Esophageal Cancer Treatment Program

Overview

The Tucker Gosnell Center for Gastrointestinal Cancers offers a collaborative, caring approach to the diagnosis and treatment of patients with confirmed or suspected esophageal cancer. Consistently ranked as one of the best in the country by U.S. News & World Report, we provide the latest, most effective treatments including many innovative approaches to clinical care and promising new therapies, including:

• Expertise in minimally invasive surgical procedures for esophageal cancer that help reduce side effects and preserve function
• A high-volume esophagectomy center, which studies have shown leads to better results
• The first program in the world to routinely conduct 4-D CT imaging to plan more accurate radiation treatment for patients whose tumors may move due to breathing and normal function
• Access to  Proton Therapy at New England’s only proton radiation facility
• Access to one of New England’s few advanced endoscopy services in collaboration with Mass General's Digestive Healthcare Center
• Rapid diagnosis and staging of all biopsied tumors by pathologists who sub-specialize in thoracic tumors

Expertise in Diagnosing and Staging Esophageal Cancer

Our gastric and thoracic cancer pathologists are internationally recognized and consulted on the diagnosis of esophageal cancer. They participate in weekly tumor board meetings, sharing information about each patient’s unique cancer with the entire treatment team to help guide care planning.

All members of our team of diagnostic radiologists are nationally recognized for their expertise. They use the most advanced imaging tools to diagnose and stage thoracic cancers and to detect changes in tumors. Our imaging methods include:

• Chest radiograph
• Computed tomography scan (CT or CAT scan)
• 4-D CT imaging
• MRI
• PET and nuclear medicine scans
• Esophageal ultrasound

Our minimally invasive image-guided procedures for diagnosis include endoscopic esophageal biopsy and molecular diagnostic tests.

Advanced Medical Oncology

For many patients diagnosed with esophageal cancer, administering chemotherapy may be the most effective treatment. Some new therapies that are currently available or in development are designed to block some of the mutations and pathways that cause tumor cells to proliferate. By targeting tumor gene mutations with these “smart drugs,” our doctors are beginning to understand how to eradicate malignant cells in some patients' tumors without using traditional chemotherapy and radiation. This is an area of investigation in clinical trials. Biologic agents are being used in combination with standard of care chemotherapy to assess improved treatment efficacy.

Excellence in Surgical Care

The expertise of our surgical team has helped make our program a major referral center for complex thoracic problems and complications. Our team provides state-of-the-art evaluation, treatment and post-surgical services, including:

• Cryotherapy for Barrett’s esophagus
• Radiofrequency ablation for Barrett’s esophagus
• Photodynamic therapy
• Minimally invasive esophageal surgery
• We also offer a number of minimally invasive surgical procedures to aid in treating thoracic malignancies, such as:
• Bronchoscopy to explore the bronchial passages
• Esophagoscopy to explore the esophagus (see below)
• Mediastinoscopy to explore the area between the lungs and nearby lymph nodes
• Thoracoscopy to explore the thorax
• Esophageal endoscopic ultrasound
• Endobronchial ultrasound

Minimally invasive approaches to esophagectomy have matured in the treatment of esophageal cancer. The procedure is designed to remove cancerous lesions with less postoperative pain and a shorter recovery time. Esophageal cancer patients benefit from this procedure because it can also be utilized to relieve symptoms and preserve function. The Cancer Center is a high-volume esophagectomy center, performing over 60 esophagectomies a year, which studies have shown lead to better outcomes for patients.

Learn about the esophageal surgery program.

Pioneering Radiation Therapies

Our radiation oncologists use the most advanced therapies to treat esophageal cancer, many of which are available at only a few select hospitals. Radiation therapy may be given alone, or in combination with surgery and chemotherapy. Depending on the nature of a patient’s cancer, our team may suggest:

• External radiation (external beam therapy), a treatment that precisely sends high levels of radiation directly to the cancer cells using high energy therapy machines.
• Internal radiation (brachytherapy, implant radiation), in which radiation is given inside the body as close to the cancer as possible using radioactive sources.

All patients scheduled for radiation therapy will undergo a 4-D CT scan for pre-treatment planning. The fourth dimension, time, refers to the movement a tumor might have due to the patient’s breathing. If planning reveals that a tumor is likely to move significantly during treatment, our radiation oncologists may use respiratory gating – a technique designed to deliver radiation only when the tumor is in the exhale phase of breathing– to target the tumor while helping to spare healthy surrounding tissue.

Learn more about the gastrointestinal radiation oncology program.

Multidisciplinary Patient Care

Our team approach ensures that every patient benefits from an individualized, coordinated and compassionate treatment plan that includes leading experts from many specialties. Depending on the stage and other characteristics of your esophageal cancer, this treatment plan may include surgery, chemotherapy, radiation or a combination of these therapies.

Your care team may include:

• Pathologists who specialize in thoracic cancers to provide a precise diagnosis of your cancer and evaluate the extent of the disease
• Diagnostic and interventional radiologists who can help diagnose and/or treat esophageal conditions
• Surgical oncologists who are leading the way in performing and developing the most advanced surgical approaches for esophageal cancer
• Gastroenterologists specializing in digestive health
• Endoscopists skilled in performing minimally-invasive diagnostic and interventional procedures
• Medical oncologists who plan the most effective chemotherapy and targeted treatments
• Radiation oncologists who specialize in treating esophageal cancer with various forms of radiation such as photons, electrons and protons
• Oncology nurses and nurse practitioners who care exclusively for patients with cancer
• Oncology psychiatrists and social workers experienced in helping with the cognitive side effects of cancer and treatment, as well the emotional and spiritual aspects of the cancer experience
• A nutritionist to help you with questions about diet and nutrition during treatment
• Palliative care providers to improve quality of life

Members of your care team meet regularly with you and contact your referring physician on an ongoing basis to ensure clear communication and seamless coordination of care.

Our multidisciplinary team of esophageal cancer specialists provides individualized care and compassionate support services tailored to the needs of each patient. We consider patients and their family and friends involved in their care to be part of this team. Esophageal cancer care at Mass General combines clinical expertise with the most advanced medical technologies, research and clinical trials available to offer every patient the most appropriate therapies. We are dedicated to ensuring that patients fully understand their diagnosis and treatment options.

Patients are usually seen within one week of referral.

Developing Better Therapies through Research

Our research program in esophageal cancer is a multifaceted effort designed to better understand cancer biology, discover new therapies and improve treatment. In addition to our extensive research into smart drugs and immunotherapy, our physician-scientists are also conducting epidemiological research on the genetic basis of lung and esophageal cancers in families, which hopefully will lead to more targeted treatments based on genetics. We also have a special focus on treating elderly patients with thoracic cancers. Our research program in esophageal and all thoracic cancers is one of New England’s largest, allowing us to bring promising new treatments to patients as quickly as possible.

Clinical Trials

The Cancer Center is a leading provider of clinical trials in New England for esophageal cancer, making clinical trials a key treatment option for many patients. The goal of the clinical trial is to seek and answer scientific questions and to find better ways to prevent, diagnose, or treat cancer.

Find clinical trials for esophageal cancer.