The esophagus is the muscular conduit in humans that carries nutrition in the form of food and liquid from the throat to the stomach. Cancer of the esophagus usually originates in the innermost lining of the esophagus, and the malignant cells grow outward through the the layers of tissue that make up the wall of the esophagus. The two types of esophageal cancer are squamous cell carcinoma, found mostly in the upper part of the esophagus, and adenocarcinoma, found in the secretory cells in the lower part of the esophagus, near the stomach.
Surgery
In the United States, the most frequently used treatment for esophageal cancer is a surgical procedure called an esophagectomy, according to the National Cancer Institute. In this procedure, doctors remove the cancerous part of the esophagus and then commonly use a plastic tube or a segment of the patient's intestine to connect the stomach to the remaining portion of healthy esophagus. Some surgeons choose to connect the stomach directly to the remaining esophagus, which shortens the digestive tract slightly. Some of the body's lymph nodes, which are part of the immune system, are found near the esophagus. The surgeon may also need to remove the lymph nodes to determine whether they are cancerous.
Side effects of surgery are the same as for any type of surgery: increased risk of infection, blood clots and general pain in the surgical area.
Radiation Therapy
According to the National Cancer Institute, radiation therapy is a method of treating cancer in which doctors use high-energy radiation, including x-rays, to destroy or hinder the growth of malignant cancer cells. Doctors may suggest using radiation therapy when esophageal cancer has reached Stage II, which means it has spread to the outermost tissues of the esophagus or to any of the nearby lymph nodes. Radiation therapy may also be a part of the treatment for Stage III and Stage IV cancer, which involves a more significant spread of the cancer. External radiation is a method of directing beams of radiation at the cancer through a machine that is located outside of the patient's body. Radiation may also be introduced via a radioactive substance contained in a needle or seed that a surgeon places directly into the esophageal tumor. A plastic or metal tube is sometimes inserted into the esophagus via the mouth to keep the esophagus open during treatment.
Side effects of radiation may be mild or severe, depending on the intensity of the dosages and the frequency of the treatments. Common side effects include difficulty or painful swallowing, dry mouth, loss of appetite, fatigue and swelling in the tissues around the area of treatment.
Chemotherapy
Chemotherapy refers to the use of drugs to destroy cancer cells. The specific drugs that doctors employ to treat esophageal cancer are epirubicin, cisplatin and fluorouracil, according to Macmillan Cancer Support. When all three drugs are used together, the chemotherapy treatment is called the ECF regimen, which is used primarily for adenocarcinomas. For large esophageal tumors, doctors may use chemotherapy before surgery in order to reduce the size of the active tumor. This shrinkage facilitates surgical removal and decreases the probability of a recurrence of the cancer after treatment. For cases in which all of the cancer cannot be removed in surgery or in which the likelihood of recurrence is great, doctors may use chemotherapy after surgery as an adjuvant therapy, which is an additional treatment meant to increase the long-term remission rate.
Doctors typically administer chemotherapy through a vein in the patient's arm or chest, and the treatment may take place in a hospital or on an outpatient basis, according to Macmillan Cancer Support. Side effects of chemotherapy may include decreased resistance to infection, anemia, bruising and bleeding, fatigue, nausea and vomiting, sore mouth, hair loss, numbness in the hands or feet and diarrhea.
