After normal people eat through the mouth, food enters the stomach through the esophagus and begins digestion and absorption of nutrients, while esophageal cancer is a “boulder” blocking this path.
Once the diagnosis of esophageal cancer is clear, surgery to remove the tumor and reconstruct the digestive tract to maximize its function is the best option for you. However, some people are too old, in poor condition, or have underlying diseases that prevent them from tolerating surgery; others are reluctant to have surgery. At this point, there are several other options:
Radical radiotherapy
In esophageal cancer, neither radiotherapy alone nor chemotherapy alone is effective. In contrast, the combination of radiotherapy and chemotherapy is more effective. Chemotherapy and radiotherapy can have a complementary and synergistic effect, improving local control of the tumor, reducing distant metastases, and improving survival rates. Although more toxic side effects are seen with concurrent radiotherapy and chemotherapy, they are generally well tolerated.
The combination of radiotherapy and chemotherapy can be divided into two modalities: concurrent radiotherapy and sequential radiotherapy, with the former having more advantages in terms of efficiency and survival. However, some people are in poor health and cannot tolerate the adverse effects of chemotherapy, so they may be considered for radiotherapy alone; and for patients whose tumors invade the trachea, large blood vessels, or heart, they may be considered for chemotherapy alone.
Molecular targeted therapy
Molecularly targeted therapy is the use of small molecule compounds, monoclonal antibodies, peptides, and other substances to specifically interfere with signaling pathways that regulate the biological behavior of tumor cells and inhibit tumor progression.
Targeted therapies are less likely to be resistant to drugs, are not restricted by peritumor cells, have a clear target of action, are highly targeted, and are also more effective in metastatic tumors.
However, compared to other tumors, molecularly targeted therapies for esophageal cancer are still in their infancy, and no targeted drug has been approved for use in esophageal cancer.
The following are currently under investigation:
- Epidermal growth factor receptor inhibitors (e.g., cetuximab, nitrozumab)
- Tyrosine kinase inhibitors (e.g., gefitinib, erlotinib)
- Monoclonal antibodies against human epidermal growth factor receptor-2 (e.g., trastuzumab, patuximab)
- Antibodies against vascular endothelial growth factor (e.g., bevacizumab)
- Cyclooxygenase-2 inhibitors (e.g., celecoxib)
- Cell cycle inhibitors
- Matrix metalloproteinase inhibitors (e.g., TIMPs), etc.
Immunotherapy
Immunotherapy, the fourth major cancer treatment in addition to surgery, radiation, and chemotherapy, works by a different mechanism than any of the other therapies. The treatment of tumors is not the same as other therapies. Surgery, radiation, and chemotherapy all rely on external “reinforcements” to cut out or kill tumors; immunotherapy, on the other hand, stimulates and strengthens the immune function of the body, and relies on the power of the immune system to “fight back” against tumor cells.
Some preliminary studies with nabolutumab (PD-1 antibody) and epirimumab (CTLA-4 antibody) have demonstrated the effectiveness of immunotherapy for locally progressive, recurrent, or metastatic esophageal cancer. Immunotherapy in combination with other treatments is a promising treatment modality. However, this treatment is not currently included in the guidelines for the management of esophageal cancer.
If you want to receive immunotherapy, there are clinical trials that you can participate in.
Endoesophageal stenting
Patients with progressive esophageal cancer are often unable to eat normally and are at high risk of death due to nutritional impairment. At one time, gastrostomy was mostly used clinically for nutritional support for patients unable to eat, but it is more invasive, not easily managed postoperatively, and prone to multiple complications.
The expanded metal spiral tube applied by Frimberger in 1983 provided new ideas and avenues for nutritional support therapy for patients with advanced esophageal cancer. Our medical doctors have conducted intensive research on endoesophageal stents, which have been able to solve temporary feeding problems for many patients. However, even if you have an endoesophageal stent placed, it needs to be combined with reasonable treatment such as radiotherapy to kill the tumor cells.
Endoscopic local injection therapy
By endoscopically injecting chemotherapy drugs into localized tumors, the drug concentration at the tumor can be significantly increased, which is effective for the treatment of localized tumors and can be an option for patients who are unwilling or unable to undergo surgery.
Photodynamic therapy
Local tumor cells can be killed by laser irradiation of the lesion area under endoscopy using the affinity of the photosensitizer to the tumor cells. A phase I clinical trial confirmed that photodynamic therapy is safe and achieves efficacy in patients who have failed local radiotherapy.