NCCN Guidelines for Patients
Esophageal Cancer, Version 1.2016
Treatment guide: Adenocarcinoma
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.
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.
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
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