Treatment for ESOPHAGEAL CANCER in the Atlanta Area

Esophageal cancer starts in the esophagus. This is a hollow, muscular tube that connects the back of the throat to the stomach. It helps the food you swallow move from your throat to your stomach for digestion. It’s located behind the trachea (windpipe) and in front of the spine. 

The two most common types of esophageal cancer are:

  • Adenocarcinoma: Cancer that begins in the glandular cells — cells that produce and release fluids, such as mucus. Adenocarcinomas usually begin in the lower part of the esophagus, near the stomach.
  • Squamous cell carcinoma (also called epidermoid carcinoma): Cancer type that forms in the thin, flat cells lining the inside of the esophagus. It is most often found in the upper and middle parts of the esophagus. 

Both of these types of esophageal cancer types tend to develop in different parts of the esophagus and develop due to different genetic changes.

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Detection and Diagnosis of Esophageal Cancer

Esophageal cancer doesn’t always cause signs and symptoms, especially in earlier stages. As of right now, there is no screening test to detect esophageal cancer at its earliest stages.

When signs and symptoms appear, you might experience one or more of the following:

  • Difficulty swallowing (dysphagia)
  • Worsening heartburn or indigestion
  • Coughing or hoarseness in the throat
  • Pain, pressure, or burning in the chest
  • Unexpected or unexplained weight loss

The earlier esophageal cancer is found, the better chance of recovery. However, because there is often a lack of symptoms early on, esophageal cancer isn’t usually diagnosed until it has reached an advanced stage.

Your doctor may perform one or more of the following procedures and tests to determine if esophageal cancer is present. 

  • Physical exam and history. If you have symptoms, a physical exam is needed to look for signs of cancer, such as lumps or any other abnormalities. A history of your health habits will also be taken, including your smoking history and a review of any past illnesses and treatments. 
  • Imaging tests. Imaging tests such as X-ray, computed tomography (CT) scan, positron emission tomography (PET) scan, or magnetic resonance imaging (MRI) scan may be recommended to see bones, organs, and other soft tissue.  
  • Esophagoscopy. This procedure is used to see inside the esophagus to check for unusual areas. An esophagoscope, a thin, tube-like instrument, is inserted through the mouth or nose and down the throat into the esophagus. It may also have a tool to remove tissue samples. These tissue samples are checked under a microscope for signs of cancer.

If cancer is suspected, a biopsy is likely to be performed during the esophagoscopy. This involves the removal of tissue from the area that is believed to be cancerous. The cells are then viewed under a microscope by a pathologist to determine if cancer is present.

If cancer is present, additional images or other tests may be needed to see if the cancer has grown outside of the esophagus or spread to lymph nodes. This is part of the staging process.

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Esophageal Cancer Stages & Grade

After an esophageal cancer diagnosis has been made, your doctor will try to determine if the cancer has spread, and if so, how far, through a process called staging. The stage of cancer determines how severe the cancer is, as well as the best approach for treatment. 

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to determine:

  • Tumor (T): the size and primary location of the tumor
  • Node (N): if the cancer has spread to the lymph nodes
  • Metastasis (M): whether the cancer has metastasized (spread) to other areas of the body

Your doctor will label your cancer as stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. The stages are often broken in to sub categories such as Stage 1A or 1B. 

The exact stages for squamous cell carcinoma are slightly different from adenocarcinoma esophageal cancer. 

Grading Esophageal Cancer

The grade of cancer is determined based on how different the cancer cells look from healthy esophagus cells. The higher the grade, the more abnormal the cells look under a microscope.

  • Grade 1: Low grade which means the cancer cells look rather similar to normal esophagus cells.

  • Grade 2: Intermediate grade esophageal cancer is somewhere between low grade and high grade.

  • Grade 3: High grade which means the cancer cells looks very different from healthy cells. 

Treatment Options for Esophageal Cancer

There are several different types of treatment available for patients diagnosed with esophageal cancer. Some treatments are standard and commonly used, while others are being tested in clinical trials. Based on each patient’s specific case, the treatments for esophageal cancer will vary but may include: surgery, chemotherapy, targeted therapy, immunotherapy, and radiation therapy. A combination of these treatment types may be used in your care plan.

Surgery to Remove Esophageal Cancer

The type of surgery commonly performed to remove the cancerous part of the esophagus is called an esophagectomy. This removes a portion of the esophagus where the cancer is located. The surgeon then reconnects the esophagus to the stomach using either a section of intestine or a plastic tube. 

Radiation Therapy for Esophageal Cancer

Radiation therapy is the use of high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. It can be used before surgery to shrink the tumor first and it can be used after surgery to be sure all of the cancer cells in the area have been killed. The most common type of radiation therapy used for esophageal cancer is external beam radiation, which is radiation therapy given from a machine outside the body.

Intensity-Modulated Radiation Therapy (IMRT)

At Radiotherapy Clinics of Georgia, we typically use intensity-modulated radiation therapy (IMRT) — an advanced form of external beam radiation treatment that precisely targets tumor cells while avoiding other organs and tissue nearby. It also makes it possible for the radiation oncologist to vary the intensity of some of the beams of radiation to focus more carefully in some areas than in others. 


When radiation treatment is given directly inside the body, it is called internal radiation therapy or brachytherapy. For esophageal cancer, this involves temporarily inserting a radioactive wire into the esophagus using an endoscope. Brachytherapy can be given 2 ways, either high-dose rate (HDR) brachytherapy or low-dose rate (LDR) brachytherapy. 

  • For high-dose rate (HDR) brachytherapy, the doctor leaves the radioactive material near the tumor for a few minutes, which may require several treatments.
  • In low-dose rate (LDR) brachytherapy, a lower dose of radiation is put near the tumor for longer periods (1 or 2 days). The patient needs to stay in the hospital during this treatment, but it can usually be completed in only 1 or 2 sessions.
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Therapies Using Medication 

Treatments using medication are used to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Medications may be given through the bloodstream (called systemic therapy) to reach cancer cells throughout the body or they may be given directly at the site of the cancer (called local therapy). 

The types of medications used for esophageal cancer include:

  • Chemotherapy: The use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. 
  • Targeted therapy: The targeting of the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.
  • Immunotherapy: Treatment designed to boost the body's natural defenses to fight cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Immunotherapy is also called biologic therapy.

Endoscopic Therapy

When the symptoms and side effects associated with esophageal cancer need to be managed, patients may receive endoscopic therapy — treatments that use a long, flexible tube called an endoscope. Endoscopic therapy could include:

  • Electrocoagulation: kills cancer cells by using an electric current
  • Cryotherapy: involves freezing and removing tumor tissue
  • Laser therapy: the use of a laser beam to kill cancer cells 

Nutritional Needs For Patients During Esophageal Cancer Treatment

Esophageal cancer can potentially make it difficult for patients to eat due to trouble with swallowing. The esophagus may become partially blocked by the tumor or as a side effect of treatment. A dietitian can help patients going through treatment for esophageal cancer understand how to get the nutrition they need to stay strong during treatment. 

It is a possibility for some patients to receive a feeding tube (a flexible plastic tube that is passed through the nose or mouth into the stomach) until they can eat on their own. This is discussed with the oncologist and dietitian to determine if this is needed and for how long.

Find Esophageal Cancer Care in the Atlanta Area

If your suggested treatment plan includes radiation therapy, it’s important to carefully consider where you will receive treatments. When choosing our clinics, you will have a dedicated team of radiation oncologists, radiation therapists, and support team members to help you along your esophageal cancer journey. The RCOG team is conveniently throughout the Atlanta area, with locations in Blairsville, Conyers, Covington, Decatur, and Snellville. Request an appointment online today to see one of our radiation specialists.

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