What is the treatment for esophageal cancer?

Surgery offers the best hope for cure of esophageal cancer. Esophagectomy with gastric pull-through and primary anastomosis is the most common surgical procedure performed. Occasionally a colonic or small-bowel interposition will be required to connect the esophagus and gastric remnants. This is done by removing a piece of large or small bowel from the patient and attaching it in place of the diseased esophagus.

Radiation therapy, either palliative or curative, is another well-accepted treatment. The treatment may be modified if side effects develop. Radiation therapy is preferred for the treatment of squamous cell carcinoma.

Chemotherapy (cisplatin-based) in conjunction with radiation therapy has been shown to be superior to radiation therapy alone in patients who are not surgical candidates. Patients with preoperative chemotherapy and radiation have demonstrateded disease-free survival after esophagectomy.

Palliative treatment is not curative but improves quality of life. Several endoscopic modalities are used including dilation of the strictured areas after chemotherapy and endoscopic laser therapy for reducing the tumor size. Photodynamic therapy (using a photosensitizing agent and a lower energy laser) causes selective tumor destruction. This method is not widely available at present and ongoing studies are being done to prove its efficacy. Esophageal stenting is another mode of palliation.

Percutaneous endoscopic gastrostomy tube placement (PEG) may be used in patients with severe dysphagia to facilitate adequate nutrition.