Esophageal Cancer Diagnosis and Treatment

Dr. John Hunter in the operating room
Dr. John Hunter, one of our expert surgeons, pioneered minimally invasive surgery to treat esophageal cancer.

Esophageal cancer is a complex illness that requires specialized care. At the OHSU Knight Cancer Institute, our expertise attracts patients from across Oregon and beyond. You’ll find: 

  • Highly skilled doctors who focus on esophageal cancer. They understand every aspect of diagnosis and treatment.  
  • A team approach, including regular meetings where specialists combine their expertise one patient at a time. 
  • Innovative treatments, including surgery pioneered at OHSU.
  • Precise diagnostic testing so you can be confident in your results.
  • A wide range of support services for you and your family.

    Diagnosing esophageal cancer

    We offer the latest tests, including: 

    • Upper endoscopy/biopsy: We guide a flexible tube (endoscope) with a camera and tiny tools down your throat. It enables us to look at your esophagus and, if needed, to take a small tissue sample (biopsy) to examine under a microscope. Our doctors have special training for a high degree of accuracy.
    • CT scan: A computed tomography scan uses an X-ray beam that circles the body to create detailed 3D images. This helps us understand the shape, size, and location of the tumor.
    • PET/CT scan: This scan combines CT imaging with a positron emission tomography scan. In a PET scan, a small amount of radioactive sugar is injected into your bloodstream. Cancer cells use more of the sugar, making them light up on the scan. This is very effective at finding out if the tumor has spread.
    • Endoscopic ultrasound: A small device is guided into the esophagus to generate sound waves and produce high-definition images. We do hundreds of these procedures a year, giving us exceptional precision.  This helps us understand how deeply the tumor has invaded the esophagus and nearby lymph nodes.
    Dr. John Hunter reviewing radiology images
    Our doctors use high-definition imaging and other advanced tests.

    Treatment for esophageal cancer

    The best course of treatment depends on several factors, including the stage of your cancer.

    For early-stage tumors, we recommend endoscopic mucosal resection (see below).

    For more advanced tumors, we recommend a course of treatment that combines several types of therapy, such as:

    • Chemotherapy
    • Targeted therapy
    • Immunotherapy
    • Radiation therapy
    • Surgery

    Endoscopic mucosal resection

    Endoscopic mucosal resection (EMR) is surgery to treat early-stage tumors. The mucosa is a layer of cells that line the inside of the esophagus, sort of like an inner tube on a bicycle wheel. If the tumors have not penetrated below the mucosal layer, doctors may be able to remove them with an endoscope. This is a flexible tube equipped with cameras and surgical tools at the tip. The endoscope is guided through your mouth and into your esophagus. Doctors use the endoscope to remove tumors from the mucosa. We do hundreds of EMRs a year with exceptional accuracy and low rates of complications.

    Chemotherapy

    Chemotherapy uses drugs to attack cancer cells. It is typically given in an IV infusion (slow drip). Our community cancer clinics, with five Portland-area locations, bring your treatment closer to home. 

    For esophageal cancer, we usually recommend chemotherapy together with radiation therapy. These two therapies are more effective when they are used together. This combination is known as chemoradiation. The goal is to shrink the tumors as much as possible before surgery.

    Targeted therapy

    Targeted therapy uses drugs that have been specially engineered to home in on cancer cells, leaving healthy cells mostly unharmed. For example, some esophageal cancers generate too much of a protein called HER2, which sends cancer cells a signal to keep growing. A targeted therapy called Herceptin, given by IV, can block HER2.

    Immunotherapy

    Immunotherapy harnesses the power of the immune system to hunt down cancer cells and target them for destruction. One medication, given by IV, can shrink or slow tumors of the gastroesophageal junction, where the stomach and esophagus meet. New research suggests that some patients benefit from immunotherapy. We are currently conducting a clinical trial to see if immunotherapy can help more patients.

    Radiation therapy

    Radiation therapy harnesses the power of subatomic particles to kill cancer cells. Doctors aim beams of energy at the precise location of your tumors. Our advanced technology enables us to track the tumor during treatment and adjust for slight movements from breathing. We offer:

    • 3D conformal radiation therapy: We direct radiation beams to match the exact shape and location of your tumor. This allows us to use a higher dose without harming healthy cells.
    • Intensity-modulated radiation therapy: This is a type of 3D conformal radiation therapy. It enables us to vary the intensity to different parts of the tumor, lowering the risk of side effects.

    Radiation therapy is even more effective when it’s used together with chemotherapy.

    Esophagectomy

    Esophagectomy is surgery to remove tumors that have invaded the deeper layers of the esophagus. This surgery usually comes after you have received chemotherapy and radiation therapy.

    We perform this surgery with techniques developed here at OHSU by Dr. John Hunter. The procedure is called minimally invasive esophagectomy. We use long surgical instruments to remove the esophagus and lymph nodes through small incisions. This leads to better outcomes, less pain and faster recovery than open surgery.  We usually borrow a section of the stomach to replace the esophagus. We perform 40-50 esophagectomies a year and have one of the most experienced teams in the nation.

    Esophagectomy is major surgery. It takes most patients six to eight weeks to recover. We provide comprehensive follow-up care to support you through recovery.

    Clinical trials

    Researchers around the world are working to better understand esophageal cancer. We are currently running several clinical trials designed to improve our knowledge and help more patients with this condition. For example, we are currently conducting a clinical trial to see if immunotherapy can help more patients.

    Holistic care

    Esophageal cancer is a serious and complex condition that requires expert care. We offer a full menu of services to help you and your family, including: 

    • Acupuncture: this alternative therapy can help you manage symptoms and side effects.
    • Palliative care: Our palliative care team can help ease anxiety and symptoms. Their services are available at any stage of treatment.
    • Nutrition: Our cancer dietitians can help you manage nutrition before, during and after treatment. They can also assist with difficulty eating or drinking.
    • Esophageal cancer registry: Our cancer registries help researchers search for better ways to detect and treat cancer. Learn how you can participate.

      Learn more

      For patients

      Call 503-494-7999 to:

      • Request an appointment
      • Seek a second opinion
      • Ask questions

      Location

      Parking is free for patients and their visitors.

      Center for Health & Healing Building 2
      3485 S. Bond Ave.
      Portland, OR 97239
      Map and directions

      Refer a patient

      Read more