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NCCN Guidelines for Patients


Esophageal Cancer, Version 1.2016


Treatment guide: Adenocarcinoma

Advanced cancer

Systemic treatment

Doctors use the term “systemic” when talking about a

cancer treatment for the whole body. Chemotherapy

is the type of systemic treatment most often used for

esophageal cancer. Chemotherapy can cause severe

side effects. As such, it is only given if your health

hasn’t seriously limited your activities.

Targeted therapy is a newer drug treatment for

advanced esophageal adencarcinomas. Trastuzumab

is one such drug. It should be received with first-line

chemotherapy if the cancer cells have too many

HER2 receptors except if taking an anthracycline.

Epirubicin is an anthracycline.

Guide 25

lists the regimens first used to manage

advanced cancers. Your doctor will choose a regimen

based on your health and treatment side effects.

Regimens consisting of two drugs have less severe

side effects than three-drug regimens. If you are

given 5-FU, leucovorin may be added to limit side

effects of the chemotherapy. No matter what regimen

you receive, you should be assessed for side effects

on a regular basis.

Guide 26

lists the regimens that are given if the

cancer doesn’t respond to first-line regimens. The

regimen that is best for you depends on your prior

treatment and performance status. Most preferred

regimens have been shown within well-designed

clinical trials to control cancer growth better than

other treatments.

Symptom control

Cancer or its treatment can cause unpleasant and

sometimes harmful symptoms. One of the most

common symptoms of esophageal cancer is trouble

with food passing through the esophagus. This

is called dysphagia. Your doctor will assess what

you can and can’t swallow and what is causing the


Dysphagia is often caused by the tumor blocking the

passage. However, sometimes it is caused by the

tumor impairing the muscles of the esophagus or

by scarring from radiation. Treatment for dysphagia

depends on the cause. Treatment for a blocked

esophagus is described on page 86.

Bleeding is another common symptom, but not as

common as dysphagia. Bleeding may be caused

by the cancer or the cancer treatment. Endoscopic

treatment that uses heat, cold, lasers, or injections

may stop bleeding from the tumor surface. EBRT may

stop ongoing blood loss.

Other symptoms related to esophageal cancer include

pain or nausea with or without vomiting. These

symptoms may be caused by the tumor blocking the

passage of the esophagus. Treatment for a blockage

is described on page 86. Otherwise, pain may be

controlled with radiation therapy, chemotherapy, pain

medication, and other methods. Likewise, there are

medicines and other methods that may help stop

nausea and vomiting.

You may have other symptoms that aren’t listed

here. If you have a new or worse symptom, tell your

treatment team. There may be ways to help you feel