How is esophageal cancer treated?
Your treatment plan will depend on your age, overall health, and the type and stage of your cancer. Our specialists work together to plan and monitor your treatment using the latest proven methods and protocols. This team approach is critical in esophageal cancer, which is often diagnosed in later stages that benefit from combination therapy. Your treatment may involve many different strategies, including:
Chemotherapy uses medicine that goes through the body to kill cancer cells wherever they are. It’s common in treating esophageal cancer because it is usually diagnosed after it has spread to other organs. Chemotherapy may be combined with radiation therapy to treat esophageal cancer, a combination that is called chemoradiation.
Radiation therapy uses high-energy beams of radiation to kill cancer cells and shrink or get rid of tumors. We use the latest advances in radiation therapy to treat esophageal cancer precisely and powerfully. Treatment often begins with several weeks of chemoradiation, radiation therapy combined with chemotherapy. It may be used as the primary treatment or to shrink the tumor before surgery. It can also be used to shrink a tumor so you can swallow better, to reduce pain, or to eliminate spots where the cancer has spread in other parts of the body. Some methods we may use to treat esophageal cancer include:
- Intensity - modulated radiation therapy (IMRT) - IMRT targets uses computers and three-dimensional images from CT scans to focus small radiation beams on and around the tumor without affecting surrounding organs.
- Image - guided radiation therapy - IGRT molds radiation beams to the contours of your tumor, and uses ultrasound and other imaging methods to deliver precise doses. It helps make sure that your esophagus’ natural movement doesn’t interfere with treatment.
- Brachytherapy - This method delivers radiation from inside your esophagus. A radioactive source is placed into your esophagus while you are under anesthesia.
- Respiratory gating - When using IMRT or IGRT, we use respiratory gating to improve accuracy. The esophagus moves as you breathe, and respiratory gating lets us analyze your breathing cycle and release radiation only at certain times. Our doctors work closely together to plan the radiation dosage.
- Proton therapy - Proton therapy delivers high doses of radiation to control and manage cancer while significantly reducing damage to healthy tissue and vital organs. Miami Cancer Institute is the first center in South Florida to offer this treatment and offers a unique combination of sophisticated technology that is unmatched.
We may recommend surgery as part of your treatment plan, depending on your overall health, the type and size of the tumor, how deep it is and whether it has spread to lymph nodes or other organs. In most cases, robotic surgery is the best option, and our team is among the area’s most experienced in its use. You may first receive chemotherapy and radiation therapy to shrink the tumor for removal. Surgery may involve:
- Esophagectomy - The surgeon removes the tumor, part of the esophagus, tissue around the tumor, and lymph nodes where cancer cells may have spread. The stomach is then attached to the remaining part of the healthy esophagus. When the stomach is not available or if it needs to be removed because it also has cancer, portions of the large or small intestine may be used instead so you can eat. Our surgeons are highly trained in minimally invasive techniques, including robotic-assisted surgery, to reduce damage to healthy tissue and help you heal faster. We’ll closely monitor you after surgery to prevent or treat any complications or side effects.
- Resection and ablation - Precancers or early-stage esophageal tumors may be treated with endoscopic mucosal resection (EMR). Using an endoscope (a flexible, narrow tube), the doctor shaves off the precancerous tissue or tumor. We also may use thermal therapy, such as radiofrequency ablation (RFA), using heat to treat precancerous areas.
- Stenting - If a tumor is blocking the esophagus, a doctor can insert a stent (a small metal or plastic device) to keep the esophagus open.
A multidisciplinary team of cancer experts including surgeons, medical oncologists, radiation oncologists, plastic reconstructive surgeons, pathologists, radiologists, genetic counselors, medical geneticists, social workers, patient navigators and clinical trials staff meet weekly to discuss select complex cases and determine the best course of care.
Experts from Miami Cancer Institute are at the forefront of the latest cancer research. Their work to develop better diagnostic tools and targeted therapies brings promising new ways of finding and treating cancer to you sooner. Talk to your doctor about what clinical trials might be right for you.
South Florida's First Proton Therapy Center
Proton therapy is a highly specialized treatment that directs proton particles toward tumors to destroy cancer cells while largely sparing healthy tissue and decreasing the risk of side effects. This sophisticated treatment is used only for certain types of cancers and in a limited number of individuals.