Helping Patients Find Their Own Sources of Strength to Get Through Treatment
- A 71‑year‑old Pennsylvania father learned his difficulty swallowing solid foods wasn’t acid reflux, as he long thought, but it turned out to be a symptom of stage 3 esophageal cancer.
- Doctors emphasize that early detection is crucial, as esophageal cancer has low cure rates but can often be treated with combinations of surgery, chemotherapy, radiation, and immunotherapy.
- Upon diagnosing esophageal cancer, Dr. Whitt Burrows, a thoracic surgeon at the University of Maryland Medical System, explains that, during an endoscopy, doctors look for changes in the esophagus’s normally smooth, uniform lining — including lesions, irregular or uneven areas — which can signal possible esophageal cancer.
- The tumor’s depth within the esophageal wall plays a major role in treatment planning.
- “There are some situations where tumors, which are very early-stage, can be removed with surgery alone. As the cancer progresses to more advanced stages, it penetrates deeper into the esophageal wall, requiring more aggressive treatment,” Dr. Brendon Stiles, a thoracic surgeon at Montefiore Medical Center, explains.
Esophageal cancer starts in the inner lining of the esophagus, the muscular tube that moves food from the throat to the stomach. Since it can spread outward through the esophageal wall, catching it early is critical.
Read MoreStill, he chalked it up to the acid reflux he’d managed for years. According to the National Institute of Diabetes and Digestive and Kidney Diseases, acid reflux or gastroesophageal reflux disease (GERD) can cause heartburn or regurgitation of food and liquids, and something he’s dealt with for years.
“I’ve had heartburn for years that was treated with basic maintenance medication, and then I developed gastroesophageal reflux disease,” he said.
Once he opened up to his children, Kimmel finally saw a doctor and learned he had stage 3 esophageal cancer.
WATCH: Preparing for Radiotherapy In Esophageal Cancer Care
Kimmel began treatment soon after his diagnosis.
“I started with chemo and radiation, followed by surgery, and then a course of immunotherapy, which I finished about two months ago,” he said.
Treatment plans for esophageal cancer often combine therapies depending on the stage and symptoms.
WATCH: Chemotherapy During Esophageal Cancer Treatment
Chemotherapy plays a vital role in treating esophageal cancer, whether it’s adenocarcinoma (a type of esophageal cancer) or squamous cell carcinoma (a type of esophageal cancer). The specific drugs used depend on the cancer type and individual patient factors.
The goals of chemotherapy include:
- Shrinking tumor size
- Reducing the number of cancer cells in the body
- Lowering the risk of cancer spreading
- Easing current symptoms
Dr. Whit Burrows, a thoracic surgeon at the University of Maryland Medical System, notes that chemotherapy circulates throughout the body to kill cancer cells wherever they may be and is quite different from surgery, which removes cancer locally, or radiation, which targets a specific area.
Today, Kimmel and his family are focused on his recovery, but his ultimate motivator is the one milestone: handing his daughter off in marriage.
“I’m getting married this May,” his daughter Laura said. “David will be there, which wasn’t always a given.”
WATCH: Explaining an Endoscopy Procedure
“The normal esophagus on endoscopy looks similar to the inside of your lips or cheeks,” Dr. Burrows tells SurvivorNet.
When doctors perform an endoscopy to check for esophageal cancer, they’re looking for changes in that smooth, uniform lining.
Signs that may raise concern include:
- A loss of the esophagus’s usual uniform appearance
- Lesions
- Irregular or uneven areas
- Disrupted symmetry
In stage 1 esophageal cancer, symptoms are often absent, and the disease is typically found during an endoscopy, Dr. Burrows explains. At this early stage, the cancer hasn’t penetrated the esophageal wall.
“It’s a very local problem,” Dr. Burrows says. “If it’s very, very superficial, you don’t even need surgery. You can actually treat it through the endoscopy.”
Expert Resources for Esophageal Cancer Patients
- Esophageal Cancer Early Detection and First Steps
- Chemotherapy for Esophageal Cancer: What Is Important To Know?
- Esophageal Cancer Surgery: What to Expect
- Esophageal Cancer: Key Terms to Know
- Esophageal Cancer: Getting Emotional Support
- Immunotherapy For Esophageal Cancer — Has It Worked?
- Kim Kardashian’s Childhood Nanny Says Robert Kardashian, Who Passed from Esophageal Cancer, Would Approve of Kim’s Divorcing Kanye West
Esophageal Cancer: Why Early Detection Is Critical for This Often-Silent Disease
“Esophageal cancer, we know, is a tough one,” Dr. Stiles said.
“It’s one of the cancers with some of the lowest cure rates out there. But like many cancers, if we find it early, we can often treat it effectively—either with surgery, with surgery and chemotherapy, or with chemotherapy and radiation,” Dr. Stiles continued.
Esophageal cancer is notoriously difficult to detect in its early stages. Its symptoms are often subtle, easily mistaken for common digestive issues, which can delay diagnosis and treatment.
Common Symptoms to Watch For
Because early signs can mimic everyday discomforts, it’s important to take persistent symptoms seriously. Known indicators include:
- Pain or difficulty swallowing
- Unexplained weight loss
- Pain behind the breastbone
- Persistent hoarseness or cough
- Indigestion or heartburn
- A lump under the skin (often near lymph nodes)
“Symptoms include things like … they’re losing weight, they’re having some burning in their esophagus or their chest, they’re having trouble or pain with swallowing,” explained Dr. Sofya Pintova, a hematologist and oncologist at Mount Sinai Cancer Center.
“That will often lead to a medical evaluation.”
How Esophageal Cancer Is Diagnosed
Diagnosis typically begins with an endoscopy—a procedure where a gastroenterologist inserts a camera down the esophagus to examine the tissue and look for abnormalities.
“If they see an area that is suspicious for a mass, or if they see a mass, they may biopsy it,” Dr. Pintova said.
“And if the biopsy confirms cancer, the next stage is usually staging.”
Types of Esophageal Cancer
There are two primary types, each originating in different cells of the esophagus:
- Squamous Cell Carcinoma: Forms in the thin, flat cells lining the inside of the esophagus
- Adenocarcinoma: Begins in glandular cells that produce mucus and other fluids
Staging the Disease
Once diagnosed, doctors determine the cancer’s stage—ranging from 0 to 4—which helps guide treatment decisions and predict outcomes. Earlier stages are more treatable, while later stages often require more aggressive, multi-modal therapies.
How Doctors Decide the Best Treatment Path for Esophageal Cancer
Esophageal cancer treatment isn’t one-size-fits-all. It depends on the tumor’s stage, location, and its impact on the patient’s ability to eat and function. Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System, explains how physicians determine the right approach.
“As a surgeon, you’re trying to figure out what kind of patient requires surgery, chemo-radiation plus surgery, or just chemotherapy, or just chemotherapy and radiation,” Dr. Flores told SurvivorNet.
The tumor’s depth within the esophageal wall plays a major role in treatment planning. Early-stage tumors—known as T1 lesions—are confined to the surface of the esophageal mucosa.
“Basically, if you have a tumor that is considered a T1 lesion … sometimes they can remove that with an endoscope,” Dr. Flores said.
“There are some situations where T1 tumors, which are very early-stage, can be removed with surgery alone.”
As the cancer progresses to T2 or T3 stages, it penetrates deeper into the esophageal wall. These cases typically require a more aggressive approach.
WATCH: Should I Consider Minimally Invasive Surgery for Esophageal Cancer?
“When it gets a little more advanced, T2, T3, where it goes through the thickness of the wall of the esophagus, that frequently requires chemotherapy and radiation, followed by surgery,” Dr. Flores added.
In cases where the tumor causes a significant blockage—making it difficult or impossible to swallow—radiation may be the first step.
“When a patient comes in with a large obstruction, which cannot be removed with just surgery, the first move may be to send this patient to the radiation oncologist to get treatment started,” Dr. Flores explained.
“The majority of the time, you’ll get a response, things will open up, and you will be able to eat.”
Ultimately, symptoms and the presence of metastasis guide whether a patient receives chemotherapy alone or in combination with radiation.
“What determines whether you can get that combination of chemotherapy and radiation depends on your symptoms,” Dr. Flores said.
“Symptoms really dictate whether or not you’re going to get radiation there, but also, do you have distant disease? If you have a tumor in the middle of the chest but a metastasis somewhere else … if you don’t need radiation to open things up so you can swallow, usually in those cases they will just give you chemotherapy.”
Chemotherapy for Esophageal Cancer: Common Drug Combinations and Side Effects
Chemotherapy plays a central role in treating esophageal cancer, often used alongside surgery or radiation, depending on the stage and type of the disease. Most patients receive a combination of two or three drugs to maximize effectiveness.
Frequently Used Chemotherapy Drugs
The most common agents include:
- Fluorouracil (5FU) or its oral form Capecitabine (Xeloda)
- Platinum-based drugs: Cisplatin, Oxaliplatin, or Carboplatin
- Taxanes: Paclitaxel or Docetaxel
Common Drug Combinations
Doctors tailor regimens based on tumor type, location, and patient health. Some widely used combinations include:
- Cisplatin and capecitabine (CX)
- Cisplatin and fluorouracil (CF)
- Epirubicin, cisplatin, and capecitabine (ECX)
- Epirubicin, cisplatin, and fluorouracil (ECF)
- Carboplatin and paclitaxel
- Fluorouracil, oxalipatin, and docetaxel (FLOT)
These combinations are selected to attack cancer cells from multiple angles, improving the chances of shrinking tumors and preventing spread.
While chemotherapy can be life-saving, it often comes with side effects that vary in intensity. Common reactions include:
- Nausea and vomiting
- Hair loss or thinning
- Fatigue and weakness
- Peripheral neuropathy (nerve damage)
- Cardiotoxicity – irregularities causing damage to the heart rhythm or vascular function
Doctors monitor patients closely and may adjust dosages or provide supportive medications to manage these effects.
Questions to Ask Your Doctor
If you are diagnosed with esophageal cancer or are experiencing concerning symptoms compelling you to seek further examination, SurvivorNet encourages you to formulate some helpful questions ahead of your next appointment with “My Health Questions,” SurvivorNet’s powerful proprietary AI tool designed to help patients and clinicians.
- What type of esophageal cancer do I have?
- How will I receive chemotherapy treatments? Will I need a port?
- How often will I have chemotherapy? For how long?
- What are the risks and benefits of treatment with these drugs?
- Will my health insurance cover my treatment with this drug?
- What are the common side effects of the chemotherapy I will receive?
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