Esophageal Cancer

At the University of Chicago Center for Gastrointestinal Oncology, our esophageal cancer team includes specialists from several fields, including gastroenterology, medical oncology, surgical oncology, radiation oncology, radiology, pain management, and nutritional care. Together, these experts provide an array of diagnostic and treatment options for patients with any stage of adenocarcinoma or squamous cell carcinoma of the esophagus as well as patients with Barrett’s esophagus, a pre-malignant condition that develops in some individuals with gastroesophageal reflux disease.

Diagnosis

Dr. Waxman with a patient

The best cancer care begins with a thorough diagnosis. If esophageal cancer is suspected, physicians look for evidence of cancerous cells and tumors within the esophagus, nearby lymph nodes, and other organs. At the University of Chicago Center for Gastrointestinal Oncology, some of the tests used to diagnose esophageal cancer include:

  • Barium swallow with X-ray: In a barium swallow, patients swallow a special liquid containing barium that coats the esophagus. The barium shows up on X-rays. A barium swallow with X-ray can indicate areas where tumors are invading the esophagus, and can also show early-stage abnormal lesions.
  • Upper endoscopy: In an upper endoscopy, a thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus. The endoscope allows the physician to view the inside of the esophagus, as well as to insert instruments through the scope for the removal of a tissue sample for biopsy.
  • Endoscopic ultrasound (EUS): EUS is a test that helps physicians determine the extent to which tumors have penetrated the esophagus and nearby lymph nodes. The endoscope is fitted with a special device--called a transducer--that emits and detects sound waves as they bounce off tissue. The transducer sends this data to a computer to create an image. In EUS-guided fine needle aspiration, the physician uses EUS to provide direction for collection of a tissue sample for examination in a lab.
  • Probe-based confocal laser endomicroscopy (pCLE): Using one of the world's smallest microscopes, our doctors are able to view esophageal tissue cells--without removing a tissue sample from the patient's body. This precise technique enables earlier and more accurate detection of esophageal tumors. In some cases, doctors may be able to remove cancerous tissue immediately upon detection. Or, in more complex cases, doctors may refer a patient directly to surgery. The University of Chicago Medical Center is the only hospital in the region offering this advanced technique.
  • Computed tomography (CT): A CT scan is a noninvasive imaging test that combines X-rays and computer technology to produce images of the body. In addition to showing tumors of the esophagus, a CT scan can assist doctors in determining if the cancer has spread into other organs, such as the lungs or liver.
  • Positron emission tomography (PET): PET is a sophisticated, noninvasive imaging test that measures the metabolic activity of cells. PET aids physicians in finding cancerous tissue that may not show up on X-rays or other tests.
  • Laparoscopy and thoracoscopy: Laparoscopy and thoracoscopy are surgical procedures that involve the use of special thin instruments equipped with a light and camera that are inserted into the body to look for tumors or gather tissue for biopsy.

Information gathered from these and other tests help physicians "stage" the cancer. Staging is a system used to determine if the cancer has spread, and if so, to what extent.

Tom Flint Tom Flint's esophageal cancer was successfully treated without removing his esophagus. »Read Tom's story

Treatment

At the University of Chicago Center for Gastrointestinal Oncology, our physicians provide an individualized approach to cancer treatment. Each patient's case is different--varying by stage of cancer, or other factors such as age, overall health, and the patient's preference for care. Here, our esophageal cancer team will discuss all of the appropriate treatment options with you, taking the time to answer questions and ease concerns.

As with most cancers, esophageal cancer treatment options differ according to the stage of disease. Treatment types may be used alone, or in combination with other therapies.

Surgery

Surgery is commonly used to treat esophageal cancer that has not spread beyond the esophagus and its surrounding lymph nodes. The goal of the operation is to remove the cancer and nearby tissue that may be affected. In an esophagectomy, the surgeon removes part of the esophagus, nearby lymph nodes, and possibly part of the stomach. The remaining part of the esophagus is then connected to the stomach.

Some patients are candidates for minimally invasive surgery, an approach that utilizes smaller incisions to remove the cancer. Benefits of minimally invasive surgery include less pain, less scarring, and a quicker recovery after surgery. University of Chicago surgeons are pioneers in minimally invasive surgery for esophageal cancer.

An esophagectomy is major surgery, and should be done by surgeons who have experience performing the procedure. Studies show that patients who have esophagectomies at hospitals that perform the procedure more frequently fare better than those who go to hospitals with less experience. At the University of Chicago Medical Center, surgeons from both the Section of General Surgery and the Section of Thoracic Surgery are experts in esophageal cancer surgery.

Chemotherapy

Chemotherapy is the use of anticancer medicines to treat cancer cells. Patients with locally advanced cancer (cancer that has not spread to other parts of the body) may receive chemotherapy and radiation therapy before surgery to reduce tumor size and kill cancer cells that are not visible. For people who are not candidates for surgery and do not have metastatic disease, chemotherapy and radiation are given together. If the cancer has spread to other organs (metastatic cancer) the patient may receive chemotherapy to lessen symptoms, such as difficulty swallowing and pain.

At the University of Chicago Center for Gastrointestinal Oncology, our medical oncologists are highly skilled at selecting the best course of chemotherapy for each patient. Our oncologists have many years of experience researching and treating esophageal cancer, and are actively conducting clinical trials of promising new drugs to treat the disease. Patients treated here have access to experimental drugs not widely available at other hospitals.

Radiation Therapy

Radiation therapy is a treatment that uses high-energy radiation to kill cancer cells. Radiation therapy is often used to treat esophageal cancer in combination with chemotherapy before surgery. Radiation therapy can be used to alleviate swallowing problems associated with esophageal cancer.

University of Chicago radiation oncologists are internationally known for their expertise in treating cancer. Our radiation oncology team is one of the largest in the nation. These specialists are leaders in determining the best type and dose of radiation therapy to treat cancer.

Endoscopic Mucosal Resection

Endoscopic mucosal resection (EMR) is emerging as an effective treatment for early stage esophageal cancer--especially for those who cannot have surgery. EMR involves the use of special tools that lift and cut abnormal lesions or tumors from the superficial lining (mucosal and submuscosal layers) of the esophagus. EMR is performed by interventional endoscopists--gastroenterologists who have special expertise using endoscopes (thin tubes equipped with cameras) to diagnose and treat disease. University of Chicago interventional gastroenterologists were among the first in the nation to employ EMR techniques to treat Barrett’s esophagus and high-grade dysplasia. Our specialists work closely with cancer surgeons to select patients who are ideally suited to endoscopic removal of their pre-cancerous lesions versus those who would require surgery for their condition.

Palliative Care

Our experts understand that symptoms associated with esophageal cancer--such as pain and difficulty swallowing--can be very troubling. In addition to treatments designed to destroy cancerous tissue, our physicians offer palliative therapy, or treatments aimed at lessening symptoms, though not likely to cure disease.

Palliative therapy options offered through the University of Chicago Center for Gastrointestinal Oncology include:

  • Stent placement, which involves the insertion of an expandable, metal tube to relieve obstructions of the esophagus and improve swallowing
  • Specialized nutritional care, to ensure that patients receive adequate nutrition
  • Individualized pain management, to help keep patients comfortable
  • Individual or group counseling to provide patients and their families with a better understanding of their disease.