- Alternative Therapies for the Treatment of Esophageal Cancer
- The potential of herb medicines in the treatment of esophageal cancer
- Chinese Herbal Medicine for Esophageal Cancer
- Foods that Help Fight Cancer: A Focus on Esophageal Cancer
- Table 1: Substances that demonstrate reduction of dysplasia or precancerous lesions, with specific risk factors
- Table 2: Food and Nutrient Associations with Esophageal Carcinoma
- Plant-Based Foods
- Micro- and Macro-nutrients
- Esophageal Cancer
- About Esophageal Cancer
- Causes and Risk Factors
- Early Detection, Diagnosis, and Staging
- About Alternative/Natural Treatment of Esophageal Cancer
Alternative Therapies for the Treatment of Esophageal Cancer
If conventional cancer treatment methods are not effectively treating your esophageal cancer, or if you want to try alternative therapies to alleviate your esophageal cancer symptoms, talk to your doctor about CAM, or complementary and alternative medicine. Such therapies can be used to supplement or replace conventional esophageal cancer treatment methods.
CAM for Esophageal Cancer
In addition to conventional esophageal cancer treatments like surgery, radiation, and chemotherapy, there are several types of therapy that can help treat or manage symptoms and side effects of esophageal cancer and cancer treatment. Few of these treatments have been as rigorously tested as traditional therapies, but they appear safe when provided by trained practioners. Whether these alternative therapies are beneficial for a number of different cancers is a question being investigated in a wide range of studies funded by the National Center for Complementary and Alternative Medicine. These CAM therapies include:
- Acupuncture. Acupuncture is an ancient practice in which very thin needles are placed into the skin at particular points on the body. Acupuncture can help alleviate symptoms and side effects of esophageal cancer and cancer treatment such as nausea, stress, and pain.
- Massage. Massage techniques vary from gentle massaging of the muscles to deep- pressure massages. Massage can help relieve pain, anxiety, and stress by helping the body to relax. Massage may also help patients manage fatigue, a common side effect of esophageal cancer and cancer treatment.
- Meditation. Regular meditation, practicing deep-breathing techniques, and using visualization techniques of peaceful and happy images, can help battle many side effects of esophageal cancer and cancer treatment. These techniques may help relieve stress and anxiety, insomnia, pain, and fatigue.
- Aromatherapy. Scents can affect your mental health and emotional well-being. Aromatherapy, the therapeutic use of scented plant extracts, may help you feel more relaxed, control nausea, help you sleep, and ease stress and anxiety.
- Yoga and tai chi. Exercise is an important part of your cancer treatment, and yoga and tai chi can help you to get some activity while combating the side effects of esophageal cancer. Yoga and tai chi, which involve slow, gentle stretches along with deep breathing, can help you remain agile, ease stress, and help you sleep.
CAM: New Research
There is much research being done to find new ways to manage and treat esophageal cancer. In addition to conventional methods, The National Cancer Institute and the National Center for Complementary and Alternative Medicine are working together to research new methods of treating different kinds of cancer with CAM therapies, and new ways to use existing CAM methods. Current clinical trials are studying the effects of acupuncture and massage, adding mistletoe extract to traditional therapy for the treatment of some tumors, and adding shark cartilage to traditional therapy for certain types of lung cancers.
They are also studying the use of hyperbaric oxygen therapy on some cancer patients who have had their larynx removed. Many of these studies use CAM methods in addition to conventional treatments; others are comparing the effectiveness of the treatments against each other.
For most people, complementary esophageal cancer treatments such as massage, meditation, and exercise offer little risk and significant benefits — they can help relieve symptoms and offer a better quality of life. New treatments are still being researched, and may be available to you now through clinical trials. Of course, before trying any type of treatment, either in addition to or instead of conventional cancer treatment, always talk to your doctor about what is safe and recommended.
If your doctor says it’s safe, take the alternative route and get a massage if you suffer from fatigue and pain. Sign up for a yoga class to help you sleep and to relieve body pain. The better you feel and the more energy you have, the better equipped you’ll be to beat esophageal cancer.
Learn more in the Everyday Health Esophageal Cancer Center.
The potential of herb medicines in the treatment of esophageal cancer
Esophageal cancer (EC) is one of common malignant neoplasms in the world. Due to dietary habits, environmental factors, stress and so on, larger numbers of person are diagnose with EC every year. Currently, the clinical treatment of EC mainly includes radiotherapy, chemotherapy, surgical resection alone or combined strategy. These treatment options are insufficient and often associated with a number of side effects. Medicinal herbs containing Traditional Chinese Medicine (TCM) have been used as an adjunct treatment for alleviating the side effects of chemotherapy or radiotherapy and for improving the quality of life of cancer patients. The monomer compounds obtained from medicinal herbs also exhibit potential anti-cancer activity against various type cancer cell lines including esophageal cancer, and have the ability to enhance cancer cells sensitizing to chemotherapy or radiotherapy. In this review, we summarize some monomers and composite of medicinal herbs with anti-cancer activity for EC, and elaborate their mechanism of action. Understanding the exact mechanism of their actions may provide valuable information for their possible application in cancer therapy and prevention. This is beneficial for the use and development of medicinal herbs for diseases therapy in the future.
Eating with esophageal cancer can present difficulties for patients before, during, and after treatment. Patients may go through radiation therapy, chemotherapy, surgery, or any combination of these in an effort to eliminate or beat back the cancer. Esophageal cancer and its treatment can also cause the esophagus to narrow and/or become dry, sore, and irritated, which may make it painful to swallow. As a result, patients can become more susceptible to weight loss and fatigue due to lack of proper nutrition.
Here are some tips on what and how to eat when living with esophageal cancer.
Maintain a soft diet
Sticking to a soft diet will allow you to eat with more comfort and ease. Liquid nutrition like soups and smoothies are tasty and easy to blend. To soften foods, try adding sauces and gravies or use a slow cooker to help break down meats and vegetables. Other healthful ideas include Greek yogurt, protein-rich puddings, eggs, avocado, and fish.
Eating healthfully is important, but during treatment it is vital to make sure you eat whatever appeals to you whenever you can, whether that be yogurt, pudding, or ice cream.
Highly acidic or spicy foods, foods with sharp pointed edges, or extremely hot or cold foods. Fluids may be irritating, especially during certain types of treatments. Use caution with foods like tough cuts of meat, doughy bread, alcohol, citrus juices or sauces, and piping hot beverages. It’s also a good idea to try cooking vegetables, as opposed to eating salads with raw vegetables.
Eat calorie-dense, high-protein foods
To limit unwanted weight loss during treatment, increase your calorie intake with everyday foods. For example, add protein powders to shakes, oatmeal and other liquids, or drink pre-made liquid supplements. For extra calories, add ingredients like avocado, nut butters, hummus and olive oil as often as possible; mix an egg or cheese into mashed potatoes, or peanut butter and banana into oatmeal. Aim for smaller, more frequent “mini-meals,” versus eating three larger meals per day.
For smoothie recipes, check out Dana-Farber’s Health Library.
- Try blending your meals.
- Stay well hydrated throughout the day. Aim to sip on fluids slowly, and limit amounts consumed during meals (drink more in between).
- Eat small, frequent meals and snacks.
- Sit upright or at 45 degrees while eating and for at least 30 minutes following a meal.
- Eat slowly and chew food well.
- Walk to help with digestion and fight fatigue.
- Limit concentrated sweets, such as desserts, juices, candy, sugar sweetened beverages, and dilute liquids that contain significant amounts of sugar. This can help avoid dumping syndrome, when foods move too quickly through the digestive system and lead to diarrhea, cramping, or sweating following a meal.
For customized plans and recommendations, see an oncology dietitian for help. It is important to make sure that your body is getting the necessary nutrients it needs to function properly and to feel your best. Learn more from Dana-Farber’s Nutrition Services.
Chinese Herbal Medicine for Esophageal Cancer
By Concepta Merry, MB, BCh, BAO, BA
Associate Professor, Global Health, School of Medicine, Trinity College Dublin; Integrative Medicine Fellow,
University of Arizona, Tucson
Dr. Merry reports no financial relationships relevant to this field of study.
SYNOPSIS: Although Chinese herbal medicine probably does not slow disease progression or improve survival in esophageal cancer patients, it may improve quality of life and reduce adverse effects of radiotherapy and chemotherapy.
SOURCE: Chen X, et al. Chinese medicinal herbs for oesophageal cancer. Cochrane Database Syst Rev 2016 Jan 22; CD004520.
- This Cochrane review found that Chinese herbal medicines for esophageal cancer may help improve quality of life and stave off the side effects of chemotherapy and radiation, but not benefit cancer overall.
Esophageal cancer ranks as the seventh leading cause of cancer deaths globally.1 Triggers for the disease are largely lifestyle-related and include nutrition,2 cigarette smoking,2 alcohol consumption,3 or drinking hot beverages.4 Traditional Chinese herbal medicine is sometimes used for advanced esophageal cancer.
There are 3813 published studies examining the use of Chinese herbal medicine in esophageal cancer.5 Two possible reasons for the high level of interest in Chinese herbal medicine for esophageal cancer are: 1) Esophageal cancer is relatively common in northern China,1 and 2) A limited number of effective allopathic treatment options for advanced esophageal cancer are available.
Several papers have suggested possible benefits of Chinese herbal medicines in esophageal cancer. For example, herbs such as mugwort (Artemisia annua, qinghaosu)6 and Hedyotis diffusa (Oldenlandia diffusa, spreading hedyotis)7 may play a role in inhibiting tumor growth.
Chen et al reviewed the efficacy and tolerability of Chinese herbal medicine when added to chemotherapy or radiotherapy for patients with esophageal cancer.5 They assessed 3813 published studies and even phoned authors to get more detail. Only 9 of the 3813 studies were deemed methodologically sound and of high enough quality to be included in the final Cochrane review. Overall, the authors found no evidence that Chinese herbal medicine is an effective adjunctive treatment for esophageal cancer. However, they concluded that Chinese herbal medicine probably is beneficial in terms of quality of life and increased tolerance of the side effects caused by radiotherapy or chemotherapy.
The Chinese herbal medicines studied were tailored to the root cause of the illness for each individual patient, which meant using a wide variety of treatments. Most Chinese herbal medicines prescribed consisted of a variety of different herbs and not a single herb. This variability would mean that a large number of patients would have to be studied to draw any reliable conclusions using the randomized, controlled trial model. The reviewers also commented that the Chinese physicians appeared to “misunderstand” the importance of random allocation in the research process. Finally, no placebo was used in any of the control groups.
Larger, more rigorously designed studies are needed to detect clinically important effects and minimize the risk of bias. Perhaps another conclusion could be that the randomized, controlled trial is not the ideal way to evaluate some types of treatments, especially those stemming from whole medical systems or individualized treatments.
- World Cancer Research Fund International. Oesophageal cancer statistics. Available at: http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/oesophageal-cancer-statistics. Accessed Feb. 12, 2016.
- Broitman SA, Vitale JJ. Ethanolic beverage consumption, cigarette smoking, nutritional status, and digestive tract cancers. Semin Oncol 1983;10:322-329.
- Tuyns AJ, et al. Esophageal cancer and alcohol consumption: Importance of type of beverage. Int J Cancer 1979;23:443-447.
- Victora CG, et al. Hot beverage and oesophageal cancer in southern Brazil: A case-control study. Int J Cancer 1987;39:710-716.
- Chen X, et al. Chinese medicinal herbs for oesophageal cancer. Cochrane Database Syst Rev 2016 Jan 22; CD004520.
- Chen HH, et al. Inhibition of human cancer cell line growth and human umbilical vein endothelial cell angiogenesis by artemisinin derivatives in vitro. Pharmacol Res 2003;48:231-236.
- Zhou J, Wang Y. Chinese herbs combined with local chemotherapy and microwave for oesophageal cancer. Henan J Trad Chinese Med 1996;16:365.
Foods that Help Fight Cancer: A Focus on Esophageal Cancer
Esophageal cancer (EC) is the eighth-most-common cancer worldwide, with two common sub-types — squamous cell carcinoma (SCC) and adenocarcinoma (AC). Several risk factors have been associated with this cancer, including smoking, alcohol consumption, gastroesophageal reflux disease (GERD) and Barrett’s esophagus (Table 1). Many studies have implicated diet and nutrition in risk of these cancers. However, dietary behaviors are complex and certain dietary habits can be correlated with other health behaviors as well as demographic factors, hence definitive conclusions are challenging. Here, we attempt to review the literature about dietary components that have been associated with either increased or decreased risk of esophageal cancer.
Table 1: Substances that demonstrate reduction of dysplasia or precancerous lesions, with specific risk factors
|GERD||Vitamins A, C and E|
|Barrett’s esophagus||Fiber, dark-green vegetables, beta-carotene, vitamins A, C and E|
Most reports demonstrating any associations are retrospective, with very few prospective studies. In addition, there are limited data regarding the exact quantities consumed to achieve these associations. Studies on single foods and nutrients found to have a beneficial effect include non-starchy vegetables, fruits, and foods containing beta-carotene and vitamin C. Other findings demonstrate a positive association between esophageal cancer and milk, soups, red meat, and butter, and an inverse relationship with white meat, fish, raw vegetables and fruits. These findings are summarized in Table 2.
Table 2: Food and Nutrient Associations with Esophageal Carcinoma
|Increased Risk||Decreased Risk||No Risk Association|
|Squamous Cell Carcinoma||↓ Folate
Red meat: ↓ Poultry
Red and processed meats in men
Green tea – in females
|Adenocarcinoma|| Meats (especially processed meats)
High dairy fat
|Regular raw fruit and vegetables intake
Vitamin B6 consumption
Green tea and coffee
Polyunsaturated fats if BMI normal
Red meat has demonstrated a positive association with EC in multiple studies. Methods of cooking at high temperature, as well as the heme iron present in red meat, are thought to contribute to the risk. The latter contributes to endogenous formation of N-nitroso compounds. White meat has a much lower association with esophageal cancers, likely due to the lower heme iron content. An increased red-meat-to-poultry ratio has been correlated with an increased risk of SCC.
Processed meat intake is probably associated with total EC risk. These foods are rich in N-Nitroso compounds, and cooking can also lead to the generation of heterocyclic amines (HCA) and polycyclic aromatic hydrocarbons (PAH), thus increasing the potential of mutagenesis.
There are limited studies investigating the relationship between esophageal cancer and components of meat or compounds formed during cooking or processing of meat. It has been hypothesized that mutagenic HCAs and PAHs generated from cooking meats at high temperature methods, such as pan frying or grilling over an open flame, could contribute to EC risk.
Fish consumption as a risk factor in esophageal carcinogenesis remains poorly studied. Studies have suggested it plays little or no direct role in risk reduction. However, incorporation of fish and other lean meats may suggest decreased consumption of red and preserved meats, leading to a perceived protective effect.
Fruit and vegetable content in diet has been suggested to be inversely associated with risk of esophageal cancer. The protective effects are thought to be mediated by fiber, lutein and folate. The association appears to be stronger for adenocarcinomas than for squamous cell carcinomas. Other studies have demonstrated a fruit-and-vegetable-rich diet was associated with a significant decrease in SCC.
Dietary fiber has several anticarcinogenic effects and is thought to be protective against esophageal cancer. Dietary fiber is thought to reduce carcinogenesis by modulating gastroesophageal reflux and aiding with weight control.
Teas have been thought to demonstrate a protective effect, as their components often exhibit antioxidative, anti-inflammatory, antimicrobial and immunostimulant effects in vitro. Tea administration could inhibit the N-nitroso-compound-induced esophageal tumorigenesis.
Coffee contains numerous anticarcinogenic components. Caffeine suppresses cyclin-dependent kinase-4-induced cell growth. Other components, cafestol and kahweol, could inhibit DNA damage. These theories still warrant further elucidation. Maté is a tea-like infusion made from the leaves of the perennial tree common in South American countries. A meta-analysis demonstrated an increased risk of cancer with maté. There were multiple confounders, but the role in pathogenesis was attributed to thermal injury, as the association was not seen with cold beverages containing maté. Consumption of green tea, as well as coffee, has demonstrated a protective effect on EC; however, black tea consumption has no association with any kind of EC.
Micro- and Macro-nutrients
Folate is a water-soluble B vitamin occurring naturally in dark-green, leafy vegetables, legumes and citrus fruits. It is significantly associated with a reduced risk of EC. Folate deficiency is implicated in carcinogenesis via effects on DNA synthesis, repair, and methylation. Efficient folate metabolism requires other B vitamins and is adversely affected by smoking and alcohol consumption.
N-nitroso compounds are believed to act as pro-oxidants and catalyze lipid peroxidation resulting in DNA damage in tissues. Processed foods and metabolism of heme iron are potential sources of N-nitroso compounds.
Dietary fat intake has been reported to have an association with EC risk, although results have been inconsistent. One prospective study found no associations between dietary fat intake and EC. The study did, however, find a protective effect of polyunsaturated fat intake in subjects with a normal BMI in AC. Another study showed that diets high in dairy fat were associated with an increased meat-and-fat pattern that increased the risk of AC.
Carbohydrates have been studied with respect to their glycemic load (GL) and glycemic index (GI) and have a possible positive association with EC and SCC, in particular. It is postulated that diets with a high GI contain rapidly absorbable carbohydrates that result in high blood glucose levels and consequently increased insulin demand. This inadvertently increased Insulin Like Growth Factor 1 (IGF1), which has been associated with potentiating several cancers.
While single foods have demonstrated either a protective effect or increased risk, diets are more complex and encompass many of the previously noted food groups. It may be more beneficial to study whole diets to learn what role diet can play in reduction of risk for esophageal SCC or AC. A few studies have already demonstrated a reduced risk of cancer in those who follow Mediterranean diets as well as diets based on the Healthy Eating Index (HEI) and Dietary Guidelines for Americans Adherence Index (DGAI) 2005. However, more prospective studies are needed.
- Xiao Q. Freedman ND. Ren J. Hollenbeck AR. Abnet CC. Park Y. (2014) Intakes of folate, methionine, vitamin B6, and vitamin B12 with risk of esophageal and gastric cancer in a large cohort study. British Journal of Cancer. 110(5):1328-33
- Eslamian G. Jessri M. Hajizadeh B. Ibiebele TI. Rashidkhani B. (2013) Higher glycemic index and glycemic load diet is associated with increased risk of esophageal squamous cell carcinoma: a case-control study. Nutrition Research. 33(9):719-25
- Zhu HC. Yang X. Xu LP. Zhao LJ. Tao GZ. Zhang C. Qin Q. Cai J. Ma JX. Mao WD. Zhang XZ. Cheng HY. Sun XC. (2014) Meat consumption is associated with esophageal cancer risk in a meat- and cancer-histological-type dependent manner. Digestive Diseases & Sciences. 59(3):664-73
- Navarro Silvera SA. Mayne ST. Gammon MD. Vaughan TL. Chow WH. Dubin JA. Dubrow R. Stanford JL. West AB. Rotterdam H. Blot WJ. Risch HA. (2014) Diet and lifestyle factors and risk of subtypes of esophageal and gastric cancers: classification tree analysis. Annals of Epidemiology. 24(1):50-7
- Jiao L. Kramer JR. Rugge M. Parente P. Verstovsek G. Alsarraj A. El-Serag HB. (2013) Dietary intake of vegetables, folate, and antioxidants and the risk of Barrett’s esophagus. Cancer Causes & Control. 24(5):1005-14
- Sharp L. Carsin AE. Cantwell MM. Anderson LA. Murray LJ. (2013) Intakes of dietary folate and other B vitamins are associated with risks of esophageal adenocarcinoma, Barrett’s esophagus, and reflux esophagitis. Journal of Nutrition. 143(12):1966-73
- Choi Y. Song S. Song Y. Lee JE. (2013) Consumption of red and processed meat and esophageal cancer risk: meta-analysis. World Journal of Gastroenterology. 19(7):1020-9
- Vermeulen E. Zamora-Ros R. Duell EJ. Lujan-Barroso L. Boeing H. Aleksandrova K. Bueno-de-Mesquita HB. Scalbert A. Romieu I. Fedirko V. Touillaud M. Fagherazzi G. Perquier F. Molina-Montes E. Chirlaque MD. Vicente Arguelles M. Amiano P. Barricarte A. Pala V. Mattiello A. Saieva C. Tumino R. Ricceri F. Trichopoulou A. Vasilopoulou E. Ziara G. Crowe FL. Khaw KT. Wareham NJ. Lukanova A. Grote VA. Tjonneland A. Halkjaer J. Bredsdorff L. Overvad K. Siersema PD. Peeters PH. May AM. Weiderpass E. Skeie G. Hjartaker A. Landberg R. Johansson I. Sonestedt E. Ericson U. Riboli E. Gonzalez CA. (2013) Dietary flavonoid intake and esophageal cancer risk in the European prospective investigation into cancer and nutrition cohort. American Journal of Epidemiology. 178(4):570-81
- Coleman HG. Murray LJ. Hicks B. Bhat SK. Kubo A. Corley DA. Cardwell CR. Cantwell MM.(2013) Dietary fiber and the risk of precancerous lesions and cancer of the esophagus: a systematic review and meta-analysis. Nutrition Reviews. 71(7):474-82
- Salehi M. Moradi-Lakeh M. Salehi MH. Nojomi M. Kolahdooz F. (2013) Meat, fish, and esophageal cancer risk: a systematic review and dose-response meta-analysis. Nutrition Reviews. 71(5):257-67
- Coleman HG. Murray LJ. Hicks B. Bhat SK. Kubo A. Corley DA. Cardwell CR. Cantwell MM. (2013) Fish consumption and risk of esophageal cancer and its subtypes: a systematic review and meta-analysis of observational studies. European Journal of Clinical Nutrition. 67(2):147-54
- Lin Y. Wolk A. Hakansson N. Lagergren J. Lu Y. (2013) Dietary intake of lignans and risk of esophageal and gastric adenocarcinoma: a cohort study in Sweden. Cancer Epidemiology, Biomarkers & Prevention. 22(2):308-12
- Andrici J. Eslick GD. (2013) Mate consumption and the risk of esophageal squamous cell carcinoma: a meta-analysis. Diseases of the Esophagus. 26(8):807-16
- Li WQ. Park Y. Wu JW. Ren JS. Goldstein AM. (2013) Taylor PR. Hollenbeck AR. Freedman ND. Abnet CC. Index-based dietary patterns and risk of esophageal and gastric cancer in a large cohort study. Clinical Gastroenterology & Hepatology. 11(9):1130-1136.e2
- Sang LX. Chang B. Li XH. Jiang M. (2013) Green tea consumption and risk of esophageal cancer: a meta-analysis of published epidemiological studies. Nutrition & Cancer. 65(6):802-12
- Jakszyn P. Lujan-Barroso L. Agudo A. Bueno-de-Mesquita HB. Molina E. Sanchez MJ. Fonseca-Nunes A. Siersema PD. Matiello A. Tumino R. Saieva C. Pala V. Vineis P. Boutron-Ruault MC. Racine A. Bastide N. Travis RC. Khaw KT. Riboli E. Murphy N. Vergnaud AC. Trichopoulou A. Valanou E. Oikonomidou E. Weiderpass E. Skeie G. Johansen D. Lindkvist B. Johansson M. Duarte-Salles T. Freisling H. Barricarte A. Huerta JM. Amiano P. Tjonneland A. Overvad K. Kuehn T. Grote V. Boeing H. Peeters PH. Gonzalez CA. (2013) Meat and heme iron intake and esophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study. International Journal of Cancer. 133(11):2744-50
- Liu J. Wang J. Leng Y. Lv C. (2013) Intake of fruit and vegetables and risk of esophageal squamous cell carcinoma: a meta-analysis of observational studies. International Journal of Cancer. 133(2):473-85
- Ibiebele TI. Hughes MC. Nagle CM. Bain CJ. Whiteman DC. Webb PM. (2013) Dietary antioxidants and risk of Barrett’s esophagus and adenocarcinoma of the esophagus in an Australian population. International Journal of Cancer. 133(1):214-24
- Zheng JS. Yang J. Fu YQ. Huang T. Huang YJ. Li D. (2013) Effects of green tea, black tea, and coffee consumption on the risk of esophageal cancer: a systematic review and meta-analysis of observational studies. Nutrition & Cancer. 65(1):1-16
- Jessri M. Rashidkhani B. Hajizadeh B. Jacques PF. (2012) Adherence to Mediterranean-style dietary pattern and risk of esophageal squamous cell carcinoma: a case-control study in Iran. Journal of the American College of Nutrition. 31(5):338-51
- Zheng P. Zheng HM. Deng XM. Zhang YD. (2012) Green tea consumption and risk of esophageal cancer: a meta-analysis of epidemiologic studies. BMC Gastroenterology. 12:165
- Lukic M. Segec A. Segec I. Pinotic L. Pinotic K. Atalic B. Solic K. Vcev A. (2012) The impact of the vitamins A, C and E in the prevention of gastroesophageal reflux disease, Barrett’s oesophagus and oesophageal adenocarcinoma. Collegium Antropologicum. 36(3):867-72
- Song Q. Wang X. Yu IT. Huang C. Zhou X. Li J. Wang D. (2012) Processed food consumption and risk of esophageal squamous cell carcinoma: A case-control study in a high risk area. Cancer Science. 103(11):2007-11
- Jeurnink SM. Buchner FL. Bueno-de-Mesquita HB. Siersema PD. Boshuizen HC. Numans ME. Dahm CC. Overvad K. Tjonneland A. Roswall N. Clavel-Chapelon F. Boutron-Ruault MC. Morois S. Kaaks R. Teucher B. Boeing H. Buijsse B. Trichopoulou A. Benetou V. Zylis D. Palli D. Sieri S. Vineis P. Tumino R. Panico S. Ocke MC. Peeters PH. Skeie G. Brustad M. Lund E. Sanchez-Cantalejo E. Navarro C. Amiano P. Ardanaz E. Ramon Quiros J. Hallmans G. Johansson I. Lindkvist B. Regner S. Khaw KT. Wareham N. Key TJ. Slimani N. Norat T. Vergnaud AC. Romaguera D. Gonzalez CA. (2012) Variety in vegetable and fruit consumption and the risk of gastric and esophageal cancer in the European Prospective Investigation into Cancer and Nutrition. International Journal of Cancer. 131(6):E963-73
- O’Doherty MG. Freedman ND. Hollenbeck AR. Schatzkin A. Murray LJ. Cantwell MM. Abnet CC. (2012) Association of dietary fat intakes with risk of esophageal and gastric cancer in the NIH-AARP diet and health study. International Journal of Cancer. 131(6):1376-87
- Ibiebele TI. Hughes MC. Whiteman DC. Webb PM. (2012) Dietary patterns and risk of oesophageal cancers: a population-based case-control study. British Journal of Nutrition. 107(8):1207-16
- Bravi F. Edefonti V. Randi G. Garavello W. La Vecchia C. Ferraroni M. Talamini R. Franceschi S. Decarli A. (2012) Dietary patterns and the risk of esophageal cancer. Annals of Oncology. 23(3):765-70
- Berretta M. Lleshi A. Fisichella R. Berretta S. Basile F. Li Volti G. Bolognese A. Biondi A. De Paoli P. Tirelli U. Cappellani A. (2012) The role of nutrition in the development of esophageal cancer: what do we know? Frontiers in Bioscience. 4:351-7
- Jessri M. Rashidkhani B. Hajizadeh B. Jessri M. Kreiger N. Bajdik CD. (2011) Adherence to dietary recommendations and risk of esophageal squamous cell carcinoma: a case-control study in Iran. Annals of Nutrition & Metabolism. 59(2-4):166-75
Preoperative Chemotherapy Becoming Standard in Japan for Stage II/III Disease
We do have several modalities available to treat this devastating disease. Unfortunately, the results of esophagectomies are still unsatisfactory when compared to the results of surgical treatment for gastric cancer or colon cancer, which means a promising novel strategy for this disease is needed. How do Japanese doctors apply a trimodality approach?
Most current approaches are not considered standard, despite the results of many clinical trials. Patients with stage T12N0 disease are treated with surgical resection alone. An esophagectomy with three-field lymph node dissection is considered standard therapy for esophageal cancer. Indeed, the use of three-field lymph node dissection has improved survival for esophageal cancer patients in many Japanese institutions. Transthoracic esophagectomy with two-field resection is recommended for intrathoracic squamous-cell carcinoma.9 Should we employ preoperative chemotherapy or chemoradiotherapy to improve surgical outcomes?
Most patients with T3 or N1/M1a disease should be evaluated for induction therapy followed by surgery.10 The usefulness of neoadjuvant chemotherapy has been examined in two large-scale randomized clinical trials.11,12 However, the results of these two studies differed. Other data on preoperative chemotherapy are also conflicting. Thus, the usefulness of preoperative chemotherapy is controversial. One meta-analysis of randomized clinical trials comparing neoadjuvant chemotherapy and surgery to surgery alone failed to demonstrate a survival benefit for the combined modality arm.13,14
Although the effectiveness of neoadjuvant chemotherapy was not supported by these trials, promising data were reported by the Japanese Clinical Oncology Group (JCOG) in 2008. Patients with locally advanced squamous-cell carcinoma of the esophagus were randomly allocated to surgery followed by chemotherapy or to neoadjuvant chemotherapy with surgery. The pre- and post-chemotherapy regimens used the same protocol, with cisplatin and 5-fluorouracil (5-FU). JCOG reported that preoperative chemotherapy improved overall survival. Accordingly, new randomized clinical trials must be conducted in Japan using neoadjuvant chemotherapy as a standard arm instead of surgery alone.15
On the other hand, definitive chemoradiotherapy has recently shown promise as a treatment modality for resectable esophageal cancer, with data suggesting potential efficacy of combination therapy with chemoradiotherapy and esophagectomy. In fact, preoperative chemoradiotherapy for resectable esophageal cancer is becoming a common therapy in Europe and North America.16,17
Randomized trials comparing induction chemotherapy and radiotherapy followed by surgery compared to surgery alone in patients with potentially resectable esophageal cancer demonstrate conflicting results. A meta-analysis of six published randomized trials comparing preoperative chemotherapy and radiation therapy followed by surgery to surgery alone revealed that the pooled estimate of treatment effects was statistically significant in favor of preoperative chemoradiotherapy followed by surgery for overall survival.18 The authors ackowleded, however, that exclusion of the controversial Walsh trial19 led to a loss of statistical significance between groups. In addition, the risk of postoperative mortality was higher in the trimodality group.
Another meta-analysis was performed to determine survival and treatment-related mortality associated with preoperative treatment in patients with resectable esophageal cancer.20 Eleven randomized trials involving 2,311 patients were analyzed, demonstrating that preoperative chemotherapy improved 2-year survival compared with surgery alone; the absolute difference was 4.4% (95% confidence interval , 3%–8.5%). For combined chemoradiotherapy, the increase in 2-year survival was 6.4% (95% CI, −1.2%–14.0%). Treatment-related mortality increased by 1.7% with neoadjuvant chemotherapy (95% CI, −.9%–4.3%) and by 3.4% with chemoradiotherapy (95%CI, −.1%–7.3%), compared with surgery alone.
A meta-analysis conducted by Urschel and colleagues assessed nine randomized trials with a total accrual of more than 1,000 patients.21 This analysis found that induction chemoradiotherapy followed by surgery was associated with improved 3-year survival and reduced local and regional recurrence compared to surgery alone.
There appears to be an increase in treatment-related mortality for patients who receive induction chemotherapy and radiotherapy. Due to the lack of consensus regarding the use of induction chemotherapy prior to surgery in patients with potentially resectable esophageal cancer, the National Comprehensive Cancer Network (NCCN) treatment guidelines support the use of induction therapy only in established clinical trial protocols (
In Japan, preoperative chemotherapy or chemoradiotherapy with planned esophagectomy represents one treatment option, while definitive chemoradiotherapy with salvage esophagectomy represents another. Patients who are not considered surgical candidates, for oncologic or physiologic reasons, are considered for chemotherapy and radiotherapy.
About Esophageal Cancer
Esophageal cancer occurs in the esophagus, the long tube through which food is pushed down your throat and into your stomach. This form of cancer can appear anywhere in the esophagus, though it more commonly starts in the cells lining the esophagus. Esophageal cancer is also more prominent in men than women and remains the sixth most common cancer-related cause of death in the world.
Esophageal cancer is categorized based on the cells it affects. The most common type of esophageal cancer in the U.S., adenocarcinoma affects the cells of the mucus-secreting glands in the esophagus and typically starts in the lower part of the esophagus. Squamous cell carcinoma – Squamous cell carcinoma is the most common form of esophageal cancer worldwide and affects the linings of the esophagus, most often in the upper and middle portions of the esophagus.
Causes and Risk Factors
All forms of cancer come from genetic mutations that cause the abnormal and uncontrolled growth of cells, which accumulate and eventually form tumors that may spread to other parts of the body.
The exact cause of this mutation is unknown, but there are certain factors known to increase your risk of getting the disease. One of the most widely known contributors to esophageal cancer is smoking, which introduces tobacco and other carcinogens into your throat and esophagus.
Chronic irritation of the esophagus can also contribute to cellular changes that may result in esophageal cancer. This is often why conditions like gastroesophageal reflux disease (GERD) and Barrett’s esophagus are common risk factors of esophageal cancer. GERD is a chronic digestive condition that results in persistent acid reflux, during which stomach acids may travel up into the esophagus, resulting in irritation and heartburn.
Early Detection, Diagnosis, and Staging
In its early stages, esophageal cancer may not present any noticeable symptoms. As the cancer spreads and progresses, some common signs and symptoms may include:
- Problems swallowing (dysphagia)
- Unintended weight loss
- Pressure, pain, or burning in the chest
- Indigestion or heartburn
- Persistent hoarseness or coughing
Diagnosis may rely on various tests. This often includes an endoscopy, during which the oncologists pass a flexible tube equipped with a video lens into your esophagus. The doctor can search your esophagus for cancer and other areas of irritation or abnormality. The doctor may also be able to take a tissue sample (biopsy) using the endoscope. This sample is then sent to a lab for further analysis.
The oncologists use information from these tests to determine the stage of your esophageal cancer. There are five stages (0 to IV) with higher numbers designating cancer that has advanced and spread to other organs or parts of the body.
About Alternative/Natural Treatment of Esophageal Cancer
Typical treatments for the disease in cancer patients include surgery to remove the tumor or part of the esophagus as well as chemotherapy and radiation therapy. While these treatments may be effective and kill cancer cells, they often come at the price of negative side effects. Chemotherapy and radiation therapy, in particular, can cause damage to healthy tissue. With alternative treatments, you can mitigate any negative side effects and support your continued recovery through natural solutions that will not hurt your body.
At Immunity Therapy Center, you can find a wide range of alternative esophageal treatment options for your esophageal cancer. Our team is committed to developing attentive care and personalized treatment plans and helping you choose options that work based on your personal preferences, cancer stage, and health needs. Regular one-on-one consultations with Dr. Bautista help to guide your treatment and allow for adjustments to your program as necessary. Our focus is on personal attention and relationships, ensuring that you are treated as a human being and not a chart or diagnosis. Contact us today to learn more or to receive a custom treatment plan.
Therapies we use