A diagnosis of esophageal cancer may be shocking and frightening, but it’s important to keep your focus on the next step, which is choosing your cancer treatment plan. Depending on the stage of your cancer, there are a number of treatment options that may be used alone or in combination as your best defense against esophageal cancer.
Esophageal Cancer Treatment
Once your Esophageal Cancer has been diagnosed and staged, the next step is starting cancer treatment. Treatments focus on removing all the cancer from your body when possible; your plan may also be designed to keep the cancer from spreading. Other times, treatment may just be used to keep you comfortable and relieve pain.
According to Srinadh Komanduri, MD, interventional gastroenterologist at Northwestern Memorial Hospital in Chicago., esophageal cancer treatment is based primarily on how advanced the cancer is when diagnosed. Potential treatments may include the following:
Surgery. There are a few types of surgery that may be performed in order to remove esophageal cancer. Portions of the esophagus, and perhaps even parts of the stomach and lymph nodes, may be removed. Typically, a large portion of the esophagus is removed in a procedure called esophagectomy. In that procedure, most of the esophagus and part of the top of the stomach are removed; it is typically performed on people who have advanced esophageal cancer. Another potential surgical option is endoscopic surgery, in which a scope is inserted into the esophagus and treatment is delivered locally through the scope. This option is appropriate only if the cancer affects the most superficial layer of the esophagus, called the mucosa.
While surgery is a common way to treat esophageal cancer, it is invasive and involves a long period of healing. The advantage of endoscopic procedures is that the recovery time is significantly less, but close follow-up with your doctor is essential.
“Surgery takes six months to recover from. Most people who have surgery have already had chemotherapy and radiation treatments,” says Sandra Starnes, MD, an assistant professor of surgery at the University of Cincinnati. Surgery for esophageal cancer usually involves “an incision in the belly and the chest that take a long time to heal,” she says.
Radiation. In this method of treating esophageal cancer, radioactive material is targeted at the cancerous cells via an external machine or through small tubes implanted in the body near the cancerous cells. Radiation may be used as a primary treatment, or along with either or both chemotherapy and surgery.
Chemotherapy. Chemotherapy is a medication regimen, which may be given intravenously (through a needle in a vein, usually in the hand or arm) or through an oral medication designed to destroy cancer cells. Chemotherapy can be used along with surgery, along with radiation therapy, or on its own to relieve the pain and symptoms of esophageal cancer.
“For more advanced cancers, the treatment of choice is chemotherapy, plus or minus radiation. This may be performed as the sole treatment or in efforts to downstage the tumor for a possible surgical resection. While chemotherapy and radiation can be very debilitating for patients, with many side effects, it can also be a very effective treatment,” says Dr. Komanduri.
PDT. Photodynamic therapy, or PDT, involves the injection of a drug that is sensitive to light, along with a laser that helps to kill cancer cells.
Electrocoagulation. This treatment method uses electrical currents to destroy cancer cells in the esophagus.
A few other treatment options are still being researched and are not widely available yet. One new method is immunotherapy, which fights cancer by boosting the patient’s immune system. Gene therapy is also being studied to try to find a way to treat unhealthy DNA that causes cancer. Research to find better chemotherapy drugs and combinations of chemotherapy treatment are also in the works.
Esophageal Cancer: Which Therapy, and When?
Surgery is usually the first line of defense against esophageal cancer. It is a recommended cancer treatment for most stages of esophageal cancer. In addition to surgery, many stage II and stage III esophageal cancer patients will have chemotherapy and radiation to destroy cancer cells. Chemotherapy and radiation therapy can also be given to patients who are not good candidates for surgery because of health concerns or other issues.
Stage IV cancer patients’ treatments will focus on palliative care — making sure that there is no pain and that you are as comfortable as possible. Radiation therapy and chemotherapy may also be used to alleviate pain, as can PDT.
Esophageal Cancer: Talking About Your Treatment
Before starting a treatment regimen to battle esophageal cancer, prepare yourself with knowledge and a plan to help combat treatment side effects. Talk to your doctor so that you understand your treatment course, how the treatment will affect you, and how to make yourself feel as good as possible during treatment and recovery.