Treatments for stage 4 esophageal cancer
The following are treatment options for stage 4 esophageal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Treatment for stage 4 esophageal cancer focuses on relieving symptoms, such as difficulty swallowing and pain, and improving your quality of life.
Endoscopic treatments @(Model.HeadingTag)>
Endoscopic treatments for stage 4 esophageal cancer are offered to relieve pain or remove a blockage. You may be offered the following endoscopic treatments.
- radiofrequency ablation (RFA)
- laser surgery
- photodynamic therapy (PDT)
- esophageal dilation
- esophageal stent
- electrocoagulation or argon plasma coagulation (may not be available in all Canadian treatment centres)
- placement of a feeding tube
Chemotherapy and chemoradiation @(Model.HeadingTag)>
Chemotherapy is sometimes offered for stage 4 esophageal cancer. Adenocarcinoma tumours of the esophagus respond better to chemotherapy than squamous cell carcinoma (SCC) tumours.
Chemoradiation is chemotherapy combined with radiation therapy. The 2 treatments are given during the same time period. It may be used before surgery for stage 4 esophageal cancer. Unfortunately, surgery is not usually an option at this stage.
The most common chemotherapy drugs used to treat stage 4 esophageal cancer are:
- cisplatin and capecitabine
- cisplatin and etoposide (Vepesid)
- cisplatin and fluorouracil
- cisplatin and irinotecan
- carboplatin and fluorouracil
- carboplatin and irinotecan
- carboplatin and paclitaxel
- epirubicin, carboplatin and fluorouracil
- epirubicin, carboplatin and capecitabine
- epirubicin, cisplatin and capecitabine
- epirubicin, cisplatin and fluorouracil
- fluorouracil and leucovorin
- docetaxel (Taxotere), oxaliplatin, fluorouracil and leucovorin
- oxaliplatin, fluorouracil and leucovorin
- oxaliplatin and capecitabine
Targeted therapy @(Model.HeadingTag)>
Targeted therapy drugs may be used to treat stage 4 adenocarcinoma tumours at the gastroesophageal (GE) junction. They are usually combined with chemotherapy.
Trastuzumab is used with chemotherapy drugs to treat HER2-positive tumours. The most common combinations are:
- trastuzumab, cisplatin and fluorouracil
- trastuzumab, cisplatin and capecitabine
Ramucirumab (Cyramza) is a
Radiation therapy @(Model.HeadingTag)>
Radiation therapy may be offered to shrink stage 4 esophageal cancer to help with swallowing and relieve pain.
External radiation therapy directs radiation at the tumour from a machine outside of the body. It may be offered either alone or as part of chemoradiation.
Intraluminal brachytherapy uses a radioactive implant placed into the esophagus near the tumour.
Esophagectomy is surgery to remove all or part of the esophagus, as well as lymph nodes around it. In rare cases it may be offered for some people with stage 4A esophageal cancer, if the cancer has spread only to the nearby lymph nodes.
If you can't or don't want cancer treatment @(Model.HeadingTag)>
You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.
Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.
Clinical trials @(Model.HeadingTag)>
American Cancer Society. Esophagus Cancer. Atlanta, GA: American Cancer Society; 2013.
Esophageal cancer treatment options. American Society of Clinical Oncology (ASCO). Cancer.Net. Alexandria, VA.: American Society of Clinical Oncology (ASCO); 2013.
Baldwin, K. M. et al . Esophageal cancer treatment and management. eMedicine.com. Omaha: eMedicine, Inc; 2014.
BC Cancer Agency. Esophagus. Vancouver: BC Cancer Agency; 2012.
Esophageal and esophagogastric junction. BC Cancer Agency (BCCA). Cancer Management Guidelines. BC Cancer Agency; 2013.
Oesophageal cancer. Cancer Research UK. CancerHelp UK. Cancer Research UK; 2014.
Esophageal adenocarcinoma. Jankowiski J & Hawk E (eds.). Handbook of Gastrointestinal Cancer. Wiley-Blackwell; 2013: Chapter 2: pp. 25-40.
National Cancer Institute. Esophageal Cancer Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.
Esophageal and esophagogastric junction cancers. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network; 2013.
Siewert JR, Molls M, Zimmermann F, et al . Esophageal Cancer: Clinical Management. Kelsen, D. P., Daly, J. M., Kern, S. E., Levin, B., Tepper, J. E., & Van Cutsem, E. (eds.). Principles and Practice of Gastrointestinal Oncology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008: 18: pp. 203-228.
Tian, J. and Wang, K. K . Esophageal squamous cell carcinoma. Jankowiski J & Hawk E (eds.). Handbook of Gastrointestinal Cancer. Wiley-Blackwell; 2013: Chapter 1: pp. 1-24.