Esophageal Cancer

ON THIS PAGE: You will find a drawing of the main body parts affected by esophageal cancer. Use the menu to see other pages.

The next section in this guide is Risk Factors . It explains the factors that may increase the chance of developing esophageal cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for esophageal cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

• Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

• Lower the number of people who develop the disease

Learn more about the basics of cancer screening .

Screening information for esophageal cancer

Regular screening tests to find esophageal cancer in people without symptoms are not used in the United States. People with Barrett's esophagus (see Risk Factors ) may be advised to have regular endoscopic examinations. An endoscopic examination is a procedure that uses a flexible, lighted tube to look inside the esophagus. During these examinations, biopsies can be taken to remove a small amount of tissue for examination under a microscope. This type of screening can help find cancer early or find changes that could become cancerous over time. Learn more about these tests in the Diagnosis section.

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems esophageal cancer can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How esophageal cancer is diagnosed

There are many tests used for diagnosing esophageal cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose esophageal cancer:

• Barium swallow, also called an esophagram. The patient swallows a liquid containing barium and then a series of x-rays are taken. An x-ray is a way to take a picture of the inside of the body. Barium coats the surface of the esophagus, making a tumor or other unusual changes easier to see on the x-ray. If there is an area looks abnormal, your doctor may recommend an upper endoscopy and biopsy to find out if it is cancerous (see below).

• Upper endoscopy, also called esophagus-gastric-duodenoscopy, or EGD. An upper endoscopy allows the doctor to see the lining of the esophagus. A thin, flexible tube with a light and video camera on the end, called an endoscope, is passed down the throat and into the esophagus while the patient is sedated. Sedation is giving medication to become more relaxed, calm, or sleepy. If there is an abnormal looking area, a biopsy will be performed to find out if it is cancerous. An endoscopy using an inflatable balloon to stretch the esophagus can also help widen the blocked area so that food can pass through until treatment begins.

• Endoscopic ultrasound. This procedure is often done at the same time as the upper endoscopy. During an ultrasound , sound waves provide a picture of the wall of the esophagus and nearby lymph nodes and structures. During an endoscopic ultrasound, an endoscopic probe with an attached ultrasound that produces the sound waves is inserted into the esophagus through the mouth. The ultrasound is used to find out if the tumor has grown into the wall of the esophagus, how deep the tumor has grown, and whether cancer has spread to the lymph nodes or other nearby structures. An ultrasound can also be used to help get a tissue sample from the lymph nodes.

• Bronchoscopy. Similar to an upper endoscopy , the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the windpipe, and into the breathing passages of the lungs. A bronchoscopy may be performed if a tumor is located in the upper two-thirds of the esophagus to find out if the tumor is growing into the airway. This part of the airway includes the trachea, or windpipe, and the area where the windpipe branches out into the lungs, called the bronchial tree.

• Biopsy. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A biopsy is the removal of a small amount of tissue from the suspicious area for examination. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

• Biomarker testing of the tumor . Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests can help determine your treatment options .

  • PD-L1 and microsatellite instability (MSI) testing. Testing may be done for PD-L1 and high microsatellite instability (MSI-H), which may also be called a mismatch repair deficiency. The results of these tests help doctors find out if a treatment called immunotherapy is an option (see Types of Treatment ). The PD-1/PD-L1 pathway is an immune checkpoint. These checkpoints are critical to the immune system’s ability to control cancer growth. Many cancers use these pathways to escape the immune system. If specific antibodies are given for treatment to block these pathways, the immune system may be able to overcome the suppression by the cancer. These antibodies are called immune checkpoint inhibitors. Drugs that target this pathway can be effective against MSI high or MSI-H, or PD-L1 positive esophageal cancers. PD-L1 and MSI testing is more common for advanced or stage IV esophageal cancer.

  • HER2 testing. Human epidermal growth receptor 2 (HER2) is a specialized protein found on the surface of cells. Many people are more familiar with HER2 when discussing breast cancer. However, doctors are finding that HER2 is also important in other types of cancer. When a cancer has abnormally high levels of HER2, it can drive its growth and spread. These types of cancer are referred to as HER2-positive. For HER2-positive cancers, certain types of targeted therapy may work well to treat these cancers. For patients diagnosed with gastroesophageal adenocarcinoma, ASCO, the American Society for Clinical Pathology (ASCP), and the College of American Pathologists (CAP) recommend HER2 testing to help guide treatment (please note, this link takes you to another ASCO website).

• Computed tomography (CT or CAT) scan. A CT scan creates takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Usually, a special dye called a contrast medium is given before the scan to provide better detail. This dye is generally injected into a patient’s vein.

• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A contrast medium is usually injected into a patient’s vein to create a clearer picture.

• Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan . However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with esophageal cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for esophageal cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections.

How esophageal cancer is treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team . Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for esophageal cancer because there are different treatment options. Learn more about making treatment decisions .

The common types of treatments used for esophageal cancer are described below. For a tumor that has not spread beyond the esophagus and lymph nodes, doctors often recommend combining different types of treatment: radiation therapy, chemotherapy, and surgery. For locally advanced esophageal cancer, treatments often include radiation therapy, chemotherapy, and surgery. Sometimes, chemotherapy and radiation therapy are combined in an approach called “chemoradiotherapy.” For metastatic esophageal cancer, treatment usually involves radiation therapy, chemotherapy, and other therapies using medication. More information is below about specific treatment options by stage of disease.

Your treatment plan will be based on several factors, including the type and stage of esophageal cancer. The type and order of treatments can vary from patient to patient. Your care plan may also include treatment for symptoms and side effects, which is an important part of your overall cancer care called palliative and supportive care.

• Surgery

• Endoscopic therapy

• Radiation therapy

• Chemotherapy

• Targeted therapy

• Immunotherapy

• Physical, emotional, and social effects of cancer

• Locally advanced esophageal cancer

• Metastatic esophageal cancer

• Remission and the chance of recurrence

• If treatment does not work

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery has traditionally been the most common treatment for esophageal cancer. However, currently, surgery without previous chemotherapy or chemoradiotherapy is only used as the main treatment in specific situations.

For most people with locally advanced esophageal cancer, ASCO recommends chemoradiotherapy or chemotherapy before surgery because combined therapy has been shown to help people live longer (see below). After chemoradiotherapy and surgery, immunotherapy may be recommended if tumor cells are still found in the tissue removed during surgery. If surgery is not possible, the best treatment option is often a combination of chemotherapy and radiation therapy.

The most common surgery to treat esophageal cancer is called an esophagectomy, where the doctor removes the affected part of the esophagus and then connects the remaining healthy part of the esophagus to the stomach so that the patient can swallow normally. If that is not possible, part of the intestine may sometimes be used to make the connection. The surgeon also removes lymph nodes around the esophagus.

Before surgery, talk with your health care team about the goals of care and possible side effects from the specific surgery you will have. Ask what you can expect during the recovery period. Learn more about the basics of cancer surgery .

Surgery for palliative care

In addition to surgery to treat the disease, surgery may be used to help people eat and relieve symptoms caused by the cancer. This is called palliative surgery. To do this, surgeons and doctors called gastroenterologists, who specialize in the gastrointestinal tract, can:

• Put in a feeding tube so that a person can receive nutrition directly into the stomach or intestine. A tube that passes nutrition directly into a person's stomach is called a percutaneous endoscopic gastrostomy or PEG. A feeding tube that passes nutrition directly into a person's intestine is called a percutaneous endoscopic transgastric jejunostomy or PEJ. This may be done before chemotherapy and radiation therapy is given to make sure that the person can eat enough food to maintain their weight and strength during treatment.

• Create a bypass, or new pathway, to the stomach if a tumor blocks the esophagus but cannot be removed with surgery. This procedure is rarely used.

People who have had trouble eating and drinking may need intravenous (IV; into a vein) feedings and fluids for several days before and after surgery, as well as antibiotics to prevent or treat infections. Patients are taught special coughing and breathing exercises to keep their lungs clear.

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Endoscopic therapy

The following treatments use a long, flexible tube called an endoscope (see Diagnosis ) to treat the symptoms associated with esophageal cancer and to manage side effects caused by the tumor.

• Endoscopy and dilation. This procedure expands the esophagus. It may have to be repeated if the tumor grows.

• Endoscopy with stent placement. This procedure uses an endoscopy to insert a stent in the esophagus. An esophageal stent is a metal, mesh device that is expanded to keep the esophagus open.

• Electrocoagulation. This type of palliative treatment helps destroy cancer cells by heating them with an electric current. This is sometimes used to help relieve symptoms by removing a blockage caused by the tumor.

• Cryotherapy. This is a type of palliative treatment that uses an endoscope with a probe attached that can freeze and remove tumor tissue. It can be used to reduce the size of a tumor to help a patient swallow easier.

Other, less-common techniques include photodynamic therapy and laser therapy. In photodynamic therapy, a light-sensitive substance called a photosensitizer is given by vein. Then, a laser is then directed at the esophageal lesions using an endoscope. In laser surgery, a laser is used to burn the esophageal lesions through an endoscope. Talk with your doctor about what to expect and possible side effects for the type of endoscopic procedure recommended for you.

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body.

When radiation treatment is given directly inside the body, it is called internal radiation therapy or brachytherapy. For esophageal cancer, this involves temporarily inserting a radioactive wire into the esophagus using an endoscope (see "Endoscopic therapy," above and in Diagnosis ).

Proton beam therapy is being studied in clinical trials for esophageal cancer. Proton beam therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells.

In general, side effects from radiation therapy may include fatigue, mild skin reactions, soreness in the throat and esophagus, difficulty or pain with swallowing, upset stomach, nausea, and loose bowel movements. Most side effects go away soon after treatment is finished.

Learn more about the basics of radiation therapy .

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for esophageal cancer include:

• Chemotherapy

• Targeted therapy

• Immunotherapy

Each of these types of therapies are discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. As explained above, chemotherapy and radiation therapy are often given at the same time to treat esophageal cancer, called chemoradiotherapy.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, nerve problems, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy .

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Targeted therapy ( updated 01/2023)

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments .

Targeted therapy for esophageal cancer includes:

• HER2-targeted therapy. For esophageal cancer, the targeted therapy trastuzumab (Herceptin, Ogivri) may be used along with chemotherapy as a first treatment for metastatic esophageal adenocarcinoma. Trastuzumab deruxtecan (Enhertu) is also approved as a first treatment for metastatic esophageal adenocarcinoma. This combines a drug that is similar to trastuzumab with a strong chemotherapy. For metastatic or recurrent gastroesophageal cancer that is HER2 positive, ASCO, ASCP, and CAP recommend a combination of chemotherapy and HER2-targeted therapy . For previously untreated gastroesophageal junction adenocarcinoma that is HER2 positive and is either metastatic or cannot be removed with surgery, ASCO recommends trastuzumab combined with pembrolizumab (see below) and chemotherapy. The gastroesophageal junction is where the stomach and esophagus meet. Trastuzumab deruxtecan is recommended for people with HER2-positive gastroesophageal junction adenocarcinoma if first-line therapy, or the first treatment given, has not worked. If the cancer is HER2 negative, HER2-targeted therapy is not a treatment option for you, and your doctor will give you other options for treating the cancer.

• Anti-angiogenesis therapy. The targeted therapy ramucirumab (Cyramza) is recommended as a treatment option in combination with paclitaxel chemotherapy (see above) for advanced gastroesophageal or gastroesophageal junction adenocarcinoma if first-line therapy has not worked. Ramucirumab is a type of targeted therapy called an anti-angiogenic. This means it is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. While ramucirumab is most commonly given with paclitaxel, it can also be given by itself.

Talk with your doctor about possible side effects for each specific targeted therapy you are prescribed and how they can be managed.

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Immunotherapy (updated 01/2023)

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune systems' ability to attack cancer cells.

There are 2 types of immunotherapy drugs that are approved to treat both adenocarcinoma and squamous cell carcinoma of the esophagus and the gastroesophageal junction, which is cancer that grows where the stomach and esophagus meet. Pembrolizumab (Keytruda) and nivolumab (Opdivo) are both checkpoint inhibitors that target the PD-1/PD-L1 pathway (see Diagnosis).

Pembrolizumab (Keytruda) is approved in the following situations:

• As a first-line treatment in combination with chemotherapy for incurable locally advanced or metastatic esophageal and gastroesophageal junction adenocarcinoma and squamous cell carcinoma, regardless of PD-L1 expression.

• As a first-line treatment in combination with chemotherapy and trastuzumab for HER2-positive incurable locally advanced or metastatic esophageal and gastroesophageal junction adenocarcinoma, regardless of PD-L1 expression.

• As a second-line treatment for esophageal squamous cell carcinoma that tests CPS positive at 10% or higher. CPS stands for "combined positive score" and it is a way to measure how many cells express the PD-L1 protein.

• It is also approved to treat gastroesophageal junction adenocarcinoma that tests positive for MSI-H or has mismatch repair deficiency after 1 or more chemotherapy treatments have not stopped the cancer.

Nivolumab (Opdivo) is approved in the following situations:

• As a first-line treatment in combination with chemotherapy for esophageal or gastroesophageal junction adenocarcinoma, regardless of PD-L1 expression.

• As a second-line treatment for esophageal squamous cell carcinoma, regardless of PD-L1 expression.

• As a post-surgery adjuvant treatment after chemotherapy, radiation, and surgery in esophageal and gastroesophageal adenocarcinoma and squamous cell carcinoma if any cancer cells remain in the tissue removed during surgery. Some research suggests that people with tumors with higher PD-L1 expression may have a greater benefit from adjuvant nivolumab, but this requires further study.

ASCO recommends nivolumab in combination with chemotherapy as first-line treatment for people with advanced HER2-negative, PD-L1-positive esophageal or gastroesophageal junction adenocarcinoma. For people with a higher PD-L1 expression, pembrolizumab in combination with chemotherapy is recommended.

For people with advanced PD-L1-positive esophageal squamous cell carcinoma, ASCO recommends pembrolizumab in combination with chemotherapy. Nivolumab combined with either chemotherapy or the immunotherapy drug ipilimumab (Yervoy) may also be recommended for people with this type of cancer, depending on how much PD-L1 is expressed.

This information is based on the ASCO guideline, “ Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer .” Please note that this link takes you to another ASCO website.

Like other cancer medications, immunotherapy can cause side effects. Talk with your doctor about each medication recommended for you, what to expect, and how possible side effects can be avoided or relieved.

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Locally advanced esophageal cancer

For locally advanced esophageal cancer, ASCO recommends a treatment plan that combines different types of treatments. This can include: radiation therapy, chemotherapy, and surgery. Sometimes, chemotherapy and radiation therapy are combined in an approach called "chemoradiotherapy." The order of treatment varies, and several factors are considered, including the type of esophageal cancer.

Squamous cell cancer. For squamous cell esophageal cancer, chemoradiotherapy is commonly recommended as the first treatment. Surgery may be used afterwards depending on how well chemoradiotherapy worked. Recent studies show using chemoradiotherapy before surgery is better than surgery alone. ASCO recommends chemoradiotherapy before surgery for all people with locally advanced esophageal squamous cell cancer. In some patients, this treatment may send the cancer into remission, and surgery may not be needed immediately.

For people who receive chemoradiotherapy and surgery, immunotherapy (see above) may be recommended if tumor cells are still found in the tissue removed during surgery. Some people may not be able to receive radiation therapy. These patients can receive chemotherapy alone before surgery.

Adenocarcinoma. For adenocarcinoma, the most common treatment in the United States is chemoradiotherapy followed by surgery. Surgery is almost always recommended after chemoradiotherapy, unless there are factors that increase the risks from surgery, such as a patient's overall health. For locally advanced esophageal adenocarcinoma, ASCO recommends chemoradiotherapy before surgery or chemotherapy before and after surgery. After chemoradiotherapy and surgery, if tumor cells are found in the tissue removed during surgery, immunotherapy (see above) may be recommended. For some people, surgery is not an option. In that case, chemoradiotherapy alone is the recommended treatment. When chemotherapy and radiation therapy are combined, there can be more severe side effects. But this treatment combination can be more effective in certain situations. It's important to discuss with your doctor which treatment options are best for you.

This information is based on the ASCO guideline, “ Treatment of Locally Advanced Esophageal Carcinoma .” Please note that this link takes you to another ASCO website.

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Metastatic esophageal cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

For metastatic esophageal cancer, palliative or supportive care is very important to help relieve symptoms and side effects. The goal of treatment is usually to lengthen a person’s life, while easing symptoms such as pain and problems with eating. Your treatment plan may include chemotherapy, as well as radiation therapy to help relieve pain or discomfort. For example, an esophageal stent, laser therapy, photodynamic therapy, or cryotherapy may help keep the esophagus open (see above).

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as a through a support group or other peer support program.

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Physical, emotional, and social effects of cancer

As explained above, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy. Several examples are described above, such as having a palliative treatment to make it easier to eat.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk with your doctor about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent esophageal cancer. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about this type of cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about esophageal cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• Chemoprevention. Researchers are looking at using aspirin and acid-reducing medication to prevent esophageal adenocarcinoma in people with Barrett’s esophagus. Research is still ongoing, and people are encouraged to talk with their doctor before taking any medications or dietary supplements for this reason. Learn about the basics of chemoprevention .

• Use of PET scan. In addition to helping find out the cancer’s stage (see Diagnosis ), PET scans may be used to find out how well treatment is working to shrink a tumor before surgery. Researchers are studying the use of PET scan to evaluate and possibly change treatment before surgery .

• Chemotherapy advances. Doctors are studying combinations of different drugs, such as capecitabine (Xeloda), cisplatin (available as a generic drug), docetaxel (Docefrez, Taxotere), fluorouracil (5-FU, Efudex), irinotecan (Camptosar), oxaliplatin (Eloxatin), paclitaxel, and trifluridine-tipiracil combination (Lonsurf). Research is ongoing to find new drugs that are effective for esophageal cancer.

• Targeted therapy. Several types of targeted therapies are currently being studied for esophageal cancer. For example, researchers are looking at new drugs that block vascular endothelial growth factor (VEGF). Learn more about advances in molecular profiling of tumors to identify targets in GI cancers, including esophageal cancer.

• Immunotherapy. New drugs and combinations that include immunotherapy continue to be studied.

• Palliative care/supportive care . Clinical trials are underway to find better ways of reducing symptoms and side effects of current esophageal cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in esophageal cancer, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now .

• Visit the Cancer.Net Blog to review research and topics related to esophageal cancers.

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given. If the esophageal cancer is in remission, follow-up care may include CT scans and upper endoscopies (see Diagnosis ) to watch for a possible recurrence.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them. For example, people who have had an esophagectomy should sleep with the head of the bed elevated to avoid acid reflux, since the stomach has been surgically moved up into the chest.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of esophageal cancer do I have?

• Is the cancer located only in my esophagus?

• What is the stage and grade of the disease? What does this mean?

• Can you explain my pathology report (laboratory test results) to me?

• What may have caused esophageal cancer for me? Does this cancer run in families and should other family members be screened for this cancer?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What clinical trials are available me? Where are they located, and how do I find out more about them?

• Are there radiation therapy and surgery options to treat the cancer?

• Is surgery needed as part of treatment?

• Can chemotherapy control the cancer?

• What treatment plan do you recommend? Why?

• What is my prognosis?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• What are the possible side effects of each treatment, both in the short term and the long term?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about having surgery

• What type of surgery will I have? Will lymph nodes be removed?

• How experienced is the surgeon with this type of surgery?
  

• How long will the operation take?
  

• How long will I be in the hospital?
  

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?
  

• What are the possible long-term effects and complications of having this surgery?

Questions to ask about having radiation therapy or therapies using medication

• What type of treatment is recommended?
  

• What is the goal of this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• How long will it take to give this treatment?
  

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?
  

• What are the possible long-term or late effects of having this treatment?
  

• What can be done to relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment I received?
  

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?
  

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.