Esophageal Cancer Treatment Options

Overview

Esophageal Cancer at Spokane CyberKnife

Esophagus cancer, also known as esophageal cancer, is a type of gastrointestinal cancer that affects the soft tube connecting your mouth to your stomach. This cancer typically originates in the inner lining of the esophagus. Today, treatment options for esophagus cancer, including radiation therapy, are continually improving. Throughout your cancer journey—from screening and diagnosis to treatment and survivorship—your medical care team at Spokane CyberKnife is here to support you every step of the way.

Where does Esophageal Cancer start?

Esophageal cancer can begin at any point along the esophagus. It originates in the inner layer of the esophageal wall and progressively grows outward through the surrounding layers.

Types of Esophageal Cancer

Squamous Cell Carcinoma

The esophagus’s inner layer, known as the mucosa, is typically lined with squamous cells. When cancer develops from these cells, it is referred to as squamous cell carcinoma. This type of cancer can occur at any point along the esophagus but is most prevalent in the neck region (cervical esophagus) and the upper two-thirds of the chest cavity (upper and middle thoracic esophagus). Squamous cell carcinoma was once the most common form of esophageal cancer in the United States; however, its prevalence has declined over time and now accounts for less than 30% of esophageal cancer cases in the country.

Adenocarcinoma

Adenocarcinomas are cancers that originate in gland cells, which are responsible for producing mucus. These tumors are typically found in the lower third of the esophagus (lower thoracic esophagus). In certain conditions, such as Barrett’s esophagus, gland cells can replace the squamous cells in the lower esophagus, which may increase the risk of developing adenocarcinoma.

Gastroesophageal (GE) Junction Tumors

Adenocarcinomas that arise at the gastroesophageal junction—the area where the esophagus meets the stomach—are treated similarly to esophageal cancers. This region includes approximately the first 2 inches (5 cm) of the stomach, and tumors here tend to behave like those found within the esophagus.

Treatment Options for Esophageal Cancer

Radiation therapy is often used alongside surgery and chemotherapy to treat esophageal and stomach cancers.
Esophageal cancer can be managed through surgery or a combination of radiation and chemotherapy. In some cases, radiation and/or chemotherapy is administered prior to surgery.
Additionally, radiation may be utilized, with or without chemotherapy, to alleviate pain in advanced stages of the disease.

External Radiation Therapy

External beam radiation therapy consists of a series of daily outpatient sessions that deliver radiation precisely to the targeted area. The radiation beam typically originates from a machine known as a linear accelerator.

Prior to starting treatment, a simulation will be scheduled to outline the area requiring therapy. This process includes X-rays and/or a CT scan. Small landmarks placed on your skin, often in the form of tiny tattoos, help radiation therapists accurately position you for each treatment session.

To reduce side effects, treatments are administered gradually over five to six weeks, five days a week. This schedule allows doctors to deliver sufficient radiation to destroy tumor cells while giving healthy cells time to recover each day.

You may encounter technical terms related to cancer treatments, including three-dimensional conformal radiation therapy (3-D CRT), intensity-modulated radiation therapy (IMRT), or image-guided radiation therapy (IGRT). Your radiation oncologist can provide more information about these various techniques.

Radiation Treatment Esophageal Cancer at Spokane CyberKnife

Radiation therapy, also known as radiotherapy, involves the precise use of radiation to effectively treat cancer.

The therapy targets cancer cells by damaging their ability to divide and multiply. As these cells die, the body naturally eliminates them. While healthy cells are also impacted by radiation, they have the ability to repair themselves in ways that cancer cells do not.

For esophageal cancer, the primary type of radiation used is external beam radiation therapy, often combined with chemotherapy. Internal radiation therapy, or brachytherapy, may also be employed in some cases.

External Beam Radiation Therapy

External beam radiation therapy consists of a series of daily outpatient treatments that deliver radiation to the esophagus. Each session lasts less than half an hour and is typically administered five days a week for five to seven weeks.

Preparing for Esophageal Cancer Treatment at Spokane Cyberknife

Step 1: Consultation 

First, you will meet with your radiation oncologist to discuss the recommended radiation treatment options for your specific case and make a collaborative decision about your treatment.

Step 2: Simulation

As part of your treatment planning, the exact location of the tumor must first be determined. This is usually done using a CT scan, which stands for computed tomography, providing a detailed 3-D image of the treatment area using X-rays. Sometimes, temporary skin marks or even tiny tattoos (about the size of a freckle) are made on your body to assist the radiation therapist in positioning you correctly each day for treatment.

Step 3: Treatment planning

After the simulation is complete, your radiation oncologist will create a personalized treatment plan. This plan will take into account the location, type, and stage of your cancer, along with your medical history, lab tests, and other relevant factors to determine the best course of treatment. Typically, radiation therapy will require you to come in for treatment five days a week.

Step 4: Positioning for treatment

On your treatment days, your radiation therapist will position you on the radiation machine’s treatment couch. The radiation therapists will adjust your position on the couch using the alignment marks on your skin and the lasers in the room to ensure proper positioning for treatment.  Subsequently, internal imaging is frequently used to further adjust targeting based on internal anatomy.

Step 5: Start of treatment

The radiation is delivered by a machine called a linear accelerator, or linac. The linac will move around you to deliver the radiation. You won’t see, hear, feel, or smell the beam. Treatment sessions typically last about 15 minutes, although your first session may take a little longer.

Step 6: Post-treatment and follow-up care

Every patient is unique, but most can maintain their daily activities during treatment, even if they experience side effects like fatigue. Once your final treatment is complete, your radiation oncologist will arrange periodic follow-up appointments to monitor your progress and the effectiveness of the treatment.