Our Approach & Expertise

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If esophageal cancer is suspected, a biopsy is performed with a thin, tube-like instrument called an endoscope. A tissue sample is removed and a diagnosis is made. A biopsy may have been performed prior to the patient coming to Memorial Sloan-Kettering, and if so, as a part of the initial evaluation at Memorial Sloan-Kettering our pathologists will review the biopsy slides to confirm the diagnosis. A second endoscopy may be necessary if the diagnosis is unclear after the initial biopsy. Once the diagnosis has been established, a number of other tests may be recommended to determine the extent of the tumor -- this is a process called staging.

After the tumor has been staged, a treatment plan is developed. Multidisciplinary input is an important aspect of the treatment plan development process since many patients will receive more than one type of treatment. For esophageal cancer, this may include some combination of surgery, chemotherapy, and/or radiation therapy. Having surgeons, medical oncologists, and radiation oncologists collaborating on treatment from the very beginning optimizes patient care.

Focus on the Patient

Communication with patients and caregivers is an important priority at Memorial Sloan-Kettering. We believe that treating the whole person, not just the disease, is the best for patients and family members. At Memorial Sloan-Kettering, we offer a broad range of emotional support programs designed to help patients and family members cope with the range of issues related to life during and after cancer treatment.

Barrett's Esophagus Screening

At Memorial Sloan-Kettering, we offer screening for patients with Barrett's esophagus, a precancerous condition of the esophagus that may be caused by the chronic, abnormal exposure of the esophagus to acid (in most cases, stomach acid). Our doctors use endoscopy to screen patients with Barrett's esophagus for precancerous changes known as dysplasia, which can be detected with a biopsy taken during this procedure. Screening allows our doctors to begin treatment at the earliest stage of disease.

Our Surgical Expertise

Many patients with esophageal cancer require some form of surgery, and our surgeons are often able to completely remove such tumors with an esophagogastrectomy (when part of the esophagus and the stomach are removed along with nearby lymph nodes). We perform more than 100 surgeries for esophageal cancer each year. Patients with more advanced cancers are offered chemotherapy and radiation first to shrink the tumor and increase the likelihood for a successful surgery.

Our surgeons may use minimally invasive surgery to biopsy, stage, and also treat many esophageal cancers and precancerous conditions.

When the tumor cannot be surgically removed, our doctors use methods such as chemotherapy, and other treatments localized at the tumor site, such as a stent to keep the esophagus open, photodynamic therapy (treatment with drugs that become active when exposed to light), and high-energy laser techniques to relieve areas of obstruction that may cause swallowing problems. A feeding tube can also be inserted temporarily.

Multimodal Therapies

For patients with esophageal cancer, we offer combined-modality treatments using chemotherapy plus radiation therapy (known as chemoradiation) followed by surgery.¹ For patients with more advanced disease, chemotherapy and radiation therapy is usually the primary treatment.

Our doctors continue to evaluate new chemotherapy agents and drug combinations to treat patients with esophageal cancer. Chemotherapy may be given before surgery (in a process known as neoadjuvant therapy) to shrink the tumor (usually in combination with radiation therapy), or it may be given after surgery (known as adjuvant therapy) in an attempt to reduce the risk of cancer recurrence. When given alone or in combination with radiation therapy, chemotherapy may help also relieve symptoms related to esophageal cancer.

Find a Clinical Trial Find out about new research studies for esophageal cancer more

Newer targeted therapies -- including agents directed against growth factor receptor pathways, tumor angiogenesis (blood vessel formation), tumor invasion, and metastasis, or spread to another part of the body -- are leading to a new generation of clinical trials combining these agents with conventional chemotherapy and radiation therapy.²

One of our areas of research focuses on the identification of novel therapeutic drugs, as well as treatment modalities and programs to improve the care of patients with esophageal cancer. To help guide therapeutic decisions, our investigators are also working to identify new molecular tumor markers. These are substances that may be found in tumor tissue or released from a tumor into the blood or other body fluids. Being able to track a tumor marker could help with diagnosis, and also during treatment -- monitoring the effectiveness of therapy and identifying a potential recurrence. In addition, we are investigating the potential to use functional imaging such as positron emission tomography (PET) and endoscopic ultrasonography (the use of a special endoscopy tube that has a tiny ultrasound probe at its tip) to guide therapy more specifically for the individual patient.

¹Anderson SE, Minsky BD, Bains M, Kelsen DP, Ilson DH. Combined modality therapy in esophageal cancer: the Memorial experience. Semin Surg Oncol. 2003;21(4):228-32. [PubMed Abstract]

²Ilson DH. New developments in the treatment of esophageal cancer.Clin Adv Hematol Oncol. 2004 Feb;2(2):97-104. Review. [PubMed Abstract]