Esophageal cancer care

Whether you or a loved one are worried about developing esophageal cancer, are going through treatment or are trying to stay well after treatment, we’re here for you every step of the way.

What is esophageal cancer?

Your esophagus is the long hollow tube that runs from the back of your throat down to your stomach. This tube moves the food you eat as the digestion process begins.

Esophageal cancer develops when normal, healthy cells in the esophagus region begin to grow and function differently. These cancerous cells can begin to build up and form a mass called a tumor, which exists as a lump inside the body and can spread.

Esophageal cancer symptoms

Common signs and symptoms of esophageal cancer may include:

Difficulty swallowing
Unintentional, significant weight loss
Pain, pressure or burning in your chest
Worsening indigestion or heartburn
Coughing or hoarseness
Frequent choking, especially with bread, raw vegetables and meat

Having these symptoms does not mean you have esophageal cancer. However, it’s still important to talk to your doctor, as these could be signs of an underlying health issue.

Esophageal cancer risk factors

Although cancers of the head and neck region (including esophageal cancer), are less common than other types of cancers, there are still risk factors. Some factors are out of your control, but there are lifestyle choices that can increase your risk of developing esophageal cancer, including smoking, alcohol use and environmental factors.

Risk factors for esophageal cancer include:

Tobacco use: 85% percent of head and neck cancers, including esophageal cancer, are linked to tobacco use. This includes smokeless tobacco, cigarettes and pipes. Tobacco use is the single largest risk factor for cancers of the head and neck.
Alcohol use: Prolonged, heavy alcohol use greatly increases your risk of certain types of head and neck cancer, including esophageal cancer.
Gastroesophageal reflux disease (GERD): The stomach normally produces strong acid and enzymes to help digest food. In some people, acid can escape from the stomach up into the lower part of the esophagus. The medical term for this is gastroesophageal reflux disease (GERD), or simply reflux. Those with GERD have a slightly higher risk of developing esophageal cancer. GERD is very common, and most people who have it don’t develop esophageal cancer. GERD can also cause Barrett’s esophagus, which is linked to an even higher risk.
Barrett’s esophagus: When the backup of stomach acid into the lower esophagus (reflux) occurs for a long period of time, it can damage the inner lining of the esophagus. This condition is known as Barrett’s esophagus. Although most people with Barrett’s esophagus don’t develop esophageal cancer, it can still increase your risk.
Other risk factors: Other risk factors that can increase the risk of developing esophageal cancer include overconsumption of processed meats, obesity, workplace or environmental exposures or injury to the esophagus.

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How is esophageal cancer diagnosed?

Our team of cancer doctors are experienced in diagnosing and treating esophageal cancer at all stages, including advanced stages. Some of the diagnostic tests your doctor may perform to test for esophageal cancer include:

Physical examination: If your doctor suspects you have esophageal cancer, he or she will perform a physical examination, feeling for lumps in the neck and chest. To confirm an initial cancer diagnosis or to determine whether the cancer has spread, you may be asked to undergo further testing.
Endoscopy: This procedure will allow your doctor to examine the inside of your esophageal area. During an endoscopy, your doctor will insert a small scope into your nose or mouth to examine the hard-to-see areas of your head and neck.
Biopsy: During a biopsy, your doctor will remove a small sample of tissue to detect whether it contains cancerous cells (also called malignant cells). The tissue will be removed using a thin needle or during a surgical procedure and will be further examined beneath a microscope.
Imaging tests: Imaging tests, such as MRIs, CT scans and PET scans, are used to produce detailed pictures of the inside of your head or neck. These tests can determine the size of tumors and whether they have grown, shrunk or spread.

Others may include:

Barium swallow: For a barium test, you will need to swallow a chalky substance known as barium. Barium coats the lining of the esophagus, stomach and intestines so tumors or other abnormalities can be seen more clearly on an X-ray.
Blood tests: Your doctor may order blood work to look for certain indicators of esophageal cancer or monitor how your treatment is progressing.

Treating esophageal cancer

At Geisinger, our highly trained team of esophageal cancer specialists includes surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, nurse navigators and support staff who come together to develop a personalized treatment plan around you.

Depending on the type, location and stage of your cancer, one or more of the following treatments may be recommended.

Surgery

At Geisinger, our surgeons use the latest techniques to treat esophageal cancer, including minimally invasive and robotic surgery, to offer you the best outcomes and path for healing. Our surgeons are highly trained and board certified, which means they have passed an optional national exam to demonstrate their medical expertise. Many of our surgeons are also fellowship trained, holding additional training in specific types of cancer surgery.

If your cancer is small and hasn't spread, your surgeon may recommend removing the cancer as well as a portion of the healthy tissue that surrounds it. Surgery can be done using an endoscope passed down your throat and into your esophagus.

Esophagectomy, in which your surgeon will remove the affected area of your esophagus, along with a portion of the upper part of your stomach and surrounding lymph nodes.

Chemotherapy

Chemotherapy is a drug-based treatment designed to slow the growth of or shrink tumors located in the esophagus.
Chemotherapy drugs can be given through an IV or taken in pill form.

The timing of your chemotherapy may be:

Before your surgery, to attempt to reduce the size of the tumor
Along with radiation therapy, which is known as chemoradiation or chemoradiotherapy
After your surgery, to destroy any cancer that still remains in the esophagus and reduce the chances of the cancer coming back

Our team includes doctors called medical oncologists who specialize in chemotherapy. Our patients have access to clinical trials that include testing new chemotherapy drugs and combinations of medications that aren’t widely available.

Keeping you comfortable while you undergo your treatment is important to us. Our state-of-the-art clinics, many which have been recently renovated, offer heated seats and individual TVs to help you stay comfortable during treatment.

Radiation therapy

Radiation oncology uses radiation to control or destroy harmful cancer cells, with tools to treat each unique cancer.

Our board-certified cancer doctors and highly skilled clinical team deliver conventional radiotherapy treatments that include:

External beam radiation, which uses special technology to send X-ray radiation (photons) to the tumor from outside the body
Internal radiation (brachytherapy), which targets the tumor using safe levels of radiation inside the body through radioactive tubes placed in the esophagus
Intensity-modulated radiation therapy (IMRT), which uses a 3D image of the tumor to deliver high-precision radiotherapy that fits its exact outline
Image-guided radiation therapy (IGRT), which is used to localize the radiation beam daily and treat cancers in areas of the body that move during and between treatments. This includes Cone Beam CT scans to accurately view the tumor and target it during treatment.
Stereotactic body radiation therapy (SBRT), which uses precise conformal beams of radiation to focus high doses of radiation to just the tumor, with very little damage to surrounding healthy tissues

Immunotherapy

This treatment involves the use of medicines that help a person’s own immune system find and destroy cancer cells. It can be used to treat some people with esophageal cancer.

Targeted therapy

Using medications that attack specific weaknesses in cancer cells, targeted therapy is a newer treatment that targets only certain parts of those cells, to slow or stop growth. Typically, there can be fewer side effects than with chemotherapy.

Clinical trials

Our extensive history with esophageal cancer research and clinical trials gives you access to new treatments, often before they become widely available. Participating in a trial may help improve your condition, even if standard approaches haven’t worked in the past. Find a clinical trial near you.

Relieving esophageal obstruction

Sometimes the esophagus will narrow as a result of a tumor. If this happens and your quality of life is affected, your surgeon may use an endoscope to place a stent into the esophagus to keep it open.

Supplemental nutrition therapy

Sometimes, a person is too ill for chemotherapy or radiation and will need a feeding tube to get the nutrition their body needs. Although the thought of having a feeding tube can be scary, it is a critical tool to deliver vital nutrients and help your esophagus heal. Rest assured, your care team will work closely with you to explain your treatment and guide you throughout your entire journey.

Second opinion clinic

When you visit our second opinion clinic, we’ll help you explore all available treatments. We’ll review diagnoses, diagnostic imaging, lab work, pathology reports and treatment plans, so you can make an informed decision about your care.