Esophageal Cancer Treatment

Esophageal cancer is cancer that develops in the lining of the esophagus — the tube that connects the throat to the stomach. Food and liquids pass through the esophagus on their way to the stomach.

It is a rare cancer, representing about 1% of cancers in the U.S., and is diagnosed more in men than in women. In 2024, the American Cancer Society estimated 22,370 newly diagnosed esophageal cancer cases and 16,130 esophageal cancer deaths in the U.S. Esophageal cancer is more common in people ages 65 to 74. Rates of esophageal cancer are higher in Wisconsin than the national average.

Because esophageal cancer tends to be aggressive, it can spread quickly. By the time symptoms appear, it is often advanced or metastatic (spread beyond the esophagus). It most often spreads to the liver but can also spread to the lymph nodes and the lungs.

This cancer has an overall (all stages combined) five-year survival rate of about 20%; however, the prognosis for survival changes depending on the stage at diagnosis.

• Localized: If it is localized, meaning cancer has not spread beyond the esophagus, the five-year survival rate increases to 48%.
• Regional: If it is regional — spread to lymph nodes and tissues nearby — the five-year survival rate is 28%.
• Distant: If it is distant, meaning it has spread beyond the esophagus to lymph nodes and other organs, the survival rate at five years drops to 5%. (Source: ACS)

In addition to stage at diagnosis, other factors affect survival, including your age, your general health and other medical conditions, and how well your cancer responds to treatment.

Although advanced esophageal cancer like stage IV is more challenging to treat, a small percentage of patients with stage IV disease will survive to reach the five-year mark. That proportion is expected to increase with clinical trials that are developing new, personalized therapies such as immunotherapy.

Expert Team Devoted to Treating Esophageal Cancer Patients

A dedicated team of experts offers disease-specific expertise and advanced technologies for treating esophageal cancer. Because they focus on esophageal cancer, they are aware of and participate in national and institution-unique clinical trials. The surgery team has a wealth of experience with esophagectomy and receives referrals from across and outside of the state. The medical oncology team offers up to date molecular studies to better define the best chemotherapies, targeted therapies and other medical therapies that will be the most effective for each person’s specific cancer. Our radiation oncologists offer sophisticated, precision radiation technology and are dedicated to improving outcomes while minimizing side effects.

Risk Factors and Prevention

You can prevent some esophageal cancers through lifestyle changes and getting treatment for Barrett’s esophagus if you have it. Treating chronic gastroesophageal reflux is an important step in preventing some esophageal cancers.

In addition to a history of Barrett’s esophagus, factors that can put you at higher risk for developing esophageal are:

• Being older
• Smoking
• Drinking alcohol (heavy drinking)

Symptoms of Esophageal Cancer

Symptoms of esophageal cancer may include the following. Most people with heartburn and other esophageal symptoms do not have cancer, but should check with their doctor if they are experiencing these symptoms.

• Problems swallowing
• Unintended weight loss (losing weight without trying)
• Chest pain
• Heartburn that doesn’t get better with medication
• Coughing
• Hoarse voice

Causes of Esophageal Cancer

Rarely, esophageal cancer has a genetic cause. It is more often related to environmental and lifestyle factors.

The most common cause of esophageal cancer is Barrett’s esophagus. Barrett’s esophagus develops when normal tissues lining the esophagus change. Cells in the tissues of the lower part of the esophagus undergo change or become abnormal, which is called dysplasia. This happens before esophageal cancer develops, and most people with Barrett’s don’t develop cancer.

Types of Esophageal Cancer

There are many types of esophageal cancer, but the most common are squamous cell carcinoma and adenocarcinoma.

Squamous Cell Carcinoma of the Esophagus

In the U.S., about 20% of people diagnosed with esophageal cancer will have squamous cell carcinoma. It usually develops in the lower third of the esophagus and is associated with obesity, a history of gastroesophageal reflux disease and tobacco use.

Adenocarcinoma of the Esophagus

Esophageal adenocarcinoma develops in the lining of the esophagus in cells that produce fluid. It is commonly associated with Barrett’s esophagus. In the U.S., about 80% of people diagnosed with esophageal cancer will have adenocarcinoma.

Diagnosing Esophageal Cancer

Esophageal cancer is often diagnosed when people have concerning symptoms and go to their doctor. If your doctor suspects you may have esophageal cancer, they may order imaging scans, which can including endoscopy. During endoscopy, the doctor uses a small, flexible tube with a camera at the end to view the throat and esophagus and look for a tumor. If cancer is found, small samples (biopsies) of tumor tissue are taken and sent to pathology for analysis.

If pathology confirms cancer, your doctor may order a CT or a PET scan to determine the size and extent of the cancer and to see if cancer has spread beyond the esophagus. This information is important in staging the cancer.

Staging

When pathologists stage esophageal cancer, they use a staging system developed by the American Joint Committee on Cancer called TNM. They look at the location, size and extent of tumors, nodal involvement (spread to nearby lymph nodes) and whether or not the disease has spread to other organs, which is called distant metastatic disease. Overall stages include stage I through IVb. The primary tumor’s stage depends on how far it has invaded esophageal tissues or spread beyond the esophagus.

If you have been diagnosed with esophageal cancer, here are five questions to ask when choosing your care team.

1. How much experience do you have treating esophageal cancer?
2. Is there a specialty team devoted to treating esophageal cancer?
3. What type and stage of esophageal cancer do I have?
4. What are my treatment options?
5. Do you offer clinical trials, and if yes, is there a clinical trial I can join as part of my treatment?

Treatment for Esophageal Cancer

There are different treatment options for esophageal cancer, many of which involve a combination of chemotherapy, radiation and surgery. Newer research shows a role for immunotherapy in some cases.

When surgery is required, our surgeons have unmatched expertise in performing esophagectomies (removal of a portion of the esophagus). Most patients will need to meet with a radiation oncologist, a medical oncologist, a gastroenterologist, a radiation oncologist, a cancer dietitian and a speech pathologist. Seeing a multidisciplinary team that is skilled in treating esophageal cancer is very important in esophageal cancer management. Treatment is tailored to each individual, the cancer stage and each person’s ability to tolerate different types of treatment.

We use a team approach to patient care, and our team of esophageal cancer specialists understands patient needs throughout the treatment process.

Esophageal Cancer Surgery

The goal of an esophagectomy is to remove the cancer within the esophagus. During the operation, your surgeon will remove parts of the esophagus using the least invasive methods. Part of your stomach and some lymph nodes will be removed, as well. Your esophagus will be reconstructed using part of the stomach.

To make sure all cancer cells are eliminated, you may need radiation therapy or drug therapy. These additional therapies can happen before or after surgery, depending on your cancer stage, the extent of your cancer and individual circumstances.

After Surgery

After surgery, you will be moved to a recovery area before moving to a patient room. You will have tubes in different places to provide fluids and nutrition and allow for healing. You will have a temporary feeding tube through the belly that connects to your small intestine to receive nutrition until you have recovered enough to eat normally. As soon your team decides you can do so safely, you will be able to get up and move around with help. You will recover in the hospital for seven or eight days.

At Home

Your care team will explain how to recover at home, including what to eat, activities you can do and concerning symptoms to watch for. Risks include infection, blood clots and bleeding. If you smoke, it is important that you quit, as smoking significantly increases your risk for complications.

Radiation Therapy

If you care team recommends radiation therapy, your team will begin planning treatment, which will include the type of external beam radiation to provide the best treatment for your cancer, how many sessions you will need and the right dose to treat the cancer while minimizing exposure to healthy tissues and organs. Part of the plan is deciding how you will be positioned on the treatment table and creating devices to help you keep still during treatment. You may receive temporary marks that help the radiation therapists know where to direct radiation beams.

During and After Radiation Therapy

Good nutrition and hydration are important during treatment. You may experience side effects such as problems swallowing and pain. If you are not able to eat normally, you may need a feeding tube until you can swallow more normally. Pain and most of the following side effects will resolve a few weeks after treatment is complete. Be sure to tell your care team about all your side effects so they can recommend ways to manage them.

Common short-term side effects include:

• Being tired
• Skin problems like dry skin and irritation. Your care team will connect you with our oncodermatology specialist, who is experienced in managing cancer-related conditions affecting the skin, hair and nails.
• GI issues like diarrhea
• Painful swallowing

Long-term or late side effects may include narrowing in the esophagus, which will need treatment. Other long-term side effects may include thyroid disease or irritation in the esophagus.

Chemotherapy and Other Drug Therapies

While chemotherapy is most often used to treat esophageal cancer, other drug therapies include targeted therapies and immunotherapy.

Chemotherapy

Chemotherapy is a drug or combination of drugs given as pills or through an IV. It may be given before surgery to shrink tumors so surgery does not have to be as extensive. It can also be given after surgery to eliminate any cancer cells left after surgery. Chemotherapy is given for two or three weeks, followed by a rest therapy and then, repeated. This may continue for three or six months.

Tell your care team about any side effects, so they can help you manage them. Common chemo side effects include:

• Losing hair
• GI problems like nausea, vomiting, diarrhea or constipation
• Poor appetite
• Sores in the mouth
• Blood problems like too few white blood cells, too few red blood cells or too few platelets, which can cause:
  • Risk of infections
  • Bleeding or easy bruising
  • Feeling tired

Targeted Therapy

If esophageal cancer is caused by specific changes in genes, targeted therapies may be used to treat it. For example, some cells have too much of a protein called HER-2 on the surface, which helps the cancer cells grow. A targeted therapy that works against that particular change can help destroy these cancer cells. Targeted therapies can be used with chemotherapy or as an alternative if the cancer is not responding to standard chemotherapy drugs. 

Immunotherapy

Immunotherapy drugs may be an option for some people who have esophageal cancer. Certain proteins (checkpoints) on the surface of immune cells can turn the immune response on or off. Cancer cells may turn off the response. Drugs called immune checkpoint inhibitors can help the immune system activate against the cancer cells. 

Support During and After Treatment

With treatment for esophageal cancer, you will need support, including visits with a dietitian to help you adjust to a new diet, swallowing therapy and pain management. We offer a full range of cancer-specific support services to address your emotional and physical needs, help you quit smoking, guide you through for financial concerns, spiritual wellness, fertility preservation and more. Locations can vary, but patients at any of our cancer centers can access support services at other Cancer Network locations. For more information, talk with your physician or nurse. 

Many other forms of support are available to you, including help coping with emotions that are common when dealing with cancer, as well as help to quit smoking. You care team can connect you with our extensive .