Esophageal Cancer Diagnosis and Treatment

Dr. John Hunter in the operating room
Dr. John Hunter, one of our expert surgeons, pioneered a minimally invasive surgery to treat esophageal cancer. Dr. Hunter is also an executive vice president of OHSU.

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 gastrointestinal cancers, including 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 a minimally invasive 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: 

Blood tests: These tests can show signs of internal bleeding. They can also detect special proteins called tumor markers that can indicate cancer.

X-rays with a barium swallow: You drink a chalky liquid (barium) that helps show details of the esophagus on an X-ray. 

CT scan: A computed tomography scan uses an X-ray beam that circles the body to create detailed 3D and cross-section views.

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 absorb more of the sugar, making them show on the scan.

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) for examination under a microscope. Our team includes doctors with special training in endoscopic techniques for a high degree of accuracy.

Endoscopic ultrasound: A small device is eased into the esophagus to generate sound waves and produce high-definition images. Our endoscopists do hundreds of these procedures a year, giving us exceptional precision.  
 

Dr. John Hunter reviewing radiology images
Dr. John Hunter and other members of our team use high-definition imaging and other advanced tests to diagnose esophageal cancer.

Esophageal cancer treatments

If surgery to remove the tumor is possible, treatment often starts with chemotherapy and radiation therapy to shrink the tumor first. 

Chemotherapy

This treatment uses one or more cancer-fighting drugs to destroy the cancer. It is typically given in an IV infusion (slow drip). Our community cancer clinics, with five Portland-area locations, help you receive treatments closer to home. 

Types include:

  • Before surgery: Chemotherapy before surgery, called neoadjuvant chemotherapy, can shrink a tumor.
  • After surgery: Chemotherapy after surgery (adjuvant chemotherapy) can kill cancer cells nearly anywhere in your body. This lowers the chances that the cancer will come back.
  • For advanced cancer: Chemotherapy can shrink tumors, possibly extending life,  and help control pain and other symptoms. 

Radiation therapy

Like chemotherapy, radiation therapy may be given:

  • Before surgery (neoadjuvant radiation therapy)
  • After surgery (adjuvant radiation therapy)
  • For advanced cancer

External beam radiation: Beams of energy delivered from outside the body target the precise location of the cancer. Our advanced technology enables us to track the tumor during treatment and adjust for slight movements from breathing. This helps us target the tumor while sparing healthy tissue. Types include:

  • 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 radiation to different parts of the tumor, lowering the risk of side effects.
Dr. Brett Sheppard in white coat, smiling
Dr. Brett Sheppard is a cancer surgeon and researcher who specializes in cancers of the digestive system.

Surgery

We specialize in removing esophageal cancer using minimally invasive techniques, with small incisions and special tools. This helps us spare healthy tissue, and means less pain and faster recovery for you.

  • Endoscopic mucosal resection: We treat early-stage tumors on the surface of the esophagus using a thin tube with surgical tools and a camera at the tip. We do hundreds of EMRs a year with exceptional accuracy and low rates of complications.
  • Laparoscopic esophagectomy: If cancer has penetrated the surface of the esophagus, we often use a technique pioneered by Dr. John Hunter, a surgeon on our team and a leader of OHSU. We use tiny surgical instruments to remove a portion of the esophagus through small incisions. A special camera produces real-time, high-definition images.

Targeted therapy

Targeted therapies are medications that target a cancer’s specific trait. For example, a small portion of esophageal cancers have too much of a protein called HER2, which signals cancer cells to grow. A medication called Herceptin, given by IV, can block HER2.

Immunotherapy

Immunotherapy medications help empower the immune system to target cancer. One medication, given by IV, can shrink or slow tumors of the gastroesophageal junction, where the stomach and esophagus meet.

Additional OHSU services

We offer a full menu of services to help you and your family, including: 

  • Palliative care: Our expert Palliative Care Service team has expertise in helping cancer patients ease anxiety and symptoms. The team’s services are available at any stage of a serious illness.
  • Esophageal cancer registry: OHSU’s cancer registries, including for esophageal cancer, help researchers search for better ways to detect and treat cancer. Learn how you can participate.
  • Clinical trials: Our clinical trials offer some patients a chance to test promising new therapies.
  • Dietitians: Our expert cancer dietitians can help you manage nutrition before, during and after treatment. They can also assist with difficulty eating or drinking.

Learn more

For patients

Call 503-494-4373 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.W. Bond Ave.
Portland, OR 97239
Map and directions

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