Esophageal cancer treatment depends on the type, location and stage of cancer as well as on your age, overall health and personal preferences. Decisions about therapy can be particularly complicated because various combinations of surgery, chemotherapy and radiation may be more effective than any single treatment. When cancer is advanced, choosing a treatment plan is a difficult decision, and it's important to take time to evaluate your choices.

You may also want to consider seeking a second opinion. This can provide additional information to help you feel more certain about the option you're considering.

First and foremost, the goal of treatment is to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or causing more harm. In some cases, an approach called palliative care may be best. Palliative care refers to treatment aimed not at removing or slowing the disease, but at helping relieve symptoms and making you as comfortable as possible.

Surgical options
Surgery is a common treatment for esophageal cancer, either as a therapy for the cancer itself or as a way to relieve symptoms, especially difficult swallowing. It's also recommended if you consistently have very abnormal cells (high-grade dysplasia) occurring with Barrett's esophagus.

Depending on the nature of the cancer, the operation may be performed in one of two ways:

• Esophagectomy. Doctors generally recommend this approach for early-stage esophageal cancer that doesn't involve your stomach. During the procedure, your surgeon removes the portion of your esophagus that contains the tumor along with nearby lymph nodes. The remaining esophagus is reconnected to your stomach. In some cases the stomach is pulled up to the esophagus. In others, part of your large intestine is used to replace the missing section of your esophagus.
• Esophagogastrectomy. In this procedure, which is used for more advanced cancer, your surgeon removes part of your esophagus, nearby lymph nodes and the upper part of your stomach. The remainder of your stomach is then pulled up and reattached to your esophagus. If necessary, part of your colon is used to help join the two.

Surgery for esophageal cancer is complex and carries risks that include infection, bleeding and leakage from the area where the remaining esophagus is reattached. Hospitals where surgeons perform a large number of esophagectomies have significantly lower mortality rates than do hospitals where few esophagectomies are performed. If you're considering this surgery, look for a hospital or medical center whose surgeons are highly experienced in the procedure.

Chemotherapy
Using drugs to kill cancer cells is another option for treating esophageal cancer. Chemotherapy medications, which can be injected into a vein or taken by mouth, travel throughout your body, attacking cancer cells in and beyond your esophagus. You usually receive a combination of anti-cancer drugs given in cycles, with periods of recovery alternating with periods of treatment.

Chemotherapy can help in several ways - before surgery to shrink the tumor, in combination with radiation when surgery isn't an option, or to relieve symptoms in advanced cases of esophageal cancer.

Unfortunately, anti-cancer drugs affect normal cells as well as malignant ones, especially fast-growing cells in your digestive tract and bone marrow. For that reason, side effects - including nausea and vomiting, mouth sores, an increased chance of infection due to a shortage of white blood cells, and fatigue - are common. Not everyone experiences side effects, however, and there are now better ways to control them if you do. Be sure to discuss any questions you may have about side effects with your treatment team.

Chemotherapy may also be given at the same time as radiation treatment. Certain chemotherapy drugs can make the radiation treatments more effective, but this also may increase some of the side effects.

Radiation therapy
Radiation is used as a primary treatment for esophageal cancer, in combination with chemotherapy or to shrink a tumor before surgery. It's also used to relieve pain and improve swallowing. Most often, the radiation comes from a machine outside your body (external beam radiation), but sometimes thin plastic tubes containing radioactive material are implanted near the cancer cells in your esophagus (brachytherapy).

The most common side effects are fatigue - which generally becomes more noticeable later in the course of treatment - skin rash or redness in the area being treated, loss of appetite, and sores in the esophagus that cause problems with swallowing. (2) In fact, swallowing may become so difficult that your doctor will recommend a feeding tube to provide nourishment during treatment.

These side effects generally aren't permanent, and most can be treated or controlled. Long-term side effects are rare, but they can be serious when they do occur and include inflammation or scarring in the lungs.

Photodynamic therapy
This therapy is generally used to relieve pain and obstruction in the esophagus, but it's also being studied as a treatment for early-stage esophageal cancer. During the procedure, you receive an injection of a light-sensitive drug that remains in cancer cells longer than it does in healthy ones. A laser light is then directed at your esophagus through an endoscope. This stimulates the production of an active form of oxygen that destroys the cancer cells while sparing healthy tissue.

Photodynamic therapy isn't without side effects. It makes your skin and eyes sensitive to light for at least six weeks after treatment, so you'll need to wear protective clothing and sunglasses every time you go outdoors.