Treatment

Treatment for esophageal cancer depends on a number of factors, including the size, location, and extent of the tumor, and the general health of the patient. Patients are often treated by a team of specialists, which may include a gastroenterologist (a doctor who specializes in diagnosing and treating disorders of the digestive system), surgeon (a doctor who specializes in removing or repairing parts of the body), medical oncologist (a doctor who specializes in treating cancer), and radiation oncologist (a doctor who specializes in using radiation to treat cancer). Because cancer treatment may make the mouth sensitive and at risk for infection, doctors often advise patients with esophageal cancer to see a dentist for a dental exam and treatment before cancer treatment begins.

Many different treatments and combinations of treatments may be used to control the cancer and/or to improve the patient's quality of life by reducing symptoms.

• Surgery is the most common treatment for esophageal cancer. Usually, the surgeon removes the tumor along with all or a portion of the esophagus, nearby lymph nodes, and other tissue in the area. (An operation to remove the esophagus is called an esophagectomy.) The surgeon connects the remaining healthy part of the esophagus to the stomach so the patient is still able to swallow. Sometimes, a plastic tube or part of the intestine is used to make the connection. The surgeon may also widen the opening between the stomach and the small intestine to allow stomach contents to pass more easily into the small intestine. Sometimes surgery is done after other treatment is finished.

• Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells. Radiation therapy affects cancer cells in the treated area only. The radiation may come from a machine outside the body (external radiation) or from radioactive materials placed in or near the tumor (internal radiation). A plastic tube may be inserted into the esophagus to keep it open during radiation therapy. This procedure is called intraluminal intubation and dilation. Radiation therapy may be used alone or combined with chemotherapy as primary treatment instead of surgery, especially if the size or location of the tumor would make an operation difficult. Doctors may also combine radiation therapy with chemotherapy to shrink the tumor before surgery. Even if the tumor cannot be removed by surgery or destroyed entirely by radiation therapy, radiation therapy can often help relieve pain and make swallowing easier.

• Chemotherapy is the use of anticancer drugs to kill cancer cells. The anticancer drugs used to treat esophageal cancer travel throughout the body. Anticancer drugs used to treat esophageal cancer are usually given by injection into a vein (IV). Chemotherapy may be combined with radiation therapy as primary treatment (instead of surgery) or to shrink the tumor before surgery.

• Laser therapy is the use of high-intensity light to destroy tumor cells. Laser therapy affects the cells only in the treated area. The doctor may use laser therapy to destroy cancerous tissue and relieve a blockage in the esophagus when the cancer cannot be removed by surgery. The relief of a blockage can help to reduce symptoms, especially swallowing problems.

• Photodynamic therapy (PDT), a type of laser therapy, involves the use of drugs that are absorbed by cancer cells; when exposed to a special light, the drugs become active and destroy the cancer cells. The doctor may use PDT to relieve symptoms of esophageal cancer such as difficulty swallowing.

Clinical trials (research studies) to evaluate new ways to treat cancer are an important option for many patients with esophageal cancer. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and the usual (standard) therapy to another group. Through research, doctors learn new, more effective ways to treat cancer. More information about research studies can be found in the NCI publication Taking Part in Clinical Trials: What Cancer Patients Need to Know. NCI's Web site has a section on clinical trials at http://www.cancer.gov/clinicaltrials/. This section provides general information about clinical trials and detailed information about specific ongoing studies. This information is also available from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). For deaf and hard of hearing callers with TTY equipment, the number is 1-800-332-8615.
Side Effects of Treatment

The side effects of cancer treatment depend on the type of treatment and may be different for each person. Doctors and nurses can explain the possible side effects of treatment, and they can suggest ways to help relieve symptoms that may occur during and after treatment.

• Surgery for esophageal cancer may cause short-term pain and tenderness in the area of the operation, but this discomfort or pain can be controlled with medicine. Patients are taught special breathing and coughing exercises to keep their lungs clear.

• Radiation therapy affects normal as well as cancerous cells. Side effects of radiation therapy depend mainly on the dose and the part of the body that is treated. Common side effects of radiation therapy to the esophagus are a dry, sore mouth and throat; difficulty swallowing; swelling of the mouth and gums; dental cavities; fatigue; skin changes at the site of treatment; and loss of appetite.

• Chemotherapy, like radiation therapy, affects normal as well as cancerous cells. Side effects depend largely on the specific drugs and the dose (amount of drug administered). Common side effects of chemotherapy include nausea and vomiting, poor appetite, hair loss, skin rash and itching, mouth and lip sores, diarrhea, and fatigue. These side effects generally go away gradually during the recovery periods between treatments or after treatment is over.

• Laser therapy can cause short-term pain where the treatment was given, but this discomfort can be controlled with medicine.

• Photodynamic therapy makes the skin and eyes highly sensitive to light for 6 weeks or more after treatment. Other temporary side effects of PDT may include coughing, trouble swallowing, abdominal pain, and painful breathing or shortness of breath.

Radiation Therapy and You, Chemotherapy and You, and Pain Control: A Guide for People with Cancer and Their Families are useful NCI booklets that suggest ways for patients to cope with the side effects they experience during and after cancer treatment.

Eating well during cancer treatment means getting enough calories and protein to control weight loss and maintain strength. Eating well often helps people with cancer feel better and have more energy.

However, many people with esophageal cancer find it hard to eat well because they have difficulty swallowing. Patients may not feel like eating if they are uncomfortable or tired. Also, the common side effects of treatment, such as poor appetite, nausea, vomiting, dry mouth, or mouth sores, can make eating difficult. Foods may taste different.

After surgery, patients may receive nutrients directly into a vein. (This way of getting nourishment into the body is called an IV.) Some may need a feeding tube (a flexible plastic tube that is passed through the nose to the stomach or through the mouth to the stomach) until they are able to eat on their own.

Patients with esophageal cancer are usually encouraged to eat several small meals and snacks throughout the day, rather than try to eat three large meals. When swallowing is difficult, many patients can still manage soft, bland foods moistened with sauces or gravies. Puddings, ice cream, and soups are nourishing and are usually easy to swallow. It may be helpful to use a blender to process solid foods. The doctor, dietitian, nutritionist, or other health care provider can advise patients about these and other ways to maintain a healthy diet.

Patients and their families may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients, which contains many useful suggestions and recipes.