms.

EBRT

External beam radiation therapy (EBRT) aims for radiation from a machine outside the body at the tumor, resembling getting an x-ray but with more intense radiation, delivered over multiple sessions.

Brachytherapy

Brachytherapy involves passing an endoscope down the throat to place radioactive material very close to the tumor, exposing nearby tissue to less radiation. It remains in the body briefly for high-dose brachytherapy, or longer for low-dose brachytherapy. This is more for relieving symptoms, especially if the cancer has already spread.

Side effects like skin changes, nausea, fatigue, mouth sores, swallowing pain, and strictures may result from radiation, worse with combined chemotherapy, but most side effects usually subside over months. Some side effects, however, like lung damage may be permanent. Constant monitoring is necessary after radiation therapy to prevent serious injury.

Endoscopic Surgery for Esophageal cancer

The endoscope may be used with other instruments to conduct treatments for esophageal cancer.

Endoscopic Mucosal Resection

Endoscopic mucosal resection (EMR) removes pieces of the inner esophageal lining for early-stage dysplasia or small cancers using instruments passed down by an endoscope. After abnormal tissue removal, proton pump inhibitors suppress stomach acid to help prevent recurrence. EMR's most common side effect is minor esophageal bleeding, but more serious possible side effects are esophageal strictures needing dilation and perforations requiring surgery.

Photodynamic Therapy (PDT)

Photodynamic therapy (PDT) uses an injected light-activated drug that collects more in cancer cells. An endoscope laser light activates it to kill esophageal precancers, very early-stage cancer, or large cancers blocking the esophagus. The light can only reach surface cancer cells, not deeper ones, so it improves swallowing but does not always destroy all the cancer.

PDT swelling can temporarily impact swallowing, and strictures often needing dilation can occur, as well as bleeding or esophageal holes; patients must avoid light for weeks after. While PDT can cure some superficial esophageal cancers, deeper cells may remain and grow into new tumors, so patients need follow-up endoscopies and acid reducers.

Radiofrequency Ablation

This treatment can be used on Barrett's esophagus disease patients to treat dysplasia before it can fully become cancer. A balloon is inserted into the esophagus, inflated, and then electrified so that the electrodes in the special balloon can kill the cells it comes in contact with in the lining. The cells will eventually grow back, so people who have used this treatment will need to take acid-production blockers.

If the esophagus is blocked, the following treatment can be used to temporarily or permanently relieve pressure for comfort or in preparation for surgery:

  • Laser ablation
  • Argon plasma coagulation
  • Electrocoagulation
  • Esophageal stent placement

Systemic Treatments for Esophageal Cancer

Systemic treatments are far-reaching treatments that usually employ oral or IV-administered drugs.

Chemotherapy for Esophageal Cancer

Chemotherapy uses anti-cancer drugs for esophageal cancer treatment which may be given via IV or orally. They are administered in cycles, with rest periods in between, because chemo drugs are extremely taxing on the body, and will cause deterioration and even kill off tissues and organs if the body cannot handle it. Common chemodrugs for esophageal cancer are:

  • Carboplatin and paclitaxel
  • Oxaliplatin and either 5-FU or capecitabine
  • Cisplatin and either 5-fluorouracil (5-FU) or capecitabine
  • Cisplatin and Irinotecan
  • Paclitaxel and either 5-FU or capecitabine

Chemoradiation is the process of combining chemotherapy and radiation treatment. It has greater efficacy but also stronger side effect potentials. Those drugs listed above are commonly used for chemoradiation. For chemotherapy alone, the following drugs and combinations are commonly used:

  • ECF: epirubicin , cisplatin, and 5-FU
  • DCF: docetaxel, cisplatin, and 5-FU
  • Trifluridine and tipiracil

Chemotherapy may be given after surgery as adjuvant treatment to kill off lingering cancer cells, or before surgery as neoadjuvant treatment to reduce tumor size and make the operation easier.

Common chemo side effects include:

  • Nausea and vomiting
  • Loss of appetite
  • Hair loss
  • Mouth sores
  • Diarrhea or constipation
  • Blood problems
  • Nerve damage
  • Hand and foot syndrome
  • Allergic reactions

Targeted Drug Therapy for Esophageal Cancer

Targeted drugs are special drugs that attack certain proteins that help the cancer grow. For esophageal cancer in particular, the protein known as HER2 can be targeted using a variety of special medications:

Trastuzumab

Trastuzumab is a monoclonal antibody targeting the HER2 protein and can treat some advanced gastroesophageal cancers that are HER2-positive. It is given by IV with chemotherapy once every 3 weeks. Trastuzumab can cause mild side effects like fever and chills, but also sometimes heart damage, so heart function is tested before starting it.

Fam-trastuzumab deruxtecan

Fam-trastuzumab deruxtecan is an antibody-drug conjugate with the anti-HER2 antibody trastuzumab linked to a chemotherapy drug. It targets HER2-positive cancer cells to deliver chemotherapy directly to them and can be used alone after trastuzumab for advanced gastroesophageal cancers. This drug is given IV every 3 weeks.

Ramucirumab

Ramucirumab blocks the VEGF protein that signals the body to make new blood vessels that tumors need to grow. It treats advanced gastroesophageal junction cancers alone or with chemo, after other drugs stop working, given via IV every 2 weeks.

Entrectinib and Larotrectinib

Entrectinib and Larotrectinib are TRK inhibitors that target NTRK gene fusions in cancer cells that drive abnormal growth. They can treat advanced, spreading esophageal cancers with NTRK fusions after other treatments fail and are taken daily in pill form.

Immunotherapy for Esophageal Cancer

Immunotherapy for cancer treatment involves administering drugs known as ‘immune checkpoint inhibitors’ to turn off the immune checkpoint proteins that the body uses to prevent attacking healthy cells. Normally, these immune checkpoints are in place to avoid the immune system cannibalizing your body. But cancer cells can hide behind these checkpoints and make treatment less effective. By turning them on or off using special drugs, doctors can help your body fight cancer more vigorously. Drugs used in immunotherapy for esophageal cancer treatment are PD-1 inhibitors like Pembrolizumab and nivolumab, and CTLA-4 inhibitors like Ipilimumab.

While they can work, they have to be monitored carefully, because they have side effects that include anything from allergic reactions in IV infusion to autoimmune reactions that can make your immune system rabid and destroy your healthy cells, and attack organs. Should the latter happen, you might be given corticosteroids that suppress your immune system.

If you or a loved one have suffered from a misdiagnosis or delayed diagnosis for your esophageal cancer, or from negligence during your treatment that caused you more harm, contact us at 833-PORTER9, or e-mail us at info@porterlawteam.com to discuss the details of our experience representing other clients and the results we were able to obtain in the past for clients who are suffering as you are. In many ways, our results speak for themselves, and we will stand ready to help you and your family in your time of greatest need.

Last Updated on March 1, 2024 by Michael S. Porter
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