Esophageal Cancer Treatment
MD Anderson has one of the most active esophageal cancer programs in the nation.
We offer many innovative treatments for esophageal cancer, including minimally invasive surgeries and targeted therapies. Additionally, our status as a major research site allows us to offer a full range of clinical trials for esophageal cancer.
If you are diagnosed with esophageal cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health. Your treatment for esophageal cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Preventative treatment
The following treatments may be recommended for patients with very early stage Barrett¡¯s esophagus that has a high risk of developing into esophageal cancer (dysplasia.)
Radiofrequency ablation (RFA): An endoscopic device uses heat to kill precancerous tissue.
Cryotherapy: A technique that uses chemicals at a very low temperature to rapidly freeze precancerous tissue in the esophagus. After the tissue has thawed, the cells die. The area heals, replacing precancerous tissue with normal esophageal cells.
Treatment for early esophageal cancer
Endoscopic mucosal resection (EMR) / Endoscopic submucosal dissection (ESD): Doctors use an endoscope to remove early-stage esophageal cancer that has only invaded the surface of the esophagus. Though these are complex procedures, they are also minimally invasive techniques that do not require any incisions or the removal of the esophagus.
Treatment for locally advanced and advanced cancers
If your cancer has spread to the surrounding tissue or beyond, the following treatments may be used to slow the disease and ease symptoms:
Surgery
Surgery is the most common treatment for esophageal cancer. To treat more advanced stages of esophageal cancer, surgery may be combined with chemotherapy and/or radiation therapy.
Esophagectomy: The most common surgery for esophageal cancer is an esophagectomy. Generally, the surgery involves removing all or part of the esophagus, part of the stomach, and nearby lymph nodes. The remaining stomach is then moved up into the chest or neck and connected to the remaining esophagus. If the stomach cannot be moved up to join the remaining esophagus, your surgeon may join the two using a section of your intestine.
There are several ways to perform an esophagectomy. Your doctor will recommend the best technique for you based on the location of the tumor and if it has spread.
Life after esophageal cancer surgery
After recovering from an esophagectomy, our surgeons expect your quality of life will be excellent. Optimally, you should be able to eat all types of food, return to work and carry on your normal activities.
After an esophagectomy, you will need to alter the way you eat and the way you sleep. Smaller, more frequent meals are necessary due to a smaller sized stomach after surgery. Additionally, sleeping with the head of the bed elevated helps prevent infection of the lungs and heartburn.
While you recover from an esophagectomy, you may temporarily use a feeding tube (a small tube that can be inserted at the time of surgery into the small bowel) to get nutrients. Your doctor removes this tube several weeks after surgery.
Chemotherapy
Chemotherapy works by killing fast-growing cells, including cancer cells. It can be used to treat esophageal cancer before or after surgery and helps treat cancer that has metastasized. MD Anderson offers the most up-to-date and advanced chemotherapy options for esophageal cancer.
Radiation therapy
Radiation therapy uses focused, high-energy photon beams to destroy cancer cells. New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
MD Anderson provides the most advanced radiation treatments for esophageal cancer, including:
Intensity-modulated radiotherapy (IMRT): Radiation beams are delivered at different angles, which are tailored to the specific shape of the tumor.
Proton therapy: High radiation particles are aimed directly at the tumor site. For some patients, this therapy may result in fewer side effects because of lower doses to surrounding normal tissue. MD Anderson's Proton Therapy Center treats some esophageal cancers.
Immunotherapy
Immunotherapy recruits the patient¡¯s own immune system in the fight against cancer. For esophageal cancer, patients may be given an immunotherapy known as immune checkpoint inhibitors, which causes the immune system to attack the tumor. Immunotherapy is most commonly used to treat advanced stages of esophageal cancer. It is still being explored in early stages.
Targeted therapies
While many treatments directly kill cancer cells, targeted therapy works by stopping or slowing the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them.
Other surgical procedures for esophageal cancer may include:
Esophageal stents
Small, expandable metal tubes are placed inside the esophagus with the aid of an endoscope. Once placed, the stent can expand and open up the blocked part of the esophagus, allowing food and liquids to pass through more easily.
Learn more about clinical trials for esophageal cancer.
Learn more about esophageal cancer:
Facing esophageal cancer at age 26
Throughout his esophageal cancer treatment, Ross Bernkrant never once looked up the survival rates.
¡°I knew it wasn¡¯t good,¡± he says. ¡°I just repeated to myself, ¡®I am a statistic of one.¡¯¡±
Ross¡¯ cancer diagnosis was a statistical outlier from the start. Esophageal cancer is rare. It makes up about 1% of all cancers diagnosed in the United States. It¡¯s even more rare in young patients ¨C fewer than 15% of cases are found in people younger than 55. But Ross was just 26 when he received his diagnosis.
And because esophageal cancer is so rare, it can be difficult to treat. ???
¡°I¡¯m very fortunate that I came to MD Anderson,¡± Ross says. ¡°I¡¯ve been cancer-free for eight years, and I don¡¯t know if I could say that if I had stayed at another hospital.¡±
Ross received his esophageal cancer diagnosis in May 2013. He had been experiencing extreme fatigue and figured it was because he¡¯d been working so much, trying to build his career in finance. But he was having trouble swallowing his food, too. Something seemed wrong.
- Related: Esophageal cancer symptoms
A gastroenterologist performed an endoscopy and found a large tumor. Ross then saw an oncologist in Boca Raton, where he lived. He underwent a CT scan and was diagnosed with esophageal cancer. The cancer had spread through a large portion of his esophagus and down through his diaphragm, stomach and lymph nodes. It was considered stage III, possibly stage IV.
Ross was scared. He couldn¡¯t believe he was dealing with a diagnosis that typically only impacted older men. He didn¡¯t have any of the esophageal cancer risk factors. He didn¡¯t use tobacco. He exercised, maintained a healthy weight and was otherwise healthy. Ross and his family began asking about the best place for esophageal cancer treatment. Over and over again, they heard MD Anderson.
Chemotherapy and radiation therapy at MD Anderson
At MD Anderson, Ross met with , an oncologist specializing in gastrointestinal medical oncology. Ross underwent a CT scan, and his cancer diagnosis was confirmed and restaged as stage III, borderline IV. They outlined his esophageal cancer treatment plan: weekly rounds of chemotherapy and concurrent daily radiation for just a little over a month. The goal was to shrink the cancer enough that it could be removed through surgery.
Ross moved to Houston for treatment with his mom and stepdad. Each Monday, he began his chemotherapy treatments and wore a chemo bag containing his weekly dose of docetaxel and 5-fluorouracil. The bag was connected by a tube to his chemo port so he could receive ongoing infusions.
Shortly after starting treatment, he began to experience nausea in the mornings. His mom suggested he wake up in the middle of the night to eat crackers and drink water so he¡¯d feel better when he woke up. It was a trick she had used when dealing with morning sickness while she was pregnant with Ross and his siblings. He never experienced nausea again after that.
Toward the end of his treatment, the radiation began to cause pain.
¡°It felt like I was swallowing with a sunburn on my throat,¡± says Ross. ¡°I didn¡¯t have much of an appetite.¡±
Through it all, Ross hoped the treatment was working.
¡°I was kind of on pins and needles for a month and a half,¡± he says. ¡°You do all this, but you don¡¯t know how the cancer¡¯s responding.¡±
Fortunately, Ross¡¯ cancer responded positively.
¡°I¡¯ll never forget what the pathology report said. In fact, it¡¯s saved as the background on my phone. It said, ¡®Remarkable metabolic response.¡¯ That was better than winning the lottery,¡± he says.
Surgery rounds out esophageal cancer treatment
The cancer had shrunk so small that it couldn¡¯t be detected on the scan. Still, Ross met with surgeon to discuss next steps. Hofstetter explained that if they didn¡¯t perform surgery, there was still a chance that the cancer would return. If it did return, it would be harder to treat. They wouldn¡¯t be able to perform radiation therapy on Ross¡¯ esophagus a second time. But if Ross had surgery to remove the parts impacted by cancer, he was very likely to live to be an old man.
Ross agreed that surgery was the best option. He spent the next month and a half recovering from his initial treatment at his mom¡¯s house in San Diego.
In August 2013, Hofstetter performed a seven-hour surgery. He removed two-thirds of Ross¡¯ esophagus, several lymph nodes and one-third of his stomach, and then reconnected the remaining parts. After the surgery, pathologists found cancer cells still in the esophagus, too small for the original scans to detect.
¡°It made me extra glad we did the surgery,¡± Ross says.?
But the recovery was difficult. Ross was unable to drink or eat following the surgery. For the first few days, he chewed on ice chips and had to spit them out because he couldn¡¯t swallow. Eventually, he was able to drink, but had to rely on a feeding tube for a month a half. He stayed in the hospital for a week and in Houston for a month. His throat and mid-section hurt. But little by little, the pain started to go away, and he began to feel stronger.
Just before Ross was about to leave Houston to return to Florida, he was hospitalized with shingles. Because it was caught early, he was able to recover at his apartment. Once the virus was behind him, he was able to go home, cancer-free.
Life after esophageal cancer treatment
It¡¯s been eight years since Ross¡¯ cancer diagnosis.
Certain foods ¨C mostly unhealthy ones, he says ¨C can upset his now-smaller stomach. For the most part, though, he doesn¡¯t notice many physical long-term side effects from cancer treatment. But it has changed how he lives his life.? ?
Before cancer, Ross was focused on his career. But since then, he¡¯s left his job in finance and began business partnerships with family and friends so he could spend more time with them. He values the time he spends with loved ones most of all and tries not to get too worried about little things.
¡°I¡¯m actually really grateful for the experience. I have such a different perspective,¡± Ross says. ¡°Most people don¡¯t know how lucky they are just to be alive.¡±
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MD Anderson esophageal cancer patients can get treatment at the following locations.
Which cancers can be treated with immune checkpoint inhibitors?
Updated April 28, 2025
Immunotherapy is a type of cancer treatment that does not target the cancer itself, unlike traditional treatments. Instead, immunotherapy trains the immune system to fight cancer. Several types of immunotherapy are now approved to treat a wide variety of cancer types.
¡°At times, our immune system can become tolerant to cancer for various reasons,¡± says , who leads an immunotherapy working group in MD Anderson¡¯s Phase I clinical trials program. ¡°With immunotherapy, we are trying to harness or reinvigorate the immune system so that it recognizes and attacks the cancer instead of being tolerant. These agents have transformed cancer care since the approval of the first immune checkpoint inhibitor for metastatic melanoma in 2011.¡±
What are immune checkpoint inhibitors?
Immune checkpoint inhibitors work by blocking checkpoint proteins ¨C including CTLA-4, PD-L1 and PD-1 ¨C on the surface of T cells. These proteins normally prevent T cells from attacking healthy cells, but treatment with checkpoint inhibitors unleashes the T cells to eliminate cancer cells more effectively. Approved checkpoint inhibitors include:
- anti-CTLA-4 therapies ipilimumab and tremelimumab
- anti-PD-1 therapies?cemiplimab, dostarlimab, nivolumab,?pembrolizumab, penpulimab-kcqx, retifanlimab-dlwr and?tislelizumab
- anti-PD-L1 therapies atezolizumab, avelumab and durvalumab
- anti-LAG-3 therapy relatlimab
Immune checkpoint inhibitors are one of several types of immunotherapy. Other forms include:
- Adoptive cellular therapies?such as chimeric antigen receptor (CAR) T cell therapies, are immune cells taken from a patient or healthy donor and modified to boost their ability to eliminate cancer.
- Targeted antibodies are treatments that mimic naturally occurring antibodies from our immune system.
- Cancer vaccines train the body to recognize specific features of cancer and stimulate an immune response.
- Oncolytic viruses use engineered viruses to infect and destroy cancer cells.
- Immune system modulators, or cytokine therapies, use immune signaling compounds to stimulate immune activity.
Immune checkpoint inhibitors treat many types of cancer
Currently, the Food and Drug Administration (FDA) has approved immunotherapies to treat certain patients with the following cancer types. FDA approval is a carefully regulated process to ensure that medicines are safe and effective for patients.
- Alveolar soft part sarcoma
- Basal cell skin cancer
- B-cell lymphoma
- Bile duct cancer
- Bladder cancer
- Cervical cancer?
- Classical?Hodgkin lymphoma
- Colorectal cancer?
- Cutaneous squamous cell cancer
- Endometrial cancer
- Esophageal cancer
- Head and neck squamous cell cancers
- Kidney cancer
- Liver cancer?
- Lung cancer
- Melanoma
- Merkel cell cancer
- Mesothelioma
- Nasopharyngeal cancer
- Stomach cancer
- Triple-negative breast cancer?
Additionally, some patients with advanced solid tumors and specific tumor characteristics, such as high microsatellite instability (MSI-H), mismatch repair deficiencies (dMMR), or high tumor mutational burden (TMB), may be eligible for treatment with certain immune checkpoint inhibitors, regardless of cancer type.
Immune checkpoint inhibitors may be used alone or in combination with other treatments, such as chemotherapy or targeted therapies. In many cases, patients must meet certain criteria to be eligible for these therapies. Keep in mind that the information shared here should not be considered medical advice.
"Immunotherapies are now not only being used to treat a large number of different cancers, but importantly, in some cancers like melanoma, they are now being used in earlier stages, either with a neoadjuvant approach (before surgery) or in the adjuvant setting. In both cases, the goal is to decrease the risk of cancer recurring at a later point. Other indications now include brain metastases," says melanoma medical oncologist "Our research is continuing to push our understanding of why these successful therapies do not work in some patients and to enable us to find ways to help more patients."
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Esophageal cancer caregiver: I¡¯m grateful we came to MD Anderson
My husband, Gary, had been healthy and active before he began complaining of a backache at age 67. Then he started having trouble swallowing. Food just wouldn¡¯t go down.
A doctor in our hometown of Russellville, Arkansas, ordered an endoscopy to examine Gary¡¯s esophagus.
After reviewing the results, the doctor pulled me aside. "It¡¯s not good,¡± he said. ¡°Your husband has esophageal cancer.¡±
The tumor was at the end of his esophagus, the tube that carries food from the throat to the stomach. That explained Gary¡¯s backaches and swallowing problems.
I struggled to comprehend his words. Things went fuzzy. ¡°What?¡± I thought. ¡°He can¡¯t have cancer.¡±
The doctor offered little hope. He told us to go home and focus on Gary¡¯s comfort.
For a few days, I grieved. I struggled to adjust to the changes that came along with Gary¡¯s diagnosis. The tumor had grown so large that he was unable to eat solid food. He¡¯d have to stick to diet of purees and soups. ?
¡°Just breathe, Mama, breathe,¡± my oldest daughter kept saying to me.
Esophageal cancer experts gave us confidence with specialized treatment plan
I decided to take action. I called MD Anderson. That turned out to be the best decision ever. We were given an appointment, and within a few days, we were in Houston.
As soon as we walked through the doors of MD Anderson on June 11, 2018, we felt hope.
Radiation oncologist ., was the first doctor we met. He was brilliant and positive, and put us at ease. He told us about proton therapy, a type of radiation therapy that uses a beam of protons to deliver radiation directly to the tumor, destroying cancer cells while sparing healthy tissues. Dr. Chun believed proton therapy, along with chemotherapy, could shrink Gary¡¯s tumor, making it easier to surgically remove.
Each doctor we met was so confident and supportive. Thoracic and cardiovascular surgeon ., sketched Gary¡¯s tumor in my notebook and showed us how he planned to remove the tumor with a surgery called a transthoracic esophagectomy. First, he¡¯d remove the cancerous portion of the esophagus. Then, through a second incision, he¡¯d pull Gary¡¯s stomach up into his chest and connect it to the remaining upper-third of the esophagus.
¡°This is doable!¡± I remember him saying with a smile. ¡°Go get the proton therapy and chemotherapy and plenty of rest. Then we¡¯ll do surgery.¡±
?¡°What? You mean you can help him?¡± I thought. ¡°Oh, my! Praise God!¡±
My husband¡¯s esophageal cancer treatment
For six weeks, Gary underwent proton therapy Monday through Friday, and chemotherapy every Wednesday. He typically suffered from nausea after chemotherapy. An MD Anderson dietitian taught us about foods that would help him feel full without upsetting his stomach.
During this time, we stayed in Houston at a nearby condo, driving back to Arkansas only a few times. Our three adult children called and texted us frequently to check in, and our six grandchildren sent us handmade artwork to lift our spirits.
After Gary completed chemotherapy and proton therapy, we returned home to Arkansas for two months to rest and prepare for his surgery. On Oct. 24, 2018, Dr. Vaporciyan successfully performed the transthoracic esophagectomy. After Gary¡¯s seven-day hospital stay, we moved to an apartment near MD Anderson. We stayed there for 48 days while Gary recovered.
Helping my husband with his feeding tube
During this time, I gave Gary his liquid meals and medicine through a feeding tube. I was initially nervous. I¡¯m a retired school teacher, not a nurse. But I took classes for caregivers at MD Anderson and learned how to do it.
Whenever I had questions or needed help, Gary¡¯s care team took my calls and walked me through the steps. It didn¡¯t matter if it was 2 a.m. to 5 p.m.
Once when Gary had extreme nausea, I reached out to his care team. They explained that he was likely dehydrated, and walked me how to give him water through an IV attached to his?feeding tube. We saw immediate changes to Gary¡¯s nausea level.
Then, just before Christmas, we received the best news. Gary was cancer-free, and we could return home.
One day at a time
Looking back, we got through that period one day at a time. After Gary had had his feeding tube removed, he was gradually able to begin eating regular foods.
The journey wasn¡¯t easy for Gary or for me as his caregiver, but it was certainly worthwhile. And none of it would have been possible if we hadn¡¯t made that call to MD Anderson.
or by calling?1-877-632-6789.