Esophageal Cancer Treatment

About Esophageal Cancer

At Penn Medicine's Abramson Cancer Center, patients with esophageal cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

Esophageal cancer is cancer that develops within the lining of the esophagus, the muscular tube through which food passes from the mouth to the stomach.

There are two types of esophageal cancer:

  • Squamous cell carcinoma: Cancer that begins in the flat skin-like cells lining the esophagus.
  • Adenocarcinoma: Cancer that begins in the intestinal-type cells that make and release mucus and other fluids.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more About Esophageal Cancer

Diagnosing Esophageal Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first step in developing personalized treatment options for esophageal cancer.

Patients who choose Penn’s Abramson Cancer Center benefit from a multidisciplinary team of cancer specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and treatment plan custom designed for each patient with esophageal cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing esophageal cancer and are actively researching better and more precise ways to detect esophageal cancer.

An accurate diagnosis is a critical step in planning cancer treatment, so it’s important patients know that when they come to the Abramson Cancer Center, they are taking an important step in getting the best cancer treatment available.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Diagnosing Esophageal Cancer

Esophageal Cancer Treatment

Following the diagnosis and staging of esophageal cancer, cancer specialists at Penn's Abramson Cancer Center develop a personalized treatment plan. Penn's treatment options for esophageal cancer include:

  • Surgery
    • Esophagectomy
  • Radiation therapy
    • 3-D conformal radiation therapy
    • Intensity-modulated radiation treatment (IMRT)
    • Volumetric-modulated arc therapy (VMAT)
    • Proton therapy
  • Chemotherapy
  • Endoscopy
    • Endoscopic mucosal resection
    • Radiofrequency ablation
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).


Surgery for Esophageal Cancer

Penn Medicine offers patients one of the largest gastrointestinal surgery programs in the United States with nationally recognized cancer specialists. Penn's GI surgery program has a record of high-quality patient care and long-term survival, offering better outcomes for patients having surgery.

Nationally, surgery is the most common treatment for esophageal cancer, though endoscopic therapies for early tumors are rapidly increasing in application. For limited stage esophageal cancer, surgery may be the only treatment needed.

Esophagectomy is the most common form of surgery for patients with esophageal cancer. In this procedure,the part of the esophagus affected by cancer is removed. The healthy part of the esophagus is then connected to the stomach. Lymph nodes near the esophagus are also removed and examined for cancer. If the esophagus is blocked by a tumor, an expandable stent, or tube, may be placed prior to surgery to help keep the esophagus open to improve nutritional status, or after surgery for palliation.

Radiation Therapy for Esophageal Cancer

Radiation oncologists at Penn Medicine are recognized for techniques that target radiation precisely to the disease site while sparing nearby tissue. Penn is one of the only health care systems in the country to use proton therapy for cancer treatment.

Proton therapy at Penn Medicine is now being used to treat upper gastrointestinal cancers and recurrent tumors in the digestive tract. Penn Medicine is one of the only facilities in the country treating gastrointestinal cancers in this way.

Radiation therapy uses high-energy radiation to kill cancer cells. A radiation therapy schedule usually consists of a specific number of treatments given over an extended period of time. In many cases, radiation therapy is capable of killing all of the cancer cells.

Radiation oncologists at Penn Medicine use both internal and external forms of radiation therapy to treat cancer.

3D Conformal Radiation Therapy

The imaging technology used by radiation oncologists at Penn Medicine helps shape the radiation treatment beam to the shape of the tumor. Known as conformal radiation therapy, this technology gives doctors more control when treating tumors.

In conformal radiation, a special computer uses CT imaging scans to create 3-D maps of the cancer’s location in the body. The system permits the delivery of radiation from several directions and the beams can then be shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.

Intensity-Modulated Radiation Treatment (IMRT)

As national leaders in radiation therapy, radiation oncologists at Penn Medicine are experts in the use of the latest therapies, including intensity-modulated radiation therapy (IMRT), to treat cancer.

This advanced type of radiotherapy uses a computer-controlled device, called a linear accelerator, to deliver precise doses of radiation to tumors or specific areas within the tumors. Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells.

Using 4-D computed tomography (CT) images along with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the shape of the tumor by controlling, or modulating, the intensity of the radiation beam while tracking any movement of the tumor.  The therapy allows higher radiation doses to be delivered to regions within the tumor while minimizing the dose to the surrounding area.

Volumetric-Modulated Arc Therapy (VMAT)

Volumetric modulated arc therapy (VMAT) is a type of specialized intensity modulated radiation therapy. VMAT delivers radiation by rotating the linear accelerator through one or more arcs while radiation is continuously delivered.

VMAT allows Penn radiation oncologists to treat complex cancers while minimizing exposure to surrounding healthy tissue. VMAT shortens radiation delivery time, and offers patient more comfort because it does not require patients to lie completely still for long periods of time.

Penn radiation oncologists use RapidArc™ radiotherapy technology to treat hard to reach tumors.

Proton Therapy

Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials.

Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. Patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at Penn Medicine. Proton therapy is external beam radiotherapy in which protons are directed at a tumor.

The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.

Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. These particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.

Chemotherapy for Esophageal Cancer

Penn Medicine specializes in a team approach to treatment with interdisciplinary care and innovative approaches that use chemotherapy to target tumors prior to surgery. Penn medical oncologists are experienced with providing chemotherapy to patients with esophageal cancer.

Chemotherapy uses drugs to kill cancer cells. It is delivered in the bloodstream intravenously or through a pill, and targets cancer cells throughout the body.

Depending on the stage of the tumor, chemotherapy in combination with radiation therapy, or chemoradiation therapy, may be used as a primary treatment or in combination with surgery.

Endoscopy

Endoscopy is performed using an endoscope, a long, narrow tube equipped with a light, video camera and other instruments, to examine the upper digestive system.

Endoscopic mucosal resection (EMR)

Endoscopic mucosal resection is performed using an endoscope. During endoscopic mucosal resection, the endoscope is passed down the throat to reach the abnormality in the esophagus. Instruments attached to the endoscope are used to remove the tumor.

Radiofrequency ablation

Radiofrequency ablation is an endoscopic procedure involving targeted thermal energy to kill the cells lining in the esophagus as a treatment for Barrett’s esophagus, a precancerous condition. The radio waves kill the altered cells and prevent them from becoming cancer.

Endoscopic Stent Placement

Endoscopic stents may be placed for palliative relief of dysphagia.

Nutrition Support for Esophageal Cancer

Many people with esophageal cancer find it hard to eat because they have trouble swallowing. The esophagus can be narrowed by the tumor or as a side effect of treatment. Some patients may receive nutrition intravenously or through a feeding tube passed through the nose or mouth into the stomach until they are able to eat on their own. Endoscopic therapies including dilation and stent placement may improve the swallowing function and nutritional status.

A specialized oncology dietitian is available to help with swallowing difficulty, weight loss, specialized diets and nutritional assessment. Speech and swallowing therapists are also available to help with symptoms.

Clinical Trials for Esophageal Cancer

Today, more and more people are surviving cancer. Clinical trials benefit patients with breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more successful.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials. Also, radiation oncologists at Penn Medicine will soon use proton therapy to treat gastrointestinal cancers in the upper digestive tract.

Other Treatments for Esophageal Cancer

In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments – not take their place.

Integrative Medicine and Wellness Programs

At Penn Medicine, integrative medicine and wellness services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer patients and their families ways to enhance the quality of their lives, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

Cancer specialists at Penn Medicine are knowledgeable and supportive of complementary cancer treatments. The cancer team works with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

The Abramson Cancer Center’s range of integrative supportive services is designed to help patients cope with the cancer experience and improve their overall sense of well-being. Services include:

The Abramson Cancer Center at Pennsylvania Hospital at Pennsylvania Hospital offers a variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.

The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight.

The Supportive Care Clinic helps to manage cancer related symptoms. Integrative support programs include:

Support groups and educational programs are available at Pennsylvania Hospital throughout the year.

Palliative Care

Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients.

Palliative care can be used to complement traditional cancer therapies, or can be used to improve quality of life when curative therapies are no longer an option.

Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end-of-life care.

Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families. The goals of palliative care are to enhance the quality of life for cancer patients and their families, and provide emotional and spiritual support to enhance personal growth.

Palliative care services are offered at Pennsylvania Hospital, and at the Hospital of the University of Pennsylvania.  

Penn Home Care and Hospice Services

Penn Home Care and Hospice Services offer a full range of home health care needs by partnering three top-level home health care services under one roof:

Penn Home Care and Hospice Services offer an array of specialized therapies and medications for patients with cancer and cancer-related conditions.

Oncology Navigation Specialists

Every step of cancer treatment; from a cancer diagnosis, to surgery and treatment to forming a survivorship plan; comes with different needs and issues that should be addressed.

Oncology Navigation Specialists at the Abramson Cancer Center are available to make a patient’s experience as seamless as possible. As experts in navigating complex health care situations, patient support specialists serve as a consistent point of contact and a reliable source for advice, support and direction for patients and families. They can help in a variety of ways including; provide emotional support, identify resources, and ensure access to information, support services, educational programs and community resources.

Learn more about Patient Navigation specialists at the Abramson Cancer Center.

Esophageal Cancer Survivorship

Survivorship programs at Penn Medicine are a distinct phase of esophageal cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle. There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete.

Read more Esophageal Cancer Survivorship


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Clinical Trials