Treatment of esophageal cancer depends on the type, location and stage of the cancer. A patient’s age, overall health and personal preferences are also taken into account. In many cases, combinations of treatment are more effective than individual therapies. For some patients, esophageal cancer may have advanced to the point that it is no longer curable. However, treatments may still help relieve symptoms associated with esophageal cancer (palliative care).

Depending on the stage and location of the cancer, surgery may be the first treatment option for esophageal cancer. A partial esophagectomy is the procedure typically used to remove the cancerous tissue. In this surgical procedure, a surgeon removes the portion of the esophagus that contains the cancer and, if the tumor is in the lower one-third, the upper portion of the stomach.  Nearby lymph nodes are also removed. The extent of the esophagus and stomach that is removed depends on the location and spread of the cancer. For some individuals, the remaining esophagus may be reconnected to the stomach so the patient can still swallow and ingest food. In others, a section of the large intestine or a plastic tube may be used to replace the missing part of the esophagus.

Esophagectomy is a complicated operation and the patient may be hospitalized up to two weeks following the surgery. There are several risks associated with these procedures, including infection, bleeding and leakage from the areas where the remaining esophagus is attached. In recent years, this procedure has been performed laparoscopically, which is less invasive than standard surgery. In laparoscopic surgery, the procedure is performed through a smaller incision with sepcialized instruments resulting in less recuperation time.

There are many different techniques and approaches to surgery for esophageal cancer. A patient’s physician can determine the best procedure based on the individual case. In addition to surgery, other therapies may be used to treat esophageal cancer. These treatments are often provided in combination with surgery and include:

• Chemotherapy. Useful powerful drugs to kill cancer cells and interfere with their ability to reproduce and spread throughout the body. It usually involves one or more drugs and is often used in conjunction with other therapies. This approach can help kill cancer cells that have spread beyond the esophagus. Chemotherapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining malignant cells. According to the American Cancer Society, 10 to 40 percent of patients respond to chemotherapy drugs with a significant reduction in tumor size. Chemotherapy without additional therapies (e.g., surgery, radiation) usually will not cure esophageal cancer.
  
  
• Radiation therapy. Uses a specific type of radiation to kill or shrink cancer cells. Radiation disrupts or destroys cancer cells' genetic material, preventing the cells from continuing to grow and spread throughout the body. This approach is most effective against esophageal cancer when it is used in combination with chemotherapy and is often used to relieve pain and improve swallowing. In most cases, the radiation comes from an external source. However, in some cases, radioactive "seeds" or wires may be implanted near the cancer cells of the esophagus or held in a tube within the esophagus for a limited time. This is known as internal radiation or brachytherapy.
  
  Recent research has indicated that chemoradiotherapy combined with surgery results in a better outcome than surgery alone. Patients who received all three therapies had a five year survival rate of 39 percent as compared to 16 percent for patients who only underwent surgery. Additional studies have not yet yielded these results.
  
  
• Photodynamic therapy. The patient receives an injection of a light-sensitive drug that remains in cancer cells longer than it does in healthy cells. A laser light is then focused through an endoscope and onto the esophagus, stimulating the production of an active form of oxygen that destroys cancer cells while leaving healthy cells alone. This treatment usually is used to relieve pain and obstruction in the esophagus, but is also being studied as a treatment for early-stage esophageal cancer.

Patients who have constrictions in their esophagus may benefit from certain procedures. In an esophageal dilation, a balloon-like device is inserted into the esophagus to stretch the opening. A stainless steel or plastic stent also may be used to push open the esophagus. In addition, patients with tracheosophageal fistulas may require surgery or the use of a stent to keep food or liquids from entering the windpipe and lungs.

Swallowing difficulties from esophageal cancer can lead to weight loss, weakness and malnutrition. Patients who develop dysphagia may benefit from swallowing therapy provided by a speech-language pathologist.