This PDQ cancer information summary has current information about the treatment of adult esophageal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.
Esophageal cancer is a disease in which malignant (cancer)
cells form in the tissues of the esophagus.
The esophagus is the hollow, muscular tube that moves food and
liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue,
including mucous membrane, muscle, and connective tissue. Esophageal cancer
starts on the inside lining of the esophagus and spreads outward through the
other layers as it grows.
The esophagus and stomach are part of the upper gastrointestinal (digestive) system.
The two most common forms of esophageal cancer are named for the
type of cells that become malignant (cancerous):
Smoking, heavy alcohol use, and Barrett esophagus can increase the
risk of esophageal cancer.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors include the following:
Signs and symptoms of esophageal cancer are weight loss and painful or
difficult swallowing.
These and other signs and symptoms may be caused by esophageal cancer or by
other conditions. Check with your doctor if you have any of the following:
Tests that examine the esophagus are used to diagnose esophageal cancer.
The following tests and procedures may be used:
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis and treatment options depend on
the following:
When esophageal cancer is found very early, there is a better
chance of recovery. Esophageal cancer is often in an advanced stage when it is
diagnosed. At later stages, esophageal cancer can be treated but rarely can be
cured. Taking part in one of the clinical trials being done to improve treatment should be considered. Information about ongoing clinical trials is available from the
NCI website.
Stages of Esophageal Cancer
After esophageal cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the esophagus or to other parts of
the body.
The process used to find out if cancercells have spread within the
esophagus or to other parts of the body is called staging. The information
gathered from the staging process determines the stage of the disease. It is
important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
There are three ways that cancer spreads in the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if esophageal cancer spreads to the lung, the cancer cells in the lung are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not lung cancer.
The grade of the tumor is also used to describe the cancer and plan treatment.
The grade of the tumor describes how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grades 1 to 3 are used to describe esophageal cancer:
The following stages are used for squamous cell carcinoma of the esophagus:
Stage 0 adenocarcinoma of the esophagus. Cancer has formed in the inner lining of the esophagus wall.
Stage I adenocarcinoma of the esophagus
Stage I is divided into stages IA, IB, and IC, depending on where the cancer has spread.
Stage II adenocarcinoma of the esophagus
Stage II is divided into stages IIA and IIB, depending on where the cancer has spread.
Stage III adenocarcinoma of the esophagus
Stage III is divided into stages IIIA and IIIB, depending on where the cancer has spread.
Stage IV adenocarcinoma of the esophagus
Stage IV is divided into stages IVA and IVB, depending on where the cancer has spread.
Esophageal cancer can recur (come back) after it has been treated.
The cancer may come back in the esophagus
or in other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with
esophageal cancer.
Different types of treatment are available for patients with
esophageal cancer. Some treatments are standard (the currently used treatment),
and some are being tested in clinical
trials. A treatment clinical trial is a research
study meant to help improve current treatments or obtain information on new
treatments for patients with cancer. When clinical trials show that a new
treatment is better than the standard treatment, the new treatment may become the standard treatment.
Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Patients have special nutritional needs during treatment for
esophageal cancer.
Many people with esophageal cancer find it hard to eat because
they have trouble swallowing. The esophagus may be narrowed by the tumor or
as a side effect of treatment. Some patients may receive nutrients directly
into a vein. Others may need a feeding tube (a flexible plastic tube that is
passed through the nose or mouth into the stomach) until they are able to eat on
their own.
Seven types of standard treatment are used:
Surgery
Surgery is the most common treatment for cancer of the esophagus.
Part of the esophagus may be removed in an operation called an esophagectomy.
Esophagectomy. A portion of the esophagus is removed and the stomach is pulled up and joined to the remaining esophagus.The doctor will connect the remaining healthy part of the esophagus to the
stomach so the patient can still swallow. A plastic tube or part of the
intestine may be used to make the connection. Lymph nodes near the esophagus
may also be removed and viewed under a microscope to see if they contain
cancer. If the esophagus is partly blocked by the tumor, an expandable metal
stent (tube) may be placed inside the esophagus to help keep it open.
Esophageal stent. A device (stent) is placed in the esophagus to keep it open to allow food and liquids to pass through into the stomach.
Small, early-stage cancer and high-gradedysplasia of the esophagus may be removed by endoscopicresection. An endoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through a small incision (cut) in the skin or through an opening in the body, such as the mouth. A tool attached to the endoscope is used to remove tissue.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy are used to treat esophageal cancer.
A plastic tube may be inserted into the esophagus to keep it open
during radiation therapy. This is called intraluminal intubation and
dilation.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both.
Laser therapy
Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
Electrocoagulation
Electrocoagulation is the use of an electric current to kill
cancer cells.
Immunotherapy
Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biologic therapy.
Immune checkpoint inhibitortherapy is a type of immunotherapy being studied to treat patients with advanced esophageal cancer that cannot be removed by surgery and recurrent esophageal cancer. Some types of immune cells, such as T cells, and some cancer cells have certain proteins, called checkpoint proteins, on their surface that keep immune responses in check. When cancer cells have large amounts of these proteins, they will not be attacked and killed by T cells. Immune checkpoint inhibitors block these proteins and the ability of T cells to kill cancer cells is increased.
There are two types of immune checkpoint inhibitor therapy:
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the
NCI website.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Monoclonal antibodytherapy is a type of targeted therapy used in the treatment of esophageal cancer.
Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Trastuzumab is a monoclonal antibody being studied in esophageal cancer. It may be given to block the effect of the growth factor protein HER2, which sends growth signals to esophageal cancer cells.
Treatment for esophageal cancer may cause side effects.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For general cancer information and other resources from the National Cancer Institute, see the following:
About This PDQ Summary
About PDQ
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.
Purpose of This Summary
This PDQ cancer information summary has current information about the treatment of adult esophageal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Reviewers and Updates
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.
Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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