Chemotherapy is a drug, or combination of drugs, that goes through the body to kill cancer cells wherever they are. Chemotherapy is an important part of treating esophageal cancer because in most cases people only find the disease after it has spread to other organs. Chemotherapy drugs can shrink the tumor in the esophagus as well as cancerous growths in other areas of the body.

Chemotherapy is used in both adenocarcinoma and squamous cell carcinoma of the esophagus. Which drugs your doctors prescribe depends on the type of cancer you have and other factors.

Our doctors are experts in determining which chemotherapy drugs give you the best chance to control the cancer. They work closely with other specialists to manage your care. This approach is particularly important for esophageal cancer because studies have shown that combining chemotherapy with other treatments has the best results.

Combining Chemotherapy with Other Approaches

In most cases, patients treated for esophageal cancer at Memorial Sloan Kettering get both chemotherapy and radiation therapy. Several studies have shown that this combination, called chemoradiation, is the best method for curing or controlling the disease.

In many people with squamous cell carcinoma of the esophagus, chemoradiation drives the cancer into remission (meaning that although there are no signs of cancer, it is not necessarily cured).

If chemoradiation alone cannot control the cancer, or if you have adenocarcinoma, we may give chemotherapy and radiation to shrink the tumor and make it easier to remove. When used before surgery, this is called induction chemotherapy or neoadjuvant chemotherapy.

The mix of chemotherapy, radiation therapy, and surgery is known as trimodality therapy, and support for this approach is growing. Chemoradiation followed by surgery offers good results for many esophageal cancer patients who have small tumors that have not spread.

Chemotherapy before surgery improves treatment for esophageal cancer in several ways:

• It can reduce the risk that the cancer will recur after the tumor has been removed.
• It can shrink the tumor, making it easier to remove the cancer in its entirety.
• It can improve a person’s ability to swallow, often after just two cycles of treatment, if a tumor is blocking the esophagus.

Chemotherapy is typically given with radiation therapy for six to ten weeks before surgery.

Imaging and Chemotherapy

During your treatment, your doctor may recommend periodic PET scans to see if your treatment is working. If it doesn’t look like the tumor is shrinking, your doctor may recommend changing your medications.