Esophageal Cancer Treatment

Surgery is for esophageal cancer that has not spread beyond the esophagus and surrounding lymph nodes. The goal is to remove the cancer and nearby tissue that may be affected. In an esophagectomy, a surgeon removes part of your esophagus, nearby lymph nodes and possibly part of the stomach. The remaining part of your esophagus is then connected to your stomach.

You may be a candidate for minimally invasive surgery, an approach that utilizes smaller incisions to remove the cancer. Benefits of minimally invasive surgery include less pain, less scarring and a quicker recovery. UChicago Medicine surgeons are pioneers in minimally invasive surgery for esophageal cancer.

An esophagectomy is major surgery, and studies show that patients who have esophagectomies at hospitals that perform the procedure more frequently fare better than those who go to hospitals with less experience. At UChicago Medicine, our general and thoracic surgeons are experts in esophageal cancer surgery.

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are effective treatments for early stage esophageal cancer, especially for patients who can’t have surgery. EMR involves the use of special tools that lift and cut abnormal lesions or tumors from the superficial lining (mucosal and submuscosal layers) of the esophagus. EMR is performed by interventional endoscopists — gastroenterologists who have special expertise using endoscopes, which are thin tubes equipped with cameras. Our interventional gastroenterologists were among the first in the nation to employ EMR and ESD techniques to treat Barrett’s esophagus and high-grade dysplasia. Our specialists work closely with cancer surgeons to select patients who are ideally suited to endoscopic removal of their pre-cancerous lesions versus those who would require surgery for their condition.

Chemotherapy is the use of anticancer medicines to treat cancer cells. Patients with advanced cancer that has not spread may receive chemotherapy with or without radiation before surgery to reduce tumor size and kill cancer cells that are not visible. If your cancer hasn’t spread but you’re not a candidate for surgery, chemotherapy and radiation are given together. If the cancer has spread to other organs, chemotherapy, and in certain cases immunotherapy, can help lessen symptoms such as difficulty swallowing and pain.

At the Center for Gastrointestinal Oncology, our oncologists are highly skilled at selecting the best course of chemotherapy, targeted therapy and immunotherapy for each patient.

Radiation therapy uses high-energy radiation to kill cancer cells. It’s often used to treat esophageal cancer in combination with chemotherapy before surgery. It can also be used to fight cancers that cannot be removed by surgery and alleviate symptoms such as swallowing problems associated with esophageal cancer.

UChicago Medicine radiation oncologists are internationally known for their expertise in treating cancer. Our radiation oncology team is a leader in conducting studies to improve the effectiveness of radiation, all while minimizing its side effects.

With decades of experience researching and treating esophageal cancer, we actively conduct clinical trials — from innovative endoscopic imaging identification techniques for precancerous changes in Barrett’s esophagus, to novel technologies for endoscopic treatment of high-grade dysplasia and promising new drugs for advanced esophageal cancer. For stage IV esophageal cancer, our researchers lead more Phase I and II trials than those at most regional institutions. As a UChicago Medicine patient participating in one of these trials, you may access experimental drugs (including targeted therapies and immunotherapies) that aren’t widely available at other hospitals.

We understand that the symptoms associated with esophageal cancer, such as pain and difficulty swallowing, can be very difficult for patients. In addition to treatments designed to destroy cancerous tissue, our physicians also offer palliative therapy. These treatments do not aim to cure your cancer, but rather lessen your symptoms and make you comfortable.

Palliative therapy options offered include the following:

• Stent placement, which involves the insertion of an expandable, metal tube to relieve obstructions of the esophagus and improve your swallowing
• Specialized nutritional care to ensure you receive adequate nutrition
• Individualized pain management to help keep you comfortable
• Individual or group counseling to provide you and your family with a better understanding of the disease

The supportive oncology program offers a wealth of resources for patients and families facing cancer.