The National Jewish Health Cancer Center team, which consists of medical oncologists, radiation oncologists, nurses, gastroenterologists, surgeons, and radiologists, will work closely to determine the best treatment plan for you. They will bring in other specialists as needed for optimal care. Some team members, such as surgeons and radiation oncologists, are based at outside hospitals, where you may go to receive treatment.
Your care team may include a dietician, physical therapist, psychologist, and social worker. Esophageal cancer treatment often includes a combination of surgery, chemotherapy, and radiation therapy.
You may meet with a surgeon to discuss the possibility of surgery to remove your cancer. The type of surgery you may receive depends on where the tumor is in your esophagus. The surgeon may remove the whole esophagus or only the part that has cancer. The surgeon often removes the section of the esophagus where the cancer is located, and the nearby lymph nodes and soft tissues. Sometimes part or all of the stomach may be removed. Most of the time the surgeon pulls up the stomach and connects it to the remaining part of the esophagus. During surgery the surgeon can place a feeding tube into your small intestine (J-tube). This will allow you to take in nutrition when you are unable to eat or drink anything by mouth.
Chemotherapy is the use of medications to kill the cancer cells and stop them from growing. Chemotherapy is often given through a vein in an IV (intravenous) catheter, or through a large catheter, called a port, that is surgically implanted in a large blood vessel in the chest. This will prevent you from having a needle inserted in a vein each time you need to receive chemotherapy or other IV medicine. Chemotherapy is less irritating to the blood vessels when it is given in a large vein through a port. Chemotherapy is called systemic therapy because it goes throughout the body to kill cancer cells. Some newer chemotherapy medications may be given in pill form. Others are given continuously over several days.
Chemotherapy is often given in cycles. These cycles last about three to four weeks, although this may vary depending on the chemotherapy regimen. Chemotherapy may be given several times during a single cycle. Your body is given a chance to rest before another cycle is started. The number of cycles may vary, but often four to six cycles of chemotherapy are given.
Two to three chemotherapy medications are often given together to treat esophageal cancer. The combination of medication is selected by your oncologist to control your esophageal cancer.
Chemotherapy may be given with radiation therapy as primary treatment, after surgery as adjuvant therapy, or alone or with radiation therapy to help control symptoms like pain or difficulty swallowing when the cancer cannot be cured. This is known as palliative treatment.
Chemotherapy can affect normal cells that duplicate quickly. Side effects of chemotherapy for esophageal cancer may include: hair loss, sores in the mouth, loss of appetite, nausea and vomiting, increased chance of infection, bruising easily, bleeding, low blood counts, and general fatigue. Talk with your health care provider about techniques to treat the side effects. Your chemotherapy may need to be adjusted based on your side effects and your response to the chemotherapy.
Radiation Therapy (Radiotherapy)
Radiation therapy is used to kill cancer cells and/or keep cancer cells from growing where the radiation is provided. There are two main types of radiation therapy: external-beam radiation therapy, where radiation therapy is aimed from a machine outside the body that targets the tumor and internal radiation therapy or brachytherapy, where radioactive material is placed inside your body using an endoscope. People who have esophageal cancer often receive concurrent chemotherapy and radiation therapy. Radiation therapy may be used to help prevent the spread of esophageal cancer to the central nervous system.
Advances in radiation therapy are able to provide higher doses of radiation and avoid normal tissue. Radiation may affect normal cells that duplicate quickly and are near the radiation area. You may experience these side effects: redness, dryness and irritation to the skin where the radiation is given; general fatigue; trouble swallowing because the radiation is given near the esophagus; and damage to healthy lung tissue resulting in scarring. Talk with your radiation oncologist about helpful techniques to treat the side effects. National Jewish Health does not have a radiation oncology center, so radiation treatment will be performed at another hospital or radiation center. You will return to National Jewish Health for follow-up care with your oncologist.
Your oncologist will consider many factors to determine the best treatment plan for you. These factors include your age, the specific type of cancer you have, the stage of cancer, your general health and your history of any past treatments given for cancer. In addition to your cancer treatment, supportive care – known as palliative care – is important, and is offered when you begin treatment. Members of your cancer center team will be involved in aspects of palliative care, which is focused on identifying your goals of care and helping you feel as well as you can feel while and after you receive treatment.
A healthy lifestyle is important for everyone, especially for people who are receiving treatment for cancer. Here are some tips to consider:
Exercise regularly. You may feel general fatigue due to the esophageal cancer and treatment. Your exercise program can be modified based on how you are feeling. Ask your health care provider about being seen in the rehabilitation program at National Jewish Health. A physical therapist can be very helpful when planning an exercise program, learning breathing techniques, and addressing non-medication pain management strategies.
Eat a well-balanced diet and drink plenty of fluid. Ask about being seen by a registered dietician at National Jewish Health. A registered dietician can be helpful when thinking of strategies to address the nutrition issues related to esophageal cancer and treatment.
Give up smoking and avoid exposure to passive smoke. Ask for techniques to help you give up smoking.
Get a flu shot every year in the fall. Get a pneumococcal vaccine every 5 to 6 years as recommended by your health care provider.