Esophageal cancer is a disease in which malignant (cancer)
cells form in the tissues of the esophagus.
Smoking, heavy alcohol use, and Barrett esophagus can increase the
risk of esophageal cancer.
Signs and symptoms of esophageal cancer are weight loss and painful or
difficult swallowing.
Tests that examine the esophagus are used to diagnose esophageal cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
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.EnlargeThe 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):
Squamous cell carcinoma: Cancer that forms in the thin, flat cells lining the inside of the esophagus. This cancer is most often found
in the upper and middle part of the esophagus, but can occur anywhere along the esophagus. This is also called epidermoid
carcinoma.
Adenocarcinoma: Cancer that begins in
glandular cells.
Glandular cells in the lining of the esophagus produce and release fluids such
as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near
the stomach.
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:
Tobacco use.
Heavy alcohol use.
Barrett esophagus: A condition in which the cells lining
the lower part of the esophagus have changed or been replaced with abnormal
cells that could lead to cancer of the esophagus. Gastric reflux (heartburn) is the most common cause of Barrett esophagus.
Older age.
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:
Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer. When the esophagus and stomach are looked at, it is called an upper endoscopy. EnlargeEsophagoscopy. A thin, lighted tube is inserted through the mouth and into the esophagus to look for abnormal areas.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy is usually done during an esophagoscopy.
Sometimes a biopsy shows changes in the esophagus that are not cancer but may
lead to cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis and treatment options depend on
the following:
The stage of the cancer (whether it affects part of the esophagus, involves the
whole esophagus, or has spread to other places in the body).
Whether the tumor can be completely removed by surgery.
The patient’s general health.
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
Key Points
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.
There are three ways that cancer spreads in the body.
Cancer may spread from where it began to other parts of the body.
The grade of the tumor is also used to describe the cancer and plan treatment.
The following stages are used for squamous cell carcinoma of the esophagus:
Stage 0 (High-grade Dysplasia)
Stage I squamous cell carcinoma of the esophagus
Stage II squamous cell carcinoma of the esophagus
Stage III squamous cell carcinoma of the esophagus
Stage IV squamous cell carcinoma of the esophagus
The following stages are used for adenocarcinoma of the esophagus:
Stage 0 (High-grade Dysplasia)
Stage I adenocarcinoma of the esophagus
Stage II adenocarcinoma of the esophagus
Stage III adenocarcinoma of the esophagus
Stage IV adenocarcinoma of the esophagus
Esophageal cancer can recur (come back) after it has been treated.
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 cancer cells 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:
Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. For esophageal cancer, the endoscope is inserted through the mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. A biopsy may also be done. This procedure is also called endosonography.
CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography,
computerized tomography, or computerized axial tomography.
PET scan (positron
emission tomography scan): A procedure to find malignanttumor cells in the body. A small amount of radioactiveglucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure may be used to remove part of the esophagus or lung.
Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples to be checked under a microscope for signs of disease.
Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as those in the neck, and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
There are three ways that cancer spreads in the body.
Tissue. The cancer spreads from where it began by growing into nearby areas.
Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of 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.
Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
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.
Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.
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:
In grade 1, the cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.
In grade 2, the cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 cancer cells.
In grade 3, the cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 and 2 cancer cells.
The following stages are used for squamous cell carcinoma of the esophagus:
Stage 0 (High-grade Dysplasia)
In stage 0, cancer has formed in the inner lining of the esophagus wall. Stage 0 is also called high-grade dysplasia.EnlargeStage 0 squamous cell carcinoma of the esophagus. Cancer has formed in the inner lining of the esophagus wall.
Stage I squamous cell carcinoma of the esophagus
Stage I is divided into stages IA and IB, depending on where the cancer has spread.
Stage IA: Cancer has spread into the mucosa layer or thin muscle layer of the esophagus wall. The cancer cells are grade 1 or the grade is not known.EnlargeStage IA squamous cell carcinoma of the esophagus. Cancer has spread into the mucosa layer or thin muscle layer of the esophagus wall. The cancer cells are grade 1 or the grade is not known. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.
Stage IB: Cancer has spread:
into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. The cancer cells are any grade or the grade is not known; or
into the thick muscle layer of the esophagus wall. The cancer cells are grade 1.
EnlargeStage IB squamous cell carcinoma of the esophagus. Cancer has spread into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. The cancer cells are any grade or the grade is not known; OR cancer has spread into the thick muscle layer of the esophagus wall. The cancer cells are grade 1. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.
Stage II squamous cell carcinoma of the esophagus
Stage II is divided into stages IIA and IIB, depending on where the cancer has spread.
Stage IIA: Cancer has spread:
into the thick muscle layer of the esophagus wall. The cancer cells are grade 2 or 3 or the grade is not known; orEnlargeStage IIA squamous cell carcinoma of the esophagus (1). Cancer has spread into the thick muscle layer of the esophagus wall. The cancer cells are grade 2 or 3 or the grade is not known. Grade 2 and 3 cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 cancer cells.
into the connective tissue layer of the esophagus wall. The tumor is in the lower esophagus; orEnlargeStage IIA squamous cell carcinoma of the esophagus (2). Cancer has spread into the connective tissue layer of the esophagus wall. The tumor is in the lower esophagus.
into the connective tissue layer of the esophagus wall. The cancer cells are grade 1. The tumor is in either the upper or middle esophagus.EnlargeStage IIA squamous cell carcinoma of the esophagus (3). Cancer has spread into the connective tissue layer of the esophagus wall. The cancer cells are grade 1. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells. The tumor is in either the upper or middle esophagus.
Stage IIB: Cancer has spread:
into the connective tissue layer of the esophagus wall. The cancer cells are grade 2 or 3. The tumor is in either the upper or middle esophagus; orEnlargeStage IIB squamous cell carcinoma of the esophagus (1). Cancer has spread into the connective tissue layer of the esophagus wall. The cancer cells are grade 2 or 3. Grade 2 and 3 cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 cancer cells. The tumor is in either the upper or middle esophagus.
into the connective tissue layer of the esophagus wall. The grade of the cancer cells is not known, or it is not known where the tumor has formed in the esophagus; or EnlargeStage IIB squamous cell carcinoma of the esophagus (2). Cancer has spread into the connective tissue layer of the esophagus wall. The grade of the cancer cells is not known, or it is not known where the tumor has formed in the esophagus.
into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor. EnlargeStage IIB squamous cell carcinoma of the esophagus (3). Cancer has spread into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 1 to 2 lymph nodes near the tumor.
Stage III squamous cell carcinoma of the esophagus
Stage III is divided into stages IIIA and IIIB, depending on where the cancer has spread.
Stage IIIA: Cancer has spread:
into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor; or
into the thick muscle layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.
EnlargeStage IIIA squamous cell carcinoma of the esophagus. Cancer has spread into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor; OR cancer has spread into the thick muscle layer of the esophagus wall. Cancer is found in 1 to 2 lymph nodes near the tumor.
Stage IIIB: Cancer has spread:
into the thick muscle layer or the connective tissue layer of the esophagus wall. Cancer is found in 1 to 6 lymph nodes near the tumor; orEnlargeStage IIIB squamous cell carcinoma of the esophagus (1). Cancer has spread into the thick muscle layer or the connective tissue layer of the esophagus wall. Cancer is found in 1 to 6 lymph nodes near the tumor.
into the diaphragm, azygos vein, pleura, sac around the heart, or peritoneum. Cancer may be found in 0 to 2 lymph nodes near the tumor.EnlargeStage IIIB squamous cell carcinoma of the esophagus (2). Cancer has spread into the (a) diaphragm, (b) azygos vein, (c) pleura, (d) sac around the heart, or peritoneum (not shown). Cancer may be found in 0 to 2 lymph nodes near the tumor.
Stage IV squamous cell carcinoma of the esophagus
Stage IV is divided into stages IVA and IVB, depending on where the cancer has spread.
Stage IVA: Cancer has spread:
into the diaphragm, azygos vein, pleura, sac around the heart, or peritoneum. Cancer is found in 3 to 6 lymph nodes near the tumor; orEnlargeStage IVA squamous cell carcinoma of the esophagus (1). Cancer has spread into the (a) diaphragm, (b) azygos vein, (c) pleura, (d) sac around the heart, or peritoneum (not shown). Cancer is found in 3 to 6 lymph nodes near the tumor.
into nearby structures, such as the aorta, airway, or spine. Cancer may be found in 0 to 6 lymph nodes near the tumor; or EnlargeStage IVA squamous cell carcinoma of the esophagus (2). Cancer has spread into nearby structures, such as the airway, aorta, or spine. Cancer may be found in 0 to 6 lymph nodes near the tumor.
to 7 or more lymph nodes near the tumor.EnlargeStage IVA squamous cell carcinoma of the esophagus (3). Cancer has spread to 7 or more lymph nodes near the tumor.
Stage IVB: Cancer has spread to other parts of the body, such as the liver or lung.EnlargeStage IVB squamous cell carcinoma of the esophagus. Cancer has spread to other parts of the body, such as the liver or lung.
The following stages are used for adenocarcinoma of the esophagus:
Stage 0 (High-grade Dysplasia)
In stage 0, cancer has formed in the inner lining of the esophagus wall. Stage 0 is also called high-grade dysplasia.EnlargeStage 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 IA: Cancer has spread into the mucosa layer or thin muscle layer of the esophagus wall. The cancer cells are grade 1 or the grade is not known.EnlargeStage IA adenocarcinoma of the esophagus. Cancer has spread into the mucosa layer or thin muscle layer of the esophagus wall. The cancer cells are grade 1 or the grade is not known. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.
Stage IB: Cancer has spread:
into the mucosa layer or thin muscle layer of the esophagus wall. The cancer cells are grade 2; or
into the submucosa layer of the esophagus wall. The cancer cells are grade 1 or 2 or the grade is not known.
EnlargeStage IB adenocarcinoma of the esophagus. Cancer has spread into the mucosa layer or thin muscle layer of the esophagus wall. The cancer cells are grade 2. Grade 2 cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 cancer cells; OR cancer has spread into the submucosa layer of the esophagus wall. The cancer cells are grade 1 or 2 or the grade is not known.
Stage IC: Cancer has spread:
into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. The cancer cells are grade 3; or
into the thick muscle layer of the esophagus wall. The cancer cells are grade 1 or 2.
EnlargeStage IC adenocarcinoma of the esophagus. Cancer has spread into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. The cancer cells are grade 3. Grade 3 cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 and 2 cancer cells; OR cancer has spread into the thick muscle layer of the esophagus wall. The cancer cells are grade 1 or 2.
Stage II adenocarcinoma of the esophagus
Stage II is divided into stages IIA and IIB, depending on where the cancer has spread.
Stage IIA: Cancer has spread into the thick muscle layer of the esophagus wall. The cancer cells are grade 3 or the grade is not known.EnlargeStage IIA adenocarcinoma of the esophagus. Cancer has spread into the thick muscle layer of the esophagus wall. The cancer cells are grade 3 or the grade is not known. Grade 3 cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 and 2 cancer cells.
into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.
EnlargeStage IIB adenocarcinoma of the esophagus. Cancer has spread into the connective tissue layer of the esophagus wall; OR cancer has spread into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 1 to 2 lymph nodes near the tumor.
Stage III adenocarcinoma of the esophagus
Stage III is divided into stages IIIA and IIIB, depending on where the cancer has spread.
Stage IIIA: Cancer has spread:
into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor; or
into the thick muscle layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.
EnlargeStage IIIA adenocarcinoma of the esophagus. Cancer has spread into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor; OR cancer has spread into the thick muscle layer of the esophagus wall. Cancer is found in 1 to 2 lymph nodes near the tumor.
Stage IIIB: Cancer has spread:
into the thick muscle layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor; or
into the connective tissue layer of the esophagus wall. Cancer is found in 1 to 6 lymph nodes near the tumor; or EnlargeStage IIIB adenocarcinoma of the esophagus (1). Cancer has spread into the thick muscle layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor; OR cancer has spread into the connective tissue layer of the esophagus wall. Cancer is found in 1 to 6 lymph nodes near the tumor.
into the diaphragm, azygos vein, pleura, sac around the heart, or peritoneum. Cancer may be found in 0 to 2 lymph nodes near the tumor.EnlargeStage IIIB adenocarcinoma of the esophagus (2). Cancer has spread into the (a) diaphragm, (b) azygos vein, (c) pleura, (d) sac around the heart, or peritoneum (not shown). Cancer may be found in 0 to 2 lymph nodes near the tumor.
Stage IV adenocarcinoma of the esophagus
Stage IV is divided into stages IVA and IVB, depending on where the cancer has spread.
Stage IVA: Cancer has spread:
into the diaphragm, azygos vein, pleura, sac around the heart, or peritoneum. Cancer is found in 3 to 6 lymph nodes near the tumor; orEnlargeStage IVA adenocarcinoma of the esophagus (1). Cancer has spread into the (a) diaphragm, (b) azygos vein, (c) pleura, (d) sac around the heart, or peritoneum (not shown). Cancer is found in 3 to 6 lymph nodes near the tumor.
into nearby structures, such as the aorta, airway, or spine. Cancer may be found in 0 to 6 lymph nodes near the tumor; orEnlargeStage IVA adenocarcinoma of the esophagus (2). Cancer has spread into nearby structures, such as the airway, aorta, or spine. Cancer may be found in 0 to 6 lymph nodes near the tumor.
to 7 or more lymph nodes near the tumor.EnlargeStage IVA adenocarcinoma of the esophagus (3). Cancer has spread to 7 or more lymph nodes near the tumor.
Stage IVB: Cancer has spread to other parts of the body, such as the liver or lung.EnlargeStage IVB adenocarcinoma of the esophagus. Cancer has spread to other parts of the body, such as the liver or lung.
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
Key Points
There are different types of treatment for patients with
esophageal cancer.
Patients have special nutritional needs during treatment for
esophageal cancer.
The following types of treatment are used:
Surgery
Radiation therapy
Chemotherapy
Chemoradiation therapy
Laser therapy
Electrocoagulation
Immunotherapy
New types of treatment are being tested in clinical trials.
Targeted therapy
Treatment for esophageal cancer may cause side effects.
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.
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.
The following types of 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.
EnlargeEsophagectomy. 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.EnlargeEsophageal 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 endoscopic resection. 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:
External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
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.
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:
CTLA-4 inhibitor therapy: CTLA-4 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow the T cells to kill cancer cells. Ipilimumab is a type of CTLA-4 inhibitor.EnlargeImmune checkpoint inhibitor. Checkpoint proteins, such as B7-1/B7-2 on antigen-presenting cells (APC) and CTLA-4 on T cells, help keep the body’s immune responses in check. When the T-cell receptor (TCR) binds to antigen and major histocompatibility complex (MHC) proteins on the APC and CD28 binds to B7-1/B7-2 on the APC, the T cell can be activated. However, the binding of B7-1/B7-2 to CTLA-4 keeps the T cells in the inactive state so they are not able to kill tumor cells in the body (left panel). Blocking the binding of B7-1/B7-2 to CTLA-4 with an immune checkpoint inhibitor (anti-CTLA-4 antibody) allows the T cells to be active and to kill tumor cells (right panel).
PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. Nivolumab is a type of PD-1 inhibitor.EnlargeImmune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).
Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.
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. 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.
How do monoclonal antibodies work to treat cancer? This video shows how monoclonal antibodies, such as trastuzumab, pembrolizumab, and rituximab, block molecules cancer cells need to grow, flag cancer cells for destruction by the body’s immune system, or deliver harmful substances to 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.
As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated 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).
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.
Adjuvant therapy given after chemoradiation therapy for patients with esophageal adenocarcinoma, esophageal squamous cell carcinoma, or gastroesophageal junction cancer.
Immunotherapy and chemoimmunotherapy for patients with previously untreated, unresectable, advanced or metastatic esophageal adenocarcinoma or gastroesophageal junction cancer.
Immunotherapy for patients with cancer that recurs after one type of therapy.
Nivolumab and chemotherapy for patients with adenocarcinoma.
Esophageal brachytherapy, which delivers a high dose of radiation therapy to the tumor while limiting the dose to nearby organs, as palliative therapy for dysphagia.
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.
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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The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
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