Treating and Managing Esophageal Cancer

*Please note: This slide show represents a visual interpretation and is not intended to be a substitute for medical and/or clinical advice.

What is esophageal cancer?

Esophageal cancer is cancer that starts in the esophagus. It is a deadly cancer that is more common in men than in women.

What is esophageal cancer?

It is important to find and diagnose esophageal cancer as soon as possible.

Too often this cancer is not found until it has spread and is harder to treat.

What are the treatment options for esophageal cancer?

The treatment plan for esophageal cancer is based on your diagnosis, including the type and stage of cancer.

What are the treatment options for esophageal cancer?

Treatments may include:

• Endoscopic therapy
• Chemotherapy
• Radiation
• Targeted therapy for specific gene mutations
• Immunotherapy
• Surgery

Creating a treatment plan for esophageal cancer

Effective treatment often takes a team approach. Your healthcare team may include gastroenterologists, surgeons, and medical and radiation oncologists.

You will work with that team to develop a plan based on your treatment goals.

Creating a treatment plan for esophageal cancer

Planning may include:

• Testing for genetic mutations to learn which treatments may help most
• Discussing clinical trials
• Planning chemotherapy, targeted therapies, immunotherapies, radiation, surgery, or a combination

Ask questions or get a second opinion if you do not understand or are not comfortable with your suggested plan.

What else could be part of my esophageal cancer treatment plan?

Nutritionists, pain specialists, and psychologists may also provide:

• Help with eating and nutrition
• Mental health support
• An exercise strategy
• Symptom relief
• Survivorship care after treatment ends

Clinical trials for esophageal cancer

It is important to consider clinical trials early in your planning.

These research studies allow patients to volunteer to receive treatments that are not yet available to the public.

Some studies are only open to people who have not had other treatments yet. So, it is important to consider trials early on.

Which clinical trials are right for you?

Clinical trials often seek patients who meet specific criteria, such as the type or stage of cancer or a specific gene mutation.

Having genomic profiling of your tumor is an important part of your diagnosis.

ECAN offers a Clinical Trials Matching Service to identify which trials might be right for you and support you through the enrollment process.

Endoscopic treatment for early cancers

If very early cancer is found, doctors may treat it through a thin, lighted tube with a camera that is called an endoscope. The scope is inserted through your mouth while you are sedated, so doctors can reach the esophagus without making a surgical incision.

Endoscopic treatment may involve heat, light, freezing, or tissue removal through the endoscope.

Chemotherapy, targeted therapy, immunotherapy, and radiation for esophageal cancer

Chemotherapy may be your main treatment for esophageal cancer, possibly combined with radiation or a targeted therapy aimed at specific genetic mutations.²

Chemotherapy, targeted therapy, immunotherapy, and radiation for esophageal cancer

You may also receive immunotherapy, which stimulates your body's immune system to fight cancer.

This is especially true if your cancer is advanced or surgery does not completely remove it.

Esophagectomy for esophageal cancer

Esophagectomy is an option if cancer has not spread to other organs. It removes all or part of the esophagus and sometimes part of the stomach.

In most cases, the surgeon pulls up the stomach to connect it to the remaining esophagus. This takes several hours, but can be done in a minimally invasive way with small incisions.

Esophagectomies are much more successful if your surgeon has performed many before and you have surgery at a hospital with a lot of experience caring for people after esophagectomy.

Tests to help plan for an esophagectomy

If esophagectomy is part of your plan, your surgeon will order tests to confirm you are still a candidate and, if so, prepare for surgery. Tests may include a CT scan, PET scan or endoscopy.

Life after esophagectomy

After surgery, you must never lie flat again because the valve that kept stomach contents from flowing into the esophagus has been removed. Failing to lie at an angle of at least 30% risks dangerous complications such as aspiration pneumonia.

You also need to eat smaller, more frequent meals because of your smaller stomach. Many people change what they eat and need a personal plan to maintain a healthy weight.

Recovery takes time, but many people lead full, active lives after surgery.

Treating depression, anxiety, and pain

Depression and anxiety are common with esophageal cancer, but you don't have to suffer alone. Ask your doctor to recommend a support group or counselor.

Exercise can also help. If you have pain, talk to your healthcare team. They may have effective remedies.

Speaking up for what you need

During and after treatment, be sure to tell your doctor about all your symptoms and concerns. That is the only way they will know you need help. Their support can dramatically improve the quality of your life. Don't just live with it – speak up!

You can also visit www.ecan.org for more information or help finding support through your treatment and survivorship journey.

References

1. Watson S. What is genomic profiling in cancer? WebMD. February 8, 2022.
   https://www.webmd.com/cancer/what-is-genomic-testing. Accessed May 22, 2023.
2. American Cancer Society. Treating esophagus cancer by stage. Last revised: June 2, 2022.
   https://www.cancer.org/cancer/types/esophagus-cancer/treating/by-stage.html. Accessed May 23, 2023.
3. Mayo Clinic. Tests and procedures: Esophagectomy. March 5, 2022.
   https://www.mayoclinic.org/tests-procedures/esophagectomy/about/pac-20385084. Accessed May 24, 2023.
4. Esophageal Cancer Action Network. Clinical trials portal.
   https://ecan.org/clinical-trials-portal/. Accessed May 26, 2023.
5. National Institutes of Health. US National Library of Medicine. ClinicalTrials.gov.
   https://clinicaltrials.gov/. Accessed May 26, 2023.
6. Esophageal Cancer Action Network. For Patients. Intelligent Nutrition Assistant: INA.
   https://ecan.org/intelligent-nutrition-assistant-ina/. Accessed May 26, 2023.