Esophageal Cancer

Treatment for people who have esophageal cancer is never one-size-fits-all. Before starting treatment at Siteman Cancer Center, a team reviews your case. This team includes WashU Medicine surgeons, medical oncologists, radiation oncologists, gastroenterologists, pathologists, and other specialists. They meet to create a plan based on your cancer’s biology, stage, and overall health. This coordinated approach is the foundation of the care you will receive here. 

Multidisciplinary Care Changes Outcomes 

The multidisciplinary tumor board meets every week for each new esophageal cancer patient at Siteman. In these meetings, WashU Medicine specialists come together to review imaging, pathology, and staging results. They also consider individual health factors before suggesting a treatment plan. 

This model is a standard of care at Siteman and ensures that no single specialist makes a recommendation alone. Patients with complex or advanced diseases can access combined expertise where we leverage different combinations of therapies for their specific needs, a standard of care and level of personalization that isn’t available at general oncology practices.

Personalized Treatment for Esophageal Cancer 

Treatment for esophageal cancer typically combines more than one approach according to your stage, type, and goals. The most effective plan will be determined by the stage of the cancer, its location, the type of cells involved, and your health. 

The main treatment options are surgery, chemotherapy, radiation therapy, and newer targeted and immune-based therapies. Often, these methods will be combined to form a personalized treatment plan. 

Esophagectomy 

An esophagectomy is the surgical removal of part or all of the esophagus. It is the cornerstone of treatment for early and locally advanced esophageal cancer. It is one of the most technically complex operations in cancer surgery. 

During the procedure, the surgeon removes the affected portion of the esophagus and often nearby lymph nodes. The stomach is then repositioned and connected to the remaining esophagus, restoring the digestive pathway. Sometimes, a portion of the intestine is used to make that connection. 

WashU Medicine surgeons at Siteman are nationally recognized for their minimally invasive approach to esophagectomy. They perform this procedure with smaller incisions, sometimes by using robotic assistance. This results in shorter hospital stays, quicker recovery times, and less pain. They specialize in complex thoracic and upper gastrointestinal cancers, performing more than 70 esophagectomies each year. 

This situates Siteman as one of the highest-volume programs in the region for the procedure. Research consistently shows that surgical volume is one of the strongest predictors of outcomes in esophageal surgery. More experience means more precision, fewer complications, and better survivability. 

Robotic-assisted esophagectomy 

Robotic-assisted esophagectomies use a minimally invasive method. The surgeon operates four robotic arms from a special console in the operating room. The robot’s high-definition 3D camera allows the surgeon to see inside the body with far greater precision than the naked eye allows. 

The benefits for eligible patients include: 

• Smaller incisions (typically less than one inch) rather than a single large opening, allowing for quicker recovery
• Less blood loss during surgery 
• Lower risk of complications 
• A shorter hospital stay 

Patients who have not had prior abdominal or thoracic surgery are often good candidates for this approach. Some tumors that are larger or attached to nearby structures may be more safely removed with an open procedure. Your surgeon will determine what is right for your situation. 

Recovery from esophageal cancer surgery 

Recovery depends on the type of procedure, your overall health before surgery, and how well your body heals. 

Patients who have robotic-assisted esophagectomy usually go home sooner than those who have open surgery. Other patients may spend several days to a week in the hospital following an open esophagectomy. 

Full recovery, including returning to eating, activity, and daily routines can take weeks to months. Nutritional support, including a feeding tube during the healing period, is a routine part of recovery. 

Siteman’s care team includes surgeons, nurses, registered dietitians, and support specialists who guide patients through every stage of recovery. 

Chemotherapy 

For patients with advanced esophageal cancer, chemotherapy is a key treatment. It may be used alone or alongside surgery, both before and after the procedure. Chemotherapy drugs can be given by mouth or through an IV. They aim to attack and destroy cancer cells in the body. 

Chemotherapy for esophageal cancer has expanded significantly in recent years. New drugs and combination therapies give oncologists more precise options than ever. Your medical oncologist will talk about drug choices, dosing, and timing based on the features of your cancer. 

Radiation Therapy 

Radiation therapy plays an important role in treating esophageal cancer. It can eliminate cancer cells in the esophagus and nearby lymph nodes and provide symptom relief in more advanced stages. 

Siteman is a leader in precision radiation delivery. External beam radiation makes up 95% of all radiation treatment at Siteman. It’s guided by intensity-modulated therapy (IMRT) and CT-based 3D planning. This approach targets the tumor accurately and reduces exposure to nearby tissue. 

WashU Medicine’s radiation oncologists have active clinical trials studying how to minimize the duration and amount of radiation patients receive. They use shorter radiation durations than the national average, with results that are equal to or better than longer regimens. We make these decisions with the idea that we should treat the patient and their disease with precision, being careful not to overtreat them while ensuring maximum effectiveness.  

First in the world to use MRI-guided radiation 

Siteman’s radiation oncology team was the first in the world to use MRI to guide external radiation. They also were the first to treat patients with this technology. This innovation enables oncologists to adjust the treatment beam in real time based on how the tumor and surrounding tissue shift during treatment. With this level of precision, we reduce side effects and protect healthy tissues. 

Chemoradiation 

Chemotherapy and radiation are often delivered together for esophageal cancer. When combined, the two therapies can be more effective than either alone. This is referred to as multimodal treatment, where physicians use a combination of treatments to eliminate cancer. 

With this type of therapy, radiation sensitizes cancer cells to chemotherapy, and chemotherapy enhances the effects of radiation. The specific combination, sequence, and duration are tailored to each patient’s stage and treatment goals. 

Treating Barrett’s esophagus at Siteman 

Siteman Cancer Center began using radiofrequency ablation (RFA) to treat Barrett’s esophagus in 2009. In this procedure, a scope is inserted through the mouth and uses controlled heat to destroy abnormal tissue while preserving the healthy deeper layers of the esophagus. 

Patients with high-grade dysplasia may be eligible for RFA. Following ablation, patients continue anti-reflux medications to reduce the risk of new abnormal cells developing. For the small number of patients with severe dysplasia that does not respond to ablation, surgical options are evaluated by your multidisciplinary team. 

WashU Medicine physicians specialize in upper gastroenterology and thoracic cancers. The specialists doing your endoscopic evaluation and treatment are incredibly experienced. They will guide you to thoracic surgeons, medical oncologists, or enroll you in clinical trials if you need more care. 

Other therapies used to treat esophageal cancer 

Siteman provides more than just surgery, chemotherapy, and radiation. They also offer various other treatment options, such as: 

• Immunotherapy, which uses immune checkpoint inhibitors to help the body’s own immune system recognize and attack cancer cells. 
• Targeted therapy for cancers with specific genetic mutations or protein expressions. Targeted drugs can interrupt the signals cancer cells use to grow and spread. 
• Laser therapy, which uses a focused laser beam to destroy cancer cells in the esophagus. 
• Electrocoagulation, which is an electrical current that kills cancer cells and can relieve obstruction in the esophagus. 
• Cryotherapy, which freezes targets and destroys cancer cells and is used in specific clinical contexts. 
   

We choose combinations of these approaches based on stage, tumor biology, and clinical trial eligibility. 
 
At Siteman, patients with esophageal cancer can join clinical trials. These trials test new combinations of multimodal and immune-based treatments. Often, these options are available here before other centers. 

Clinical Trials: Access to Tomorrow’s Treatments Today 

As an NCI-designated Comprehensive Cancer Center affiliated with WashU Medicine, Siteman Cancer Center leads and participates in clinical trials for esophageal cancer across medical oncology, surgery, and radiation oncology. Many of the physicians and researchers here serve as principal investigators on these trials. 

Clinical trials offer patients new treatment options. These include innovative immunotherapy regimens, fresh chemotherapy combinations, and multimodal approaches. Plus, patients receive complete support from Siteman’s clinical team. 

Managing the Effects of Treatment 

Specialists design cancer treatment for positive outcomes, but therapy can be physically demanding. Knowing what to expect helps patients prepare and advocate for the support they need. 

You may experience the following side effects of treatment: 

• Fatigue 
• Difficulty eating 
• Nausea and vomiting 
• Pain 
• Peripheral neuropathy 
• Vocal changes 
• Changes in heart health 

Your care team includes helpful services like nutritionists, psychologists, occupational therapists, and cardio-oncologists. They will track your symptoms after treatment and support your recovery. Our main goal is to give you the best quality of life after treatment. We work with you to assess and manage your risks every step of the way.