Esophageal cancer: treatment options other than surgery

Esophageal cancer is cancer that begins in the cells that line the esophagus, the muscular tube that connects the throat to the stomach. It is less common than other types of cancer, but cases still account for roughly 1 percent of all cancer diagnoses in the United States.

The treatment of esophageal cancer will depend on the stage of the cancer and if the cancer has spread to other areas of the body. In the earlier stages of esophageal cancer, endoscopic procedures and surgery can be used to destroy or remove cancer cells and tumors in the esophagus. Surgery may also be used to place a feeding tube before treatment, which will allow a person to receive liquid nutrition when they will be unable to swallow.

However, surgery is not always a treatment option. Tumors may be too large to remove, surgery may be too risky for some people (especially people with other health conditions), or surgery may not be an effective treatment option because the cancer has spread beyond the esophagus to other areas of the body, such as lymph nodes, the lungs, the liver, or other organs.

In cases where surgery is not an option, esophageal cancer can be treated with other types of cancer therapies.

Chemotherapy

Chemotherapy drugs kill cancer cells and/or stop cancer cells from dividing, which can prevent tumors from growing and spreading. When used to treat esophageal cancer, chemotherapy is often used alongside radiation therapy—an approach that is referred to as chemoradiation. The choice of chemotherapy drug, the dosages and schedule, and the combination of therapies being used will vary from person to person—and your healthcare team will be your best source of information.

Radiation therapy

Radiation therapy involves the use of high-energy particles or energy waves, which cause damage to the DNA of cancer cells. This damage causes the cancer cells to die—a process that can take some time, but it can be very effective at shrinking tumors and stopping the cancer from growing and spreading. Most often, esophageal cancer is treated with external beam radiation, which uses a machine to target the area of the body where the tumor is located.

Targeted therapies

Cancer cells are biologically different than normal cells—they have undergone genetic mutations and make abnormal amounts of certain proteins and hormones that they used to grow. Targeted therapy drugs are designed to target cells that have undergone specific changes. This helps the drugs act on cancer cells while minimizing damage to healthy cells. This may cause fewer side effects, but targeted therapies still cause side effects—all cancer treatments do.

Immunotherapy

Immunotherapy works by helping the immune system recognize and destroy cancer cells. In 35 to 45 percent of esophageal cancers, the cancer cells produce large amounts of a protein called PD-L1. This protein helps the cancer cells avoid detection by the immune system. Drugs called immune checkpoint inhibitors can be used to block these proteins so that the immune system will recognize cancer cells as harmful invasive growths that should be destroyed and removed from the body.

Remember, there is no best treatment option for esophageal cancer, only the treatment options that are best for a particular person at a particular time. Your best source of information about your treatment options will be your healthcare providers.