Located behind your “windpipe” (trachea), the esophagus is a tube through which foods and liquid pass from the throat to the stomach. It is 10 – 13 inches long and, at its smallest point, less than an inch wide. Esophageal cancer is three times more common in men than in women. More than 17,000 cases of esophageal cancer are diagnosed each year in the United States, mostly in patients over the age of 65 years old.

The risk factors for esophageal cancer include smoking, heavy drinking, diets low in fruits and vegetables, obesity and acid reflux or patients with Barrett’s esophagus. Symptoms may include food getting caught in the throat, pain swallowing, heartburn or reflux and unexpected weight loss.

Cancer of the esophagus can be treated using surgery, chemotherapy, targeted therapy and radiation therapy. Which esophageal cancer treatment option is best for your particular case depends on its exact location, the stage of the disease and whether you are a good candidate for surgery.

Surgery

If your esophageal cancer was caught early, your surgeon may be able to remove the tumor or tumors through an endoscope inserted down the throat and into the esophagus. Using more common procedures, the surgeon may remove the cancerous portion of your esophagus, lymph nodes and nearby soft tissue, reconnecting the remaining section directly to your stomach. Or a piece of the small or large intestine may be used to replace the removed portion. In some cases, the surgeon may also remove a portion of the stomach itself.

Chemotherapy

Your Medical or Surgical Oncologist may recommend one of three different forms of chemotherapy. Neo-adjuvant or primary systemic chemotherapy is used before radiation or surgery to shrink the cancer. Adjuvant chemotherapy is used after radiation or surgery to destroy any remaining cancer cells. Systemic chemotherapy circulates throughout the body via the bloodstream when the cancer is metastatic. Chemotherapy alone is rarely used as the sole esophageal cancer treatment. It is typically given together with radiation therapy.

Targeted Therapy

Some esophageal cancers have too much of a protein called HER2 on their cells, causing the cancer to grow. Drugs that target this protein may interfere with the cancer’s growth. They are usually used in conjunction with chemotherapy drugs.

Esophageal Cancer Radiation Therapy

Radiation therapy may be used as a primary treatment when surgery is not an option, post-surgery in order to destroy any cancerous cells left behind, or in combination with chemotherapy and targeted therapy. One of several highly sophisticated forms of External Beam Radiation Therapy or Internal Radiation Therapy may be recommended depending on the size and location of the tumor or tumors.

3D-Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy (IMRT) 

3D-Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy (IMRT) are two forms of External Beam Radiation Therapy. During 3D-Conformal treatments, a device called a "multi-leaf collimator" will shape the individual radiation beams to “conform” to the shape of your tumor according to the data and instructions it receives from the system computer. IMRT uses thousands of radiation “beamlets” from many different angles to deliver a single dose of radiation. The intensity of the “beamlets” can change during the treatment session to modulate the dose, so that the tumor receives a very precise high dose of radiation, while minimizing damage to surrounding, normal tissue.

Before each session, a Radiation Therapist will carefully position you on the treatment table using a body immobilizer for precise body placement. Image guidance will be used to confirm the location of the tumor before the therapy begins. During your treatment sessions, the radiation delivery system will revolve around you, delivering the radiation according to the plan set by your Radiation Oncologist. Each treatment session lasts from 10 to 30 minutes. If radiation is your primary form of treatment, you will be scheduled for five sessions a week for eight weeks. The sessions are pain-free and require no sedation so you can return to your normal activities right away.

Internal Radiation Therapy or Brachytherapy 

Internal Radiation Therapy or Brachytherapy targets tumors with radiation delivered through a catheter directly to the tumor site guided by an endoscope. High Dose-Rate (HDR) and Low Dose-Rate (LDR) are most often used with more advanced stages of esophageal cancers to improve swallowing. During HDR treatment, a computer-controlled machine sends tiny radioactive pellets into the catheter to deliver the radiation at multiple depths and varying times. The overall treatment time at the tumor site is 10 to 20 minutes. Your esophageal cancer treatment plan may require one session or multiple sessions. The catheter is then removed so that no radioactive material remains in the body. During LDR treatment, tiny radioactive seeds, each the size of a rice grain, are implanted at the tumor site through tiny catheters. The catheters are removed and the seeds remain near the tumor. Over time, the seeds become non-radioactive. You are free to resume normal activity with either treatment.