Esophageal Cancer

      What causes esophageal cancer and what treatment options are available? SurvivorNet spoke to top surgeons and experts to come up with this in-depth guide to help you navigate the disease.

      Staging esophageal cancer

      The two most common types of esophageal cancer are:

      • Squamous cell carcinoma (which forms in the thin, flat cells lining the inside of the esophagus)
      • Adenocarcinoma (cancer begins in the glandular cells, or the cells in the lining of the esophagus that produce and release fluids like mucus)

      After you receive an esophageal cancer diagnosis, your doctor will need to determine the type, as well as the stage. Both types of esophageal cancer are broken up into five stages (0, 1, 2, 3, and 4).

      "Once you do get diagnosed, ask what's the stage," Dr. Stiles said. "Patients should never be afraid to push doctors and say, 'What is my stage? What are the treatment options at my stage? Do I have less invasive treatment options? Do I need multi-modality therapy?' That means therapy with more than just surgery or more than just radiation with chemotherapy."

      Treatment Options

      The treatment route you and your medical team decide on after an esophageal cancer diagnosis will depend on several factors, including the severity of the disease and your overall health. Often, the treatment approach will involve several different types of therapy, Dr. Stiles explained.

      Dr. Brendon Stiles provides an overview of treatment options for esophageal cancer. 

      "It's rare these days that I just do surgery for a patient with esophageal cancer. They've often gotten other treatments," Dr. Stiles said. "Remarkably, with very early stage disease, stage one, a patient can often have their tumor resected endoscopically, through a scope down their esophagus without the need to invasive surgery. That's a very selected group of very early, invasive cancer but increasingly, as we do more endoscopies, we're able to find those patients."

      Currently, there are several treatment options available for people with esophageal cancer. These include:

      • Surgery
      • Radiation
      • Chemotherapy
      • Chemo-radiation
      • Laser therapy
      • Electroagulation (using heat from an electric current to destroy abnormal tissue)
      • Immunotherapy (training the immune system to recognize and attack cancer cells)

      Dr. Whit Burrows explains how chemotherapy is given for esophageal cancer. 

      There are also clinical trials underway to look at targeted therapies for esophageal cancer.

      Staying Healthy During Treatment

      Because of where esophageal cancer develops, patients often have trouble swallowing, or can’t swallow at all, which leads to issues eating and drinking, and ultimately, getting enough nutrition. The rate of malnutrition in esophageal cancer patients is as high as 78.9%, and weight loss often continues throughout treatment.

      There are some things that patients can do both before and during the treatment process to supplement that nutrition, including temporarily using feeding tubes.

      Dr. Raja Flores explains how esophageal cancer patients who become malnourished can supplement their nutrition intake

      "Before you can really treat [patients], many of them look emaciated where they're not getting enough nutrition," Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System, told SurvivorNet. "So, what we like to do is fatten them up a little bit, maybe put a tube in their intestine, give them food that way, start treating with some chemotherapy and radiation, and give them time to try and open up [to reduce the issues eating/swallowing]."

      Living With Esophageal Cancer

      Getting the news that you have cancer, especially a disease that is known for being difficult to treat like esophageal cancer, can be a very traumatic experience. When it comes to treating cancer, making sure the patient feels healthy mentally is part of the process as welland that may look different from patient to patient.

      Esophageal cancer is more commonly diagnosed in men, who stereotypically have a more difficult time asking for help when they are struggling mentally.

      Dr. Raja Flores explains why taking care of patients’ mental health is so important as well. 

      "The esophageal cancer population is a unique population," Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System, told SurvivorNet. "Many of the people who develop esophageal cancer are men who are taking care of their families, who are proud, who are strong, who are self-reliant. So when they get faced with this diagnosis and this real vulnerability, they get depressed in a way that can make them crawl up in bed and not want to get outand that's when the family comes into play."

      Dr. Flores stressed the importance of having a good support system in place. Having close friends or family members there to rally for you when you feel the lowest can make a huge difference in how a patient handles treatment.

      There are also plenty of resources available for people living with cancer who feel like they're struggling mentally, from traditional therapy to support groups to integrative medicine that may include treatment approaches like acupuncture or meditation. Check out SurvivorNet's resources on mental health for cancer survivors.


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