Your treatment plan will depend on how deeply the tumor has penetrated the tissue, if lymph nodes are involved, and if cancer has spread to other parts of your body. This is called staging.
If you have esophageal cancer, you will probably have an operation to treat it. We use minimally invasive surgery for as many patients as possible. The stage of your cancer and tumor location determine whether this is possible. Your surgeon will decide if minimally invasive surgery or open surgery is best for you.
Minimally invasive procedures use small incisions. In general, they result in less pain (and less pain medication), faster recovery, and smaller scars. Your NewYork-Presbyterian/Columbia University Irving Medical Center esophageal cancer surgeons have pioneered many of the techniques we use here. We have some of the highest survival rates in the world thanks to our innovation and care.
We use two types of surgery to treat esophageal cancer.
Endoscopic Mucosal Resection (EMR) and BARRX Balloon Ablation
We can usually treat very early esophageal cancer with this combination of minimally invasive techniques.
First, your surgeon removes the diseased portion of your esophagus lining using an endoscope. An endoscope is a thin flexible tube with a light and camera in it. They can also pass tools through the tube to perform procedures guided by the camera view. During this procedure, they will also take a tissue sample for a biopsy. A pathologist will examine the tissue for problems.
After your doctor removes the tissue, you may have another procedure called BARRX balloon ablation. This procedure uses a balloon catheter to deliver a short burst of radiofrequency energy to kill abnormal cells around the inside of your esophagus.
Minimally Invasive Esophagectomy (MIE)
If your cancer is more advanced, you may require an esophagectomy. This operation removes your esophagus and surrounding lymph nodes. Then, your surgeon makes an incision in your abdomen to access your stomach. They create a replacement esophagus using part of your stomach. The remaining part of your stomach continues to work normally.
You should only have this operation performed by a specially trained thoracic or general surgeon who is highly skilled in this procedure.
We use MIE for 80% of esophageal procedures. Depending on which part of your esophagus is diseased and your anatomy, your surgeon may make incisions in your chest, your neck, or both.
Trans-hiatal esophagectomy (THE), generally used for early-stage cancers, involves incisions in your abdomen and neck.
Ivor Lewis esophagectomy or trans-thoracis esophagectomy (TT), generally used when the tumor or cancerous tissues are in the upper part of your esophagus, involves incisions in your abdomen and chest.
Sometimes open surgery, where we use a large incision to access your esophagus and lymph nodes, is necessary.
A stent is a tube made of metal mesh, plastic, or silicone. Your surgeon places it in your esophagus to make it easier for you to swallow.
Chemotherapy is the most commonly known cancer treatment. Chemotherapy uses medications (chemicals) to stop cancer growth and spread and to prevent cancer from recurring by causing rapidly dividing cancer cells to become damaged and die.
Chemotherapy is “systemic” medicine—it interferes with all fast-dividing cells in your body. This is why it causes side effects like hair loss.
Chemotherapy is often given through an IV in our infusion center, but it can sometimes be given through a pill. It’s given in cycles across a few weeks, with each treatment followed by a rest period.
You may have chemotherapy before surgery (neoadjuvant) to shrink the tumor so it can be removed with less extensive surgery. Or, you may have chemotherapy after surgery (adjuvant) to address cancer cells that might have been left behind or may have spread, but cannot be detected, even on imaging tests.
Chemotherapy rarely cures esophageal cancer by itself. We often pair it with radiation therapies, called chemoradiation. We use this treatment to help control pain and improve trouble swallows when cancer can’t be cured, called palliative treatment.
We also use combinations of chemotherapy drugs to help manage locally advanced and metastatic esophageal cancer, such as EOX, ECF, XELOX, Folfox, and carboplatinum/Taxol.
We routinely test tumors for biomarkers—proteins and genes—using an unprecedented, broad genetic panel that tells us if you can benefit from new targeted therapies.
For example, scientists have discovered that the monoclonal antibody called Herceptin helps people whose esophageal cancer produces a protein called Erbb2. They have also discovered that some patients can benefit from adding a medication that keeps tumors from growing new blood vessels, called angiogenesis. The drug ramucirumab is an antiangiogenic medication that can help some people.
You may qualify to participate in a clinical trial, which is a research study to learn more about promising new treatments or supportive care therapies. The hope is to improve the quality of life and survivorship of esophageal cancer patients. Columbia Cancer offers dozens of esophageal cancer clinical trials. You can talk to your care team about whether a clinical trial is an option for you.
Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as X-rays, gamma rays, electron beams, or protons. Radiation oncology specialists direct these particles to the tumor site from outside of your body to precisely target cancer cells, often sparing nearby tissue. You might hear this called external beam radiation therapy.
You might receive radiation therapy to treat cancer or as a palliative care to lessen pain and make it easier to swallow.
Your radiation oncologist, who is part of your personal care team, will design an optimal treatment plan for you for the best possible results. Your treatment may be daily, weekly, every other day, or a single treatment.
With advanced radiation therapy techniques doctors can better target tumors while reducing the radiation to nearby healthy tissues. Here at Columbia Cancer, our radiation oncology experts have the ability to provide state-of-the-art treatments for esophageal cancer.