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Esophageal Cancer Diagnosis & Treatment

With state-of-the-art diagnosis and treatment, there’s no better place for esophageal cancer care than Virginia Mason Franciscan Health. In fact, people come from all over the country to be treated here. We care for the most esophageal cancer patients in the western United States, and seventh most nationally, according to the Commission on Cancer. Our high patient volumes speak to the experience and expertise of our team, and have resulted in survival outcomes that exceed national and international averages.

Here, you’ll benefit from the collaborative approach of our Cancer Care and Center for Digestive Health teams, both of which offer exemplary outcomes in esophageal cancer treatment.

Esophageal cancer screening and diagnosis

While esophageal cancer screenings aren’t recommended for the general public, people at high risk of esophageal cancer may benefit from regular screenings. Having Barrett’s esophagus, being a heavy smoker or being a heavy alcohol user can put you at greater risk for esophageal cancer. We offer a number of screening tests for esophageal cancer depending on your risk factors and symptoms. A referral from your primary care provider is needed.

Esophageal cancer is a treatable disease if found in its early form. Tests and procedures to diagnose esophageal cancer include:

  • During this procedure, you will be asked to swallow a liquid containing barium, which coats the esophagus. Any changes in the shape of the esophagus will show up on X-rays.

  • An esophagoscopy is an examination of the inside of the esophagus using an endoscope (a thin tube with a light at its end). The endoscope also is able to take tissue samples (biopsy) for evaluation.

  • This technique, which uses an endoscope connected to an ultrasound machine, sends images to a computer screen. Because it can visualize all of the layers of muscle and tissue in the esophagus, it’s the best technique to determine the extent (depth) of the tumor and if there has been any spread to the lymph nodes in the neck.

  • A simple chest X-ray shows abnormalities in the lungs.

  • This procedure uses a bronchoscope, a thin lighted tube inserted into the nose or down the throat and into the bronchial tubes of the lungs. It can pick up abnormalities in the trachea and lungs.

  • A procedure using a laryngoscope (a thin, lighted tube) to view the larynx or voice box.

  • A CT scan uses X-rays and a computer to show three-dimensional images of organs in the body.

  • A positron emission tomography (PET) scan shows cancer growth in other parts of the body by means of a substance called radionuclide glucose (sugar), which is injected into a vein. This substance is “taken up” by cancer cells because they use sugar more readily than normal cells do. In some instances, both a PET scan and a CT scan will be used to determine if the cancer has spread beyond the esophagus.

  • During this procedure, an endoscope is used to examine the inside of the chest. The endoscope is inserted through an incision in the chest wall.

  • This procedure uses a laparoscope, which is similar to an endoscope, to view internal organs and take tissue samples. It is inserted through an incision in the abdomen.

Esophageal cancer treatment

Treatment for esophageal cancer has improved significantly with advances in imaging technology and more precise staging of the disease. People are now living longer and with a greater quality of life than they were just 10 years ago.

Treatment will depend on the size and extent (stage) of the tumor, its location and your overall general health. At Virginia Mason Franciscan Health, the Thoracic Oncology Tumor Board—a multidisciplinary group of experts from thoracic surgery, medical oncology, radiation oncology, gastroenterology, radiology and pathology—reviews each individual’s case and creates a comprehensive treatment plan.

Nonsurgical esophageal cancer treatments

Individuals who aren’t candidates for surgery benefit from medical and technological advances available at Virginia Mason Franciscan Health:

  • Endoscopic mucosal resection (EMR) is a procedure in which the top layer of esophageal tissue, called the mucosal layer, is removed by an endoscope. In time, another layer of tissue will grow back in its place. This procedure is often used in precancerous conditions, such as Barrett's esophagus, and even some very early-stage esophageal cancers.
  • Photodynamic therapy, a form of light or laser therapy, is currently being studied in clinical trials as a potential treatment for early-stage cancer. Patients receive an injection of a light-sensitive drug that is “taken up” in cancer cells. Laser light at the end of an endoscope is then applied to the tumor, which activates the drug and kills the cancer. Results can be remarkable—some people who could not swallow solid food are able to eat a nearly normal diet within four to five days of treatment. 

Other treatment options include chemotherapy, radiation therapy and palliative care.

We understand how esophageal cancer impacts quality of life, and we’re committed to helping you lead a productive life beyond your treatment. We offer extensive nutritional counseling both before and after surgery, and we continually monitor our patients following surgery in an ongoing quality-of-life study.

This study, begun more than a decade ago, found that people treated here show improvements in quality of life within the first year of surgery and that 82% who were employed full time prior to surgery returned to their presurgical work levels.

Esophageal cancer surgery

Surgery is the most common treatment for esophageal cancer and often is curative when cancer hasn’t spread beyond the esophagus. In more than 50% of cases, we can perform esophageal surgery with the use of a robot, which improves recovery and minimizes postoperative pain.

There are two types of surgery for esophageal cancer:

  1. Esophagectomy: During this procedure, your surgeon will remove the portion of the esophagus that contains cancer, along with the nearby lymph nodes. The doctor will then connect the remaining portion of your esophagus to your stomach. An esophagectomy is performed in people with early-stage disease, in which the cancer has not spread to the stomach.
  2. Esophagogastrectomy: In this procedure, the portion of the esophagus with cancer, the upper portion of the stomach and nearby lymph nodes are removed. The remaining portion of the stomach is then connected to the remaining portion of the esophagus. Your surgeon may first replace the part of the esophagus that was removed with a section of the large intestine before connecting it to the stomach. This procedure is called a colonic interposition.

Esophageal cancer clinical trials

For more than 20 years, the goal of our clinical research program has been to provide each of our patients with a research option at every step of their disease, from initial diagnosis to long-term follow-up. Our trials include the use of chemotherapy, radiation and targeted therapies, as well quality of life/symptom management trials. Learn more about our current esophageal cancer clinical trials.

Esophageal cancer: Wellness and support

Our comprehensive cancer program includes a variety of wellness and support services.

Find a colorectal cancer specialist

If you’ve been recently diagnosed or would like a second opinion, consult with one of our expert cancer specialists.