Patients with stage I esophageal cancer have cancer that invades beneath the surface lining of the esophagus, but not into the muscle wall of the esophagus, the lymph nodes or other locations in the body. This is also called an early, superficial or localized cancer that is surgically resectable.

A variety of factors ultimately influence a patient's decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient's chance of cure, or prolong a patient's survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of stage I esophageal cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied to your situation. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.

Optimal treatment of patients with stage I esophageal cancer often requires more than one therapeutic approach. Thus, it is important for patients to be treated at a medical center that can offer multi-modality treatment involving medical oncologists, radiation oncologists, surgeons, medical gastroenterologists and nutritionists.

Stage I esophageal cancer is relatively uncommon. It is difficult to estimate the outcomes of patients with stage I esophageal cancer who do not undergo surgery as primary therapy because clinical staging is frequently inaccurate. Many patients who have clinical stage I cancer will in fact have more extensive cancer discovered at surgery. For example, in one clinical study from Japan, almost half of patients who were originally diagnosed with stage I esophageal cancer were found to have previously undetected cancer in local lymph nodes and were reclassified as stage IIB cancer following surgery. Patients with stage I esophageal cancer can be treated with curative intent using either surgery or chemotherapy and radiation therapy. Currently, the chemotherapy and radiation therapy approach is usually reserved for patients who cannot tolerate surgery.

Primary Treatment with Surgery Alone: The current preferred treatment for patients with stage I esophageal cancer who are in good clinical condition is esophagectomy (complete removal of the esophagus). In addition, when patients truly have cancer that does not invade the muscle wall of the esophagus, surgery can frequently be performed through an endoscope. In one clinical study from Japan, the 5-year survival rate for patients with stage I esophageal cancer was 86% following endoscopic surgical resection. In another study from Japan, the average survival for 6 patients treated with surgery alone was 15 years.

Primary Treatment with Radiation and Chemotherapy:

Patients who are not well enough or who do not wish to undergo major surgery can be treated with a combination of radiation therapy and chemotherapy. Chemotherapy is the treatment of cancer with anti-cancer drugs. Chemotherapy has the ability to kill cancer cells. Chemotherapy and radiation therapy may act together to increase the destruction of cancer cells. The results of several clinical studies using concurrent chemotherapy and radiation therapy in patients with esophageal cancer have indicated that combination chemotherapy and radiation may improve remission rates and prolong survival compared to chemotherapy or radiation therapy alone. In one clinical study, 26 patients with stage I esophageal cancer received radiation therapy combined with fluorouracil and Mutamycin® chemotherapy, resulting in a 3-year survival rate of 73%. Since no direct comparisons between surgical resection and radiation plus chemotherapy have been made, it is unknown whether these results are equivalent to esophagectomy.

Strategies to Improve Treatment

The progress that has been made in the treatment of esophageal cancer has resulted from improved patient participation in clinical studies. Future progress in the treatment of esophageal cancer will result from continued participation in appropriate studies. Currently, there are several areas of active exploration aimed at improving the treatment of esophageal cancer.