There are different types of treatment for patients with esophageal cancer, depending on the stage of the cancer and the person’s overall health. For each type and stage of esophageal cancer there are standard treatments and there are clinical trials that are evaluating promising new treatments. At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer. That’s why careful diagnosis is so important.
As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge.
Many of our physicians are principal investigators in these trials, which cover medical oncology, surgery, and radiation therapy. Discuss with your physician how your cancer might benefit from clinical trials.
Proper staging is crucial for esophageal cancer patients. Experts at Siteman have studied and published numerous scientific reports about the strength and weaknesses of common staging tests. Most patients will still require some additional testing to provide as much certainty as possible about the specific stage. The stage of a cancer will direct the therapy, so the results of CT scans, PET scans, biopsies and endoscopic ultrasound procedures are key to treatment planning.
Each new patient’s case is presented at a multidisciplinary conference to personalize his or her treatment, including surgery, radiation oncology, chemotherapy and pathology to take into account specific tumor characteristics.
Because the esophagus provides the primary way we get nutrients into our bodies, patients with esophageal cancer have special nutritional needs during treatment. Besides having pain upon swallowing (a common symptom of esophageal cancer), patients may have barriers to eating when the esophagus is narrowed by the tumor or scarring effects of treatment. Consequently, during treatment or healing, you may receive nutrients directly from a feeding tube into the stomach or small intestine directly from the outside until you are able to return to eating on your own.
Surgical resection is an important treatment option for early cancer of the esophagus. It usually involves removing the diseased part during an operation called an esophagectomy. After that is done, the stomach is pulled up and joined to the remaining esophagus. There are several unique procedures for putting things back together. Occasionally a part of the intestine may be used to make the connection. During the operation, the surgeon will remove many lymph nodes nearby to test for cancer and to improve the outcomes of therapy.
For advanced esophageal cancer, chemotherapy is the main treatment. Chemotherapy involves the administration of drugs, either orally or intravenously, to kill cancer cells. Recently, several new drugs have increased the options for physicians treating patients with esophageal cancer. Medical therapy for advanced esophageal cancer has a wide range of approaches, including the individual drugs, the amounts and the timing of treatment. Your doctor will discuss these options in detail.
Radiation oncology is an important component for treatment and can be delivered in a variety of ways. Oncologists have active trials for minimizing the duration and amount of radiation a patient receives to reduce long-term side effects. The goal of these trials is that no one should be over-treated or under-treated. Siteman is a leader in using shorter radiation durations than the national average with the same or better outcomes. Radiation therapy is commonly used as part of the treatment program for tumors in the esophagus and nearby lymph nodes. Its effect is to provide symptom relief or, in combination with chemotherapy, to eradicate the cancer.
External beam radiation
Ninety-five percent of radiation treatment at Siteman is external beam from outside the body. Siteman fine-tunes the radiation planning with intensity modulated therapy, using a CT scan simulator for 3D planning to precisely target therapy. Our team was the first in the world to have the ability to do external radiation with MRI guidance, and the first to treat patients with that technology.
Internal radiation may be used in some cases to implant in seeds or catheters adjacent to the cancer.
Often given together to treat different stages of esophageal cancer, the two together can work more effectively than either along, depending on the stage. This treatment combines chemotherapy and radiation to increase the effects of both.
Other therapies aimed to treat esophageal cancer
Cancer cells may be targeted directly, depending on the specifics of your cancer, with:
- Laser therapy: using a laser beam instead of surgery to kill cancer cells.
- Electrocoagulation: using an electrical current to kill cancer cells.
- Cryotherapy: freezing cancer cells.
Different combinations of therapies may be used depending on the stage of the cancer and grade of the cancer cells. New combinations of therapies are always being tested in clinical trials and are available at Siteman before other places may have access to them.