After determining a diagnosis and completing a full pre-treatment evaluation, doctors will recommend a course of treatment for their patients. In general, there are three different options for the treatment of cervical esophageal cancers that can be used alone or in combination.
Surgery
Surgery may be an option for the treatment of cervical esophageal cancers, depending on the type, grade, and stage of the cancer. Some rare early stage cancers may be treated endoscopically; however, most require an open surgical approach. Surgery may also be followed by adjuvant radiation and/or chemotherapy depending on how advanced the cancer is.
The most common open surgical treatment is esophagectomy, which involves the removal of either a portion or the entire esophagus. The esophagus is then replaced and reconstructed using either the stomach or tissue from elsewhere in the body, such as a portion of the intestine or skin from the forearm or thigh, depending on the amount of esophagus removed and the location of the primary tumor. Cervical esophageal cancers may also be treated by a pharyngectomy, laryngectomy, or a more complex reconstructive surgery.
Radiation
For the treatment of cervical esophageal cancers, there are two types of radiation that may be used. Radiation therapy is a form of primary treatment, in which an external beam of radiation is directed at the tumor in order to destroy the rapidly dividing cancer cells. Radiation can also be given following surgical resection, termed adjuvant radiation, with the goal of decreasing the chances that the cancer will come back.
Chemotherapy
Chemotherapy is typically given in combination with radiation therapy and/or surgery as a treatment for more advanced cervical esophageal cancers.
General Treatment Options for Cervical Esophageal Squamous Cell Carcinomas & Adenocarcinomas
These options depend on T, N, and M stages.
For M0 patients healthy enough to undergo surgery
- pTis: Endoscopic therapies, such as endoscopic resection (ER), ablation, or ER followed by ablation, are preferred.
- pT1a: ER with or without ablation is the preferred treatment; esophagectomy is also an option.
- Superficial pT1b (Only adenocarcinoma): ER followed by ablation or esophagectomy is the preferred treatment.
- pT1b, N0: Esophagectomy.
- cT1b, N+ and cT2-T4a, Any N:
- Esophagectomy plus:
- Chemotherapy with radiation followed by esophagectomy is the preferred treatment.
- Esophagectomy alone is an option for non-cervical esophagus tumors (low risk lesions that are <2cm and are well differentiated).
- If the cancer is adenocarcinoma, chemotherapy is also recommended, alone, before, during, or after esophagectomy.
- Definitive chemoradiation is an option for patients who decline surgery.
- Esophagectomy plus:
- cT4b: Definitive chemoradiation.
- If the cancer is Squamous Cell Carcinoma, or if the cancer has spread to the trachea, great vessels, or heart, palliative chemotherapy alone may be considered.
For M0 patients who are NOT good candidates for surgery or who choose not to undergo surgery
- pTis: Endoscopic therapies, such as endoscopic resection (ER), ablation, or ER followed by ablation, are preferred.
- pT1a: ER or ER followed by ablation.
- pT1b that is not very deep: ER or ER followed by ablation or chemotherapy with radiation (for particularly bad tumors).
- cT1b, N+ and cT2-T4a, Any N or cT4b (unresectable): For all other tumors, the options are definitive chemoradiation, palliative radiation, or best supportive care.
For patients who are NOT good candidates for surgery or chemotherapy
- Doctors should consider radiation therapy to help with symptoms and improve quality of life (palliative radiation).
Stage IV (M1, metastatic disease)
- Treatment options include palliative radiation or chemotherapy
- This could include radiation, chemotherapy, drugs, or surgical procedures to remove obstruction in the esophagus but not cure disease.
