Treatment for esophageal cancer depends on a number of factors, including the size, location, and extent of the tumor, and the general health of the patient. Patients are often treated by a team of specialists, which may include a gastroenterologist (a doctor who specializes in diagnosing and treating disorders of the digestive system), surgeon (a doctor who specializes in removing or repairing parts of the body), medical oncologist (a doctor who specializes in treating cancer), and radiation oncologist (a doctor who specializes in using radiation to treat cancer). Because cancer treatment may make the mouth sensitive and at risk for infection, doctors often advise patients with esophageal cancer to see a dentist for a dental exam and treatment before cancer treatment begins.

Many different treatments and combinations of treatments may be used to control the cancer and/or to improve the patient's quality of life by reducing symptoms.

• Surgery is the most common treatment for esophageal cancer. Usually, the surgeon removes the tumor along with all or a portion of the esophagus, nearby lymph nodes, and other tissue in the area. (An operation to remove the esophagus is called an esophagectomy.) The surgeon connects the remaining healthy part of the esophagus to the stomach so the patient is still able to swallow. Sometimes, a plastic tube or part of the intestine is used to make the connection. The surgeon may also widen the opening between the stomach and the small intestine to allow stomach contents to pass more easily into the small intestine. Sometimes surgery is done after other treatment is finished.

• Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells. Radiation therapy affects cancer cells in the treated area only. The radiation may come from a machine outside the body (external radiation) or from radioactive materials placed in or near the tumor (internal radiation). A plastic tube may be inserted into the esophagus to keep it open during radiation therapy. This procedure is called intraluminal intubation and dilation. Radiation therapy may be used alone or combined with chemotherapy as primary treatment instead of surgery, especially if the size or location of the tumor would make an operation difficult. Doctors may also combine radiation therapy with chemotherapy to shrink the tumor before surgery. Even if the tumor cannot be removed by surgery or destroyed entirely by radiation therapy, radiation therapy can often help relieve pain and make swallowing easier.

• Chemotherapy is the use of anticancer drugs to kill cancer cells. The anticancer drugs used to treat esophageal cancer travel throughout the body. Anticancer drugs used to treat esophageal cancer are usually given by injection into a vein (IV). Chemotherapy may be combined with radiation therapy as primary treatment (instead of surgery) or to shrink the tumor before surgery.

• Laser therapy is the use of high-intensity light to destroy tumor cells. Laser therapy affects the cells only in the treated area. The doctor may use laser therapy to destroy cancerous tissue and relieve a blockage in the esophagus when the cancer cannot be removed by surgery. The relief of a blockage can help to reduce symptoms, especially swallowing problems.

• Photodynamic therapy (PDT), a type of laser therapy, involves the use of drugs that are absorbed by cancer cells; when exposed to a special light, the drugs become active and destroy the cancer cells. The doctor may use PDT to relieve symptoms of esophageal cancer such as difficulty swallowing.

Clinical trials (research studies) to evaluate new ways to treat cancer are an important option for many patients with esophageal cancer. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and the usual (standard) therapy to another group. Through research, doctors learn new, more effective ways to treat cancer. More information about research studies can be found in the NCI publication Taking Part in Clinical Trials: What Cancer Patients Need to Know. NCI's Web site has a section on clinical trials at http://cancer.gov/clinicaltrials. This section provides general information about clinical trials and detailed information about specific ongoing studies. This information is also available from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). For deaf and hard of hearing callers with TTY equipment, the number is 1-800-332-8615.

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