What To Expect During Esophageal Cancer Treatment

Being diagnosed with esophageal cancer can be scary, even at the earlier stages. That’s because a person’s following thought relates to what happens next. Depending on the stage of your esophageal cancer, your treatment may take more effort for both you and your cancer care team. To get through your cancer journey with confidence, it’s essential to understand your treatment options.

Mary Maish, MD, thoracic surgeon with Franciscan Physician Network in Lafayette, Ind., explains what you can expect during esophageal cancer treatments and what the process can be like at each cancer stage.

Key Takeaways: Treating Esophageal Cancer

• Esophageal cancer is diagnosed with an endoscopy or a barium swallow.
• Stage I through stage III cases of esophageal cancer require different treatments, including endoscopic tumor removal, surgery and chemotherapy.
• It’s crucial not to sit with your symptoms for long. Schedule an appointment with your doctor if you experience concerning symptoms.

How Esophageal Cancer Is Diagnosed

Experiencing heartburn, trouble swallowing, coughing, chest pain or unexpected weight loss are signs to see a doctor for further evaluation. These symptoms could mean esophageal cancer or other concerning medical conditions.

“If somebody visits me with difficulty swallowing, the first thing that I'll do is start with an endoscopy,” Dr. Maish said. During an endoscopy, you’ll fall asleep lightly as we insert a camera into the esophagus to look around. With this, we’re generally able to find a concern, take some biopsies with a forcep and send them to pathology to determine if it’s esophageal cancer.”

Another method for diagnosing esophageal cancer is through a barium swallow. In this case, the barium will pass through the esophagus and will change patterns as it contacts esophageal cancer. Even so, Dr. Maish said, a provider would ultimately recommend a tissue diagnosis via biopsy.

Getting an esophageal cancer diagnosis is the first step towards timely treatment.

Treatment Options For Esophageal Cancer

If you’ve been diagnosed with esophageal cancer, your cancer care team will discuss appropriate treatment options with you. As with most cancers, being treated earlier for esophageal cancer can be simpler and with good results.

Endoscopic treatments

‘“In early-stage or stage I cancer, there are different aspects of the stage,” Dr. Maish said. “Still, early-stage I cancers can now be removed without surgery. It's all done endoscopically.”

Dr. Maish explained that a camera and small instruments are placed into the esophagus to remove early-stage cancerous lesions.

“This is really a great breakthrough because, even 25 years ago, we would just remove the entire esophagus for these super early lesions,” Dr. Maish said. “Now we don't need to do that.”

Even stage I tumors that are a bit deeper in the esophagus can be salvaged with endoscopic techniques, Dr. Maish said. Still, if a stage I tumor has gone all the way through into the esophageal wall, then it can require removing the esophagus and assisting that area of your body with adjustments to your stomach.

Staging tests for esophageal cancer

“Before we take somebody to the operating room or recommend a treatment program, we will complete an extensive staging workup,” she said. “It includes things like a PET scan and an endoscopic ultrasound.”

An endoscopic ultrasound is a test in which your provider inserts a camera into the esophagus and sends ultrasound waves through and around the esophagus to see whether any lymph nodes are positive.

“Lymph nodes are all over the body,” Dr. Maish said. “They collect things that are accumulating in the body that are not supposed to be there, like cancer cells. If we see lymph nodes that have cancer cells, before going to the operating room, we recommend chemotherapy and possibly radiation to the primary tumor to control its growth.”

These radiation decisions depend on tumor size, Dr. Maish said.

Surgery for cancer in the esophagus

The stage of esophageal cancer can impact whether surgery may be needed as part of the treatment plan.

• Early Stage or Stage I: “In the early stages of esophageal cancer, we have the possibility of not removing the tumor in the surgical suite, but rather in the endoscopic suite,” Dr. Maish said.
• Early Stage II: “Moving into the operating room to remove the esophagus for the more advanced stage Is and early stage IIs,” she said.
• Late Stage II and Stage III: “When we get to a later stage II or a stage III, offer chemotherapy and possibly radiation therapy before going to the operating room to remove the esophagus and rotate that stomach up into the area where we can connect the esophagus to the stomach,” Dr. Maish said.

Don’t Ignore Your Symptoms Of Esophageal Cancer

Signs of esophageal cancer can be subtle but noticeable. “Having difficulty swallowing is not normal,” Dr. Maish said. “Additionally, having unexpected or unintended weight loss, which is another symptom, isn’t normal either.”

Dr. Maish explained that it’s crucial not to sit with your symptoms for long. Schedule an appointment with your doctor if you experience concerning symptoms.

“If you’re diagnosed with esophageal cancer, make sure that you find a provider that has significant experience with that specific condition, because there are several approaches to treating it,” Dr. Maish said. “This is not a one-size-fits-all disease. So, you may find surgeons or hospitals with treatment groups that just want to fit you into their familiar protocol.”

Dr. Maish also explained the risks of trying to understand your condition solely through the internet.

“Esophageal cancer has a really bad rap on the internet,” Dr. Maish said. “Try to avoid going to the internet and getting information that is more than likely outdated.”

Dr. Maish said that she has treated many esophageal cancer survivors, including those she operated on more than 20 years ago, who are still doing great.

“It is not a death sentence,” Dr. Maish said. “However, it’s still a marathon to get through the treatment in order to be able to save your life. Your effort is well worth it, and we have a lot of resources to help any patient get through that in my practice. The critical thing really is landing in a place that offers several definite treatment options for you.”