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National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Esophageal cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is cancer of the esophagus?
STAGE EXPLANATION
Stages of cancer of the esophagus
Stage 0 or carcinoma in situ
Stage I
Stage II
Stage III
Stage IV
Recurrent
TREATMENT OPTION OVERVIEW
How cancer of the esophagus is treated
Treatment by stage
STAGE 0 ESOPHAGEAL CANCER
STAGE I ESOPHAGEAL CANCER
STAGE II ESOPHAGEAL CANCER
STAGE III ESOPHAGEAL CANCER
STAGE IV ESOPHAGEAL CANCER
RECURRENT ESOPHAGEAL CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is cancer of the esophagus?

Cancer of the esophagus is a disease in which cancer (malignant) cells are found in the tissues of the esophagus. The esophagus is the hollow tube that carries food and liquid from the throat to the stomach.

The most common sign of cancer of the esophagus is difficulty swallowing. Pain may be felt when swallowing or pain may be felt from behind the breastbone.

If there are symptoms, a doctor will usually do a special x-ray called a barium swallow. For this test the patient drinks a liquid containing barium, which makes the esophagus easier to see in the x-ray. This test is usually done in a doctor's office.

A doctor may also look at the inside of the esophagus with a thin, lighted tube called a esophagoscope. This test is called an esophagoscopy. For the test, the esophagoscope is passed through the mouth and down the throat into the esophagus. Before the test, a local anesthetic (a substance that causes temporary loss of feeling) is applied to the throat so no pain is felt. This test is usually done in a doctor's office. If the doctor sees tissue that does not look normal, he or she will remove a small piece of tissue so it can be looked at under a microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the esophagoscopy while the anesthetic is still working so no pain is felt. Sometimes a biopsy may show changes in the esophagus that are not cancer but may lead to cancer.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the esophagus or if it has spread to other places) and the patient's general state of health.


STAGE EXPLANATION


Stages of cancer of the esophagus

Once esophageal cancer is found, more tests will be done to find out if cancer cells have spread to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for esophageal cancer:


Stage 0 or carcinoma in situ

Stage 0 cancer of the esophagus is very early cancer. Cancer is found only in the first layer of cells in the lining of the esophagus.


Stage I

Cancer is found in only a small part of the esophagus and has not spread to nearby tissues, lymph nodes, or other organs. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)


Stage II

Cancer is found in a large portion of the esophagus and has spread to all sides of the esophagus, and may have spread to local lymph nodes, but has not spread to other tissues.


Stage III

Cancer has spread to tissues or lymph nodes near the esophagus, but has not spread to other parts of the body.


Stage IV

Cancer has spread to other parts of the body.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the esophagus or in another part of the body.


TREATMENT OPTION OVERVIEW


How cancer of the esophagus is treated

There are treatments for all patients with cancer of the esophagus. Three kinds of treatment are used:

Surgery is the most common treatment for cancer of the esophagus. A doctor may remove the esophagus in an operation called an esophagectomy. The doctor will connect the remaining healthy part of the esophagus to the stomach so the patient can still swallow. A plastic tube or part of the intestine may sometimes be used to make the connection. The doctor may also remove lymph nodes around the esophagus and look at them under a microscope to see if they contain cancer.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that contain radiation through thin plastic tubes (internal radiation therapy) in the area where the cancer cells are found. When radiation therapy is used to treat cancer of the esophagus, a plastic tube is sometimes inserted into the esophagus to keep it open. This is called intraluminal intubation and dilation.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy with or without radiation is being tested in clinical trials. The use of chemotherapy and radiation therapy before surgery (neoadjuvant therapy) is also being tested in clinical trials.


Treatment by stage

Treatments for cancer of the esophagus depend on the stage of the disease and the patient's general health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of cancer of the esophagus. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE 0 ESOPHAGEAL CANCER

Treatment is usually surgery to remove the tumor.


STAGE I ESOPHAGEAL CANCER

Treatment may be one of the following:

1. Surgery to remove the tumor and all or part of the esophagus (esophagectomy).

2. Chemotherapy plus radiation therapy. Surgery may be performed after other therapy is completed. Clinical trials are testing changes in the timing of when chemotherapy and radiation therapy are given.

3. A clinical trial of surgery with or without radiation therapy.

4. Clinical trials of chemotherapy and radiation therapy with surgery.


STAGE II ESOPHAGEAL CANCER

Treatment may be one of the following:

1. Surgery to remove the tumor and all or part of the esophagus (esophagectomy).

2. Chemotherapy plus radiation therapy. Surgery may be performed after other therapy is completed. Clinical trials are testing changes in the timing of when chemotherapy and radiation therapy are given.

3. A clinical trial of surgery with or without radiation therapy.

4. Clinical trials of chemotherapy and radiation therapy with surgery.


STAGE III ESOPHAGEAL CANCER

Treatment may be one of the following:

1. Surgery to remove the tumor to relieve pain or discomfort.

2. Chemotherapy plus radiation therapy. Surgery may be performed after other therapy is completed.

3. Clinical trials of chemotherapy plus radiation therapy.


STAGE IV ESOPHAGEAL CANCER

Treatment may be one of the following:

1. Radiation therapy with or without insertion of a tube to keep the esophagus open (intraluminal intubation and dilation).

2. Tumor removal by laser or electrical current.

3. Clinical trials of chemotherapy plus radiation therapy.


RECURRENT ESOPHAGEAL CANCER

Surgery or radiation therapy may be used to relieve pain or discomfort. A patient may choose to take part in a clinical trial.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about cancer of the esophagus, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklet about cancer of the esophagus may be helpful:

What You Need To Know About Cancer of the Esophagus

The following general booklets on questions related to cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get materials and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 05/1998


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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