ESOPHAGEAL CANCER: TYPES, SYMPTOMS, STAGES, AND MORE

Photo from cancerhealth.com

The esophagus is a hollow, muscular tube that connects the throat to the stomach. It is about 10 inches long. It is a component of the gastrointestinal (GI) tract, often known as the digestive system. When a person swallows, the esophageal walls contract to drive food down into the stomach.

Cancer develops when healthy cells mutate and expand uncontrollably, generating a mass known as a tumor. A tumor might be malignant or noncancerous. A malignant tumor is one that can grow and spread to other regions of the body. A benign tumor is one that can develop but does not spread. Esophageal cancer, also known as esophagus cancer, develops in the cells lining the esophagus.

Cancer of the esophagus, in particular, develops in the inner layer of the esophageal wall and spreads outward. If it enters the esophageal wall, it can spread to lymph nodes, which are small, bean-shaped organs that help fight infection, as well as blood arteries in the chest and other adjacent organs. Esophageal cancer can spread to the lungs, liver, stomach, and other organs.


ESOPHAGEAL CANCER TYPES

Esophageal cancer is classified into two types:
  • Squamous cell carcinoma: This kind of esophageal cancer begins in the lining of the esophagus’s squamous cells. It typically develops in the upper and middle esophagus.
  • Adenocarcinoma: This variety begins in the glandular tissue of the lower esophagus, where the esophagus and stomach meet.
Both kinds of esophageal cancer are treated similarly. Other forms of esophageal tumors are quite rare. These malignancies, which include small cell neuroendocrine tumors, lymphomas, and sarcoma, account for fewer than 1% of all esophageal cancers.

SYMPTOMS AND SIGNS OF ESOPHAGEAL CANCER

The following symptoms or indicators may be experienced by people with esophageal cancer. A symptom, such as weariness, nausea, or discomfort, is something that only the person experiencing it can identify and explain. A symptom is something that others can recognize and quantify, such as a fever, rash, or an increased pulse. Signs and symptoms, when combined, can assist describe a medical situation. People with esophageal cancer may not exhibit any of the signs and symptoms listed below. Alternatively, the origin of a symptom or sign could be a medical disease other than cancer.
Swallowing difficulty and pain, especially while eating meat, bread, or raw vegetables. As the tumor grows, it has the potential to obstruct the passage to the stomach. Even liquids can be difficult to swallow.
  • In the chest, you may feel pressure or a burning sensation.
  • Heartburn or indigestion
  • Vomiting
  • Choking on food on a regular basis
  • Unknown cause of weight loss
  • Hoarseness or coughing
  • Throat or back of the breastbone pain
Please consult your health care provider if you are worried about any changes you are experiencing. In addition to other questions, your doctor will inquire as to how long and how frequently you have been experiencing the symptom(s). This is done to assist in determining the cause of the condition, which is referred to as a diagnostic.
If cancer is discovered, symptom relief is an important element of cancer care and treatment. This is known as palliative care or supportive care. It is frequently initiated shortly after diagnosis and continues throughout treatment. Make an appointment with your health care provider to discuss your symptoms, especially any new or changing symptoms.

STAGES OF ESOPHAGEAL CANCER

Staging describes where the cancer is present, whether or not it has spread, and whether or not it is impacting other sections of the body. Doctors utilize diagnostic tests to determine the stage of cancer, therefore staging may not be complete until all tests are completed. Knowing the stage allows the doctor to propose the best course of treatment and can assist estimate a patient’s prognosis, or possibility of recovery. Distinct forms of cancer have different stage descriptions.

TNM system of staging

The TNM system is one technique that clinicians use to describe the stage. Doctors use diagnostic test and scan results to address the following questions:
Tumor(T): How far has the primary tumor penetrated the esophageal wall and surrounding tissue?
Node(N): Has the cancer spread to your lymph nodes? If so, where are they and how many are there?
Metastasis(M): Is the cancer in other parts of the body? If so, where and how much?
The results are aggregated to establish each person’s cancer stage. There are five stages: stage 0 (zero), stages I through IV (1 through 4). The stage provides a common language for doctors to describe the cancer so that they can collaborate to determine the best treatments.
Doctors also classify this sort of cancer based on its grade (G). When viewed under a microscope, the grade describes how much cancer cells resemble healthy cells. The malignant tissue is compared to healthy tissue by the doctor. In healthy tissue, numerous different types of cells are clustered together. The cancer is said to be “differentiated” if it resembles healthy tissue and has various cell groupings. When malignant tissue differs significantly from healthy tissue, it is said to be “poorly differentiated.”

Cancer stage grouping

Doctors determine the cancer stage by integrating the T, N, and M classifications. The two most frequent kinds of esophageal cancer, squamous cell carcinoma and adenocarcinoma, have unique staging schemes. Each staging system is explained below.
Squamos cell carcinoma of the esophagus staging

The phases of squamous cell carcinoma can be classified based on whether the tumor is in the upper, middle, or lower esophagus, as well as the grade (G) of the tumor cells.
Stage 0: The cancer has only spread to the upper lining of the esophagus.
Stage IA: The cancer has spread only to the upper layers of the esophagus.
Stage IB: The cancer fits one of the following criteria:
  • The cancer has spread to the upper layers of the esophagus, although the tumor cells are not well differentiated.
  • The tumor is located in the third layer of the esophagus and has not migrated to the lymph nodes or other sections of the body.
Stage IIA: Satisfies any of the following criteria:
  • The tumor is located in the esophagus’s third layer. Cancer cells have migrated into, but not through, the esophageal muscular wall.
  • The tumor is located in the outer layer of the upper or middle esophagus.
  • The tumor is located in the outer layer of the lower esophagus.
Stage IIB: Meets the following requirements:
  • The tumor is located in the outer layer of the upper or middle esophagus. Tumor cells have a lower level of differentiation.
  • The tumor might be found in any section of the esophagus’s outer layer.
  • The tumor can be found in any area of the esophagus, and cancer cells have progressed into the lining and underneath layers. Cancer may have spread to one or two lymph nodes near the tumor as well.
Stage IIIA: Satisfies any of the following criteria:
  • The tumor can be found in any area of the esophagus, and cancer cells have progressed into the lining and underneath layers. Cancer cells have also spread to three to six lymph nodes close to the tumor.
  • The tumor might be found in any area of the esophagus and has spread to the third layer. One or two lymph nodes have been infiltrated by cancer cells.
  • The cancer has migrated from the esophagus to adjacent tissue but not to lymph nodes or other parts of the body.
Stage IIIB: Satisfies any of the following criteria:
  • The tumor might be found in any area of the esophagus and has spread to the third layer. It has also infiltrated 3 to 6 lymph nodes.
  • The tumor can be found in any area of the esophagus and has spread to the outer layer of the esophagus as well as 1 to 2 or 3 to 6 lymph nodes.
  • The tumor has expanded to structures surrounding the esophagus and can be found in any section of the esophagus. It has either not spread to any lymph nodes or has only disseminated to one or two lymph nodes.
Stage IVA: Satisfies one of the following conditions:
  • The tumor can be found anywhere along the esophagus and has spread to surrounding structures. It could potentially have progressed to 3 to 6 lymph nodes.
  • Cancer has spread to at least seven regional lymph nodes.
Stage IVB: Other regions of the body have been affected by the cancer.

Adenocarcinoma of the esophagus staging

Doctors utilize the T, N, and M classifications, as well as the grade, to describe adenocarcinoma (G).
Stage 0: The cancer has only spread to the upper lining of the esophagus.
Stage IA: Cancer cells have migrated into the esophageal lining and the layers beneath it.
Stage IB: The cancer fits one of these criteria.
  • The cancer has migrated to the layers beneath the esophageal lining. The tumor cells have a moderate level of differentiation.
  • The cancer has spread to the submucosa layer of the esophagus.
Stage IC: The cancer fits either of these criteria.
  • The cancer has spread to the layers beneath the lining of the esophagus, known as the submucosa. The cancer cells are not well differentiated.
  • The cancer has spread to the third layer of the esophagus. The cancer cells are well or moderately differentiated.
Stage IIA: Cancer has spread to the third layer of the esophagus. The grade cannot be determined, or the cells are poorly differentiated.
Stage IIB: Any of the following conditions:
  • Cancer has spread to the esophagus’s outer layer.
  • Cancer has spread to one or two lymph nodes from an inner layer of the esophagus.
Stage IIIA: Any of the following conditions:
  • Cancer has progressed to 3 to 6 lymph nodes near the tumor from the inner layers of the esophagus.
  • The cancer has spread to one or two lymph nodes and is in the third layer of the esophagus.
Stage IIIB: Any of the following conditions:
  • Cancer has spread to the third layer of the esophagus as well as 3 to 6 lymph nodes.
  • Cancer has progressed to 1 to 2 or 3 to 6 lymph nodes from the esophagus’s outer layer.
  • The tumor has progressed to structures around the esophagus and to either no or one or two lymph nodes.
Stage IVA: Any of the following conditions:
  • The tumor has expanded to structures around the esophagus, as well as no lymph nodes or up to three to six lymph nodes.
  • The tumor has expanded to at least seven lymph nodes.
Stage IVB: Cancer has spread to another portion of the body at this stage.
Recurrent: Cancer that recurs after therapy is referred to as recurrent cancer. It may reappear in the esophagus or elsewhere in the body. If the cancer returns, more tests will be performed to determine the degree of the recurrence. These tests and scans are frequently identical to those performed at the time of the first diagnosis.

DIAGNOSIS OF ESOPHAGEAL CANCER

Many tests are used by doctors to detect or diagnose cancer. They also perform tests to see whether the cancer has spread to another place of the body from where it began. This is referred as as metastasis. Imaging tests, for example, can reveal whether or not the cancer has spread. Images of the inside of the body are produced via imaging tests. Doctors may also conduct tests to determine which treatments are most likely to be effective.
A biopsy is the only guaranteed way for a doctor to know if a part of the body has cancer in most cases of cancer. During a biopsy, the doctor extracts a small sample of tissue for laboratory testing. If a biopsy is not possible, the doctor may recommend alternative tests to aid in the diagnosis.

How is esophageal cancer diagnosed?

There are numerous tests available to help diagnose esophageal cancer. Not all of the tests outlined here will be utilized on every individual. When selecting a diagnostic test, your doctor may take the following variables into account:
  • The cancer type suspected
  • Your symptoms and signs
  • Your age and general well-being
  • The outcomes of previous medical tests
The following tests, in addition to a physical examination, may be used to identify esophageal cancer:
Barium swallow, also called an esophagram: After swallowing a barium-containing drink, the patient is subjected to a series of x-rays. An x-ray is a method of photographing the inside of the body. Barium coats the esophageal surface, making tumors and other odd alterations more visible on x-ray. If an area appears to be abnormal, your doctor may recommend an upper endoscopy and biopsy to determine whether it is cancerous.
Upper endoscopy, also known as esophageal-gastric-duodenoscopy (EGD): An upper endoscopy allows the clinician to examine the esophageal lining. While the patient is sedated, a thin, flexible tube with a light and video camera on the end is passed down the mouth and into the esophagus. Sedation is the administration of drugs in order to become more relaxed, tranquil, or sleepy. A biopsy will be performed if there is an abnormal looking spot to see if it is malignant. An endoscopy with an inflatable balloon to expand the esophagus can also assist broaden the blocked region, allowing food to pass through until treatment begins.
Endoscopic ultrasound: This treatment is frequently performed concurrently with an upper endoscopy. During an ultrasound, sound waves create a picture of the esophageal wall as well as adjacent lymph nodes and structures. During an endoscopic ultrasound, an endoscopic probe with a connected ultrasound that generates sound waves is introduced through the mouth into the esophagus. The ultrasound is used to determine whether or not the tumor has grown into the esophageal wall, how deep the tumor has grown, and whether or not cancer has spread to the lymph nodes or other adjacent tissues. An ultrasound can also be utilized to assist in the collection of a tissue sample from the lymph nodes.
Bronchoscopy: A thin, flexible tube with a light on the end is sent into the mouth or nose, down through the windpipe, and into the breathing tubes of the lungs, similar to an upper endoscopy. If a tumor is found in the upper two-thirds of the esophagus, a bronchoscopy may be performed to determine whether the tumor is growing into the airway. This section of the airway includes the trachea, or windpipe, and the bronchial tree, which is where the windpipe branches out into the lungs.
Biopsy: Other tests can indicate the presence of cancer, but only a biopsy can provide a definitive diagnosis. A biopsy is the removal of a small sample of tissue from a questionable location to be examined. The material is next examined by a pathologist (s). A pathologist is a medical professional who specializes in interpreting laboratory tests and assessing cells, tissues, and organs to identify disease.
Computed tomography (CT) scan: A CT scan provides images of the inside of the body by using x-rays acquired from various angles. A computer combines these images to create a detailed, three-dimensional image that identifies any anomalies or malignancies. A CT scan can be performed to determine the size of the tumor. To improve detail, a specific dye known as a contrast medium is usually administered before to the scan. In most cases, this dye is injected into a patient’s vein.
Magnetic resonance imaging (MRI): An MRI produces detailed images of the body by using magnetic fields rather than x-rays. The tumor’s size can be determined via an MRI. To provide a crisper image, a contrast material is frequently injected into a patient’s vein.
Positron emission tomography (PET) or PET-CT scan: A PET scan is frequently coupled with a CT scan to form a PET-CT scan. However, your doctor may refer to this technique simply as a PET scan. A PET scan is a technique for creating images of organs and tissues within the body. A radioactive sugar compound is put into the patient’s body in modest amounts. This sugar molecule is absorbed by the cells that consume the most energy. Cancer absorbs more radioactive stuff because it aggressively uses energy. The amount of radiation in the material, however, is too low to be dangerous. The material is then detected by a scanner, which produces images of the inside of the body.
Biomarker testing of the tumor: Your doctor may advise you to undertake laboratory testing on a tumor sample to discover specific genes, proteins, and other tumor-specific components. This is also known as tumor molecular testing. The results of these tests can help you decide on a treatment plan.
PD-L1 and microsatellite instability (MSI) testing: Testing for PD-L1 and high microsatellite instability (MSI-H), also known as a mismatch repair defect, is available. The findings of these tests assist doctors in determining whether immunotherapy, a type of treatment, is a possibility. The PD-1/PD-L1 signaling pathway is a type of immunological checkpoint. These checkpoints are crucial to the immune system’s ability to regulate cancer progression. Many cancers exploit these pathways to avoid detection by the immune system. If specific antibodies are used to inhibit these pathways during treatment, the immune system may be able to overcome the cancer’s repression. Immune checkpoint inhibitors are the name given to these antibodies. Drugs that target this pathway may be beneficial against MSI high or MSI-H esophageal cancers, as well as PD-L1 positive esophageal malignancies. Testing for PD-L1 and MSI is more common in advanced or stage IV esophageal cancer.
HER2 testing: The human epidermal growth receptor 2 (HER2) protein is present on the surface of cells. When addressing breast cancer, many individuals are more familiar with the term HER2. Doctors are discovering, however, that HER2 is also crucial in other types of cancer. When a cancer has abnormally high HER2 levels, it might fuel its growth and spread. These cancers are known as HER2-positive cancers. Certain types of targeted therapy may be effective in treating HER2-positive tumors. ASCO, the American Society for Clinical Pathology (ASCP), and the College of American Pathologists (CAP) all suggest HER2 testing for patients with gastroesophageal adenocarcinoma to help guide treatment.

TREATMENT OF ESOPHAGEAL CANCER

Different types of specialists frequently collaborate in cancer care to develop a patient’s overall treatment plan, which mixes many sorts of therapy. This is referred to as a multidisciplinary team. Other health care professionals on cancer care teams include physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others.
The most frequent types of esophageal cancer therapies are mentioned below. Treatment for symptoms and side effects, which is an important element of cancer care, may also be part of your treatment plan.
The type and stage of cancer, potential side effects, and the patient’s preferences and overall health all influence treatment options and recommendations. Take the time to read about all of your treatment options, and don’t be afraid to ask clarifying questions. Discuss the aims of each treatment with your doctor, as well as what you can expect during treatment. These discussions are known as “shared decision-making.” When you and your doctors collaborate to identify therapies that meet the goals of your care, this is referred to as shared decision-making. Because there are various treatment choices for esophageal cancer, shared decision-making is very vital.
Doctors frequently propose combining multiple types of treatment for a tumor that has not migrated beyond the esophagus and lymph nodes. These treatments include radiation therapy, chemotherapy, and surgery. Chemotherapy and radiation therapy are sometimes combined in a technique known as “chemoradiotherapy.” The order of therapy varies depending on numerous factors, including the type of esophageal cancer.
ASCO recommends a treatment regimen that combines various types of therapy for locally advanced esophageal cancer.
Chemoradiotherapy is generally suggested as the first treatment for squamous cell carcinoma. Depending on how well the chemoradiotherapy worked, surgery may be used later. According to recent research, employing chemoradiotherapy before surgery is superior to surgery alone. Chemoradiotherapy is recommended before surgery for all persons with locally advanced esophageal squamous cell carcinoma, according to ASCO. In some people, this treatment may cause the cancer to go into remission, and surgery may not be required right away. If tumor cells are still identified in the tissue removed during surgery after chemoradiotherapy and surgery, immunotherapy may be indicated. Some patients may be unable to receive radiation therapy. Before surgery, these patients can get chemotherapy on their own.
Chemoradiotherapy, followed by surgery, is the most prevalent treatment for adenocarcinoma in the United States. Unless there are conditions that increase the risks of surgery, such as a patient’s overall health, surgery is almost always indicated after chemoradiotherapy. ASCO advises chemoradiotherapy before surgery or chemotherapy before and after surgery for locally advanced esophageal cancer. If tumor cells are discovered in the tissue removed during surgery after chemoradiotherapy and surgery, immunotherapy may be advised. Surgery is not an option for some people. In that circumstance, chemoradiotherapy is the only treatment option. When chemotherapy and radiation therapy are combined, the adverse effects can be more severe. However, in other cases, this treatment combination may be more successful. It is critical to consult with your doctor about which treatment options are appropriate for you.
Treatment for advanced or metastatic esophageal cancer typically includes radiation therapy, chemotherapy, and other medication-based therapies.

Surgery

During a surgery, the tumor and some surrounding healthy tissue are removed. A surgical oncologist is a specialist who specializes in the surgical treatment of cancer. Traditionally, surgery has been the most common treatment for esophageal cancer. However, surgery without prior chemotherapy or chemoradiotherapy is currently employed as the primary treatment only in a few cases.
ASCO advises chemoradiotherapy or chemotherapy before surgery for most persons with locally advanced esophageal cancer since combination therapy has been found to help people live longer lives. If tumor cells are still identified in the tissue removed during surgery after chemoradiotherapy and surgery, immunotherapy may be indicated. If surgery is not an option, a combination of chemotherapy and radiation therapy is frequently the best therapeutic choice.
The most frequent treatment for esophageal cancer is an esophagectomy, in which the doctor removes the diseased portion of the esophagus and then joins the remaining healthy portion of the esophagus to the stomach so that the patient may swallow normally. If this is not possible, a section of the intestine may be utilized to make the connection. The lymph nodes surrounding the esophagus are also removed by the surgeon.
Before surgery, discuss the goals of treatment with your health care team, as well as any potential adverse effects from the specific surgery you will undergo.

Palliative care surgery

In addition to cancer treatment, surgery may be used to help people eat and relieve cancer-related discomfort. This is known as palliative surgery. To accomplish this, surgeons and gastroenterologists (specialists in the gastrointestinal tract) can:
  • Insert a feeding tube so that sustenance can be delivered straight to the stomach or intestine. A percutaneous endoscopic gastrostomy, or PEG, is a tube that delivers nutrients directly into a person’s stomach. A percutaneous endoscopic transgastric jejunostomy, or PEJ, is a feeding tube that delivers nutrients straight into a person’s intestine. This may be done prior to the administration of chemotherapy and radiation therapy to ensure that the patient can eat enough food to maintain their weight and strength during treatment.
  • If a tumor blocks the esophagus but cannot be removed surgically, create a bypass, or new pathway, to the stomach. This method is rarely employed.
People who have difficulty eating and drinking may require intravenous (IV) feedings and fluids for several days before and after surgery, as well as medications to prevent or cure infections. To keep their lungs clear, patients are taught particular coughing and breathing exercises.

Endoscopic therapy

The following procedures employ a long, flexible tube known as an endoscope to treat esophageal cancer symptoms and manage tumor-related adverse effects.
  • Endoscopy and dilation: The esophagus is expanded with this surgery. If the tumor grows, the procedure may have to be repeated.
  • Endoscopy with stent placement: Endoscopy is used in this technique to place a stent in the esophagus. A metal mesh device that is extended to keep the esophagus open is known as an esophageal stent.
  • Electrocoagulation: This sort of palliative treatment works by heating cancer cells with an electric current. This is occasionally performed to assist ease symptoms by eliminating a tumor-caused obstruction.
  • Cryotherapy: This is a palliative treatment that involves the use of an endoscope with a probe that can freeze and remove tumor tissue. It can be used to shrink a tumor to make it simpler for a patient to swallow.
Photodynamic therapy and laser therapy are two less-common procedures. A photosensitizer, a light-sensitive chemical, is administered by vein in photodynamic therapy. An endoscope is then used to focus a laser at the esophageal lesions. A laser is used in laser surgery to burn esophageal lesions using an endoscope.

Radiation therapy

The use of high-energy x-rays or other particles to eliminate cancer cells is known as radiation therapy. A radiation oncologist is a doctor who specializes in the use of radiation therapy to treat cancer. A radiation therapy regimen, or schedule, typically consists of a predetermined number of treatments administered over a predetermined time period. External-beam radiation therapy, which is radiation therapy delivered from a machine outside the body, is the most prevalent method of radiation treatment.
Internal radiation therapy, also known as brachytherapy, is a type of radiation therapy that is administered directly inside the body. For esophageal cancer, an endoscope is used to briefly inject a radioactive wire into the esophagus.
In clinical studies for esophageal cancer, proton beam therapy is being investigated. Proton beam therapy is a type of external-beam radiation therapy in which protons are used instead of x-rays. Protons have the ability to destroy cancer cells at high energies.
Fatigue, moderate skin reactions, soreness in the mouth and esophagus, trouble or pain with swallowing, upset stomach, nausea, and loose bowel movements are all possible side effects of radiation therapy. The majority of negative effects fade quickly after treatment is completed.

Chemotherapy

Chemotherapy is the use of medications to eradicate cancer cells, typically by preventing the cancer cells from growing, dividing, and proliferating.
A chemotherapy regimen, or schedule, typically consists of a predetermined number of cycles administered over a predetermined time period. A patient may be administered one medicine at a time or a mixture of drugs at the same time. As previously stated, chemotherapy and radiation therapy are frequently used concurrently to treat esophageal cancer, a procedure known as chemoradiotherapy.
Chemotherapy side effects vary according to the individual and the dose administered, but they can include exhaustion, infection risk, nausea and vomiting, hair loss, nerve difficulties, lack of appetite, and diarrhea. These adverse effects normally fade away once the treatment is completed.

Targeted therapy

Targeted therapy is a type of cancer treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This sort of treatment inhibits cancer cell growth and spread while causing minimal harm to healthy cells.
The targets of all cancers are not the same. Your doctor may order tests to determine the genes, proteins, and other variables in your tumor in order to find the most effective treatment. This enables clinicians to provide the most effective treatment to each patient whenever possible. Furthermore, research studies are continuing to learn more about specific molecular targets and new treatments aimed at them. Discover more about the fundamentals of tailored therapy.
The following are examples of targeted therapies for esophageal cancer:
  • HER2-targeted therapy: As a first-line treatment for metastatic esophageal adenocarcinoma, the targeted medicine trastuzumab (Herceptin, Ogivri) may be administered in conjunction with chemotherapy. Trastuzumab deruxtecan (Enhertu) is also approved as a first-line therapy for advanced esophageal cancer. This treatment includes a medication similar to trastuzumab with aggressive chemotherapy. ASCO, ASCP, and CAP advocate a combination of chemotherapy and HER2-targeted therapy for HER2-positive metastatic or recurrent gastroesophageal cancer. If your cancer is HER2-negative, HER2-targeted therapy is not an option for you, and your doctor will discuss other treatment choices with you.
  • Anti-angiogenesis therapy: If first-line therapy, or the first medicines offered, have not succeeded, the targeted drug ramucirumab (Cyramza) may be a treatment option. Ramucirumab is a form of anti-angiogenic targeted treatment. Its goal is to halt angiogenesis, or the process of forming new blood vessels. Because tumors require the nutrients given by blood vessels to develop and spread, anti-angiogenesis medicines aim to “starve” the tumor. Ramucirumab is most usually used in conjunction with paclitaxel, a kind of chemotherapy, but it can also be used alone.
Discuss with your doctor the potential side effects of each medicine you are taking and how to manage them.

Immunotherapy

Immunotherapy, also known as biologic therapy, is intended to increase the body’s natural defenses against cancer. It employs components created by the body or in a laboratory to enhance, target, or restore immune system activity.
There are two types of immunotherapy medications approved to treat both adenocarcinoma and squamous cell carcinoma of the esophagus and gastroesophageal junction cancer, which grows where the stomach and esophagus connect. Checkpoint drugs that target the PD-1/PD-L1 pathway include pembrolizumab (Keytruda) and nivolumab (Opdivo).
Pembrolizumab (Keytruda) has been approved for the following indications:
  • In combination with chemotherapy, as a first-line treatment for incurable locally advanced or metastatic esophageal and gastroesophageal junction adenocarcinoma and squamous cell carcinoma, independent of PD-L1 status.
  • In conjunction with chemotherapy and trastuzumab, as a first-line treatment for HER2-positive incurable locally progressed or metastatic esophageal and gastroesophageal junction adenocarcinoma and squamous cell carcinoma, independent of PD-L1 expression.
  • As a second-line treatment for esophageal squamous cell carcinoma with a CPS positivity rate of 10% or greater. CPS is an abbreviation for “combined positive score,” and it is a method of determining how many cells express the PD-L1 protein.
  • It is also approved for the treatment of gastroesophageal junction adenocarcinoma that tests positive for MSI-H or has a mismatch repair deficit after one or more chemotherapy treatments have failed to halt the tumor.
Nivolumab (Opdivo) has been approved for the following indications:
  • Regardless of PD-L1 expression, as a first-line treatment in combination with chemotherapy for esophageal or gastroesophageal junction cancer.
  • Regardless of PD-L1 expression, as a second-line treatment for esophageal squamous cell carcinoma.
  • If any cancer cells remain in the tissue removed after surgery following chemotherapy, radiotherapy, and surgery in esophageal and gastroesophageal adenocarcinoma and squamous cell carcinoma. Some data suggests that persons with tumors with increased PD-L1 expression may benefit more with adjuvant nivolumab, but more research is needed.

Metastatic Esophageal cancer

Doctors refer to cancer that has spread to another place of the body from where it began as metastatic cancer. If this occurs, it is advisable to consult with specialists who have treated similar cases in the past. Different doctors may have differing views on the optimal conventional treatment strategy. Clinical trials are another possibility. Learn more about getting a second opinion before beginning treatment so that you are confident in your treatment plan.
Palliative or supportive therapy is critical for patients with metastatic esophageal cancer to assist ease symptoms and adverse effects. The goal of treatment is usually to extend a person’s life while alleviating symptoms such as pain and eating difficulties. Chemotherapy and radiation therapy may be part of your treatment plan to help relieve pain and discomfort. An esophageal stent, laser therapy, photodynamic therapy, or cryotherapy, for example, may help keep the esophagus open.
A diagnosis of metastatic cancer is extremely stressful and challenging for the majority of people. You and your family are encouraged to express your feelings to doctors, nurses, social workers, and other members of the health care team. Talking with other patients, such as in a support group or other peer support program, may also be beneficial.

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