Oesophageal cancer treatment depends on where the tumour starts, whether it is squamous cell carcinoma or adenocarcinoma, and how far it has spread. Selected very early cancers can be removed through an endoscope. For locally advanced disease, treatment often starts with chemotherapy or chemoradiation, and surgery is part of the plan for some patients. When the cancer has spread to distant organs, treatment usually focuses on controlling the disease, improving swallowing, and maintaining quality of life. [1–3]
By Dr Raman Narang, Consultant Medical & Hemato-Oncologist, New Delhi
Last clinically reviewed [Insert review date]
A biopsy report may say “cancer of the lower oesophagus,” but the next step can differ considerably depending on what the tumour looks like under the microscope. One patient may be advised to have chemotherapy before and after surgery. Another may receive chemotherapy and radiation together as the main treatment. If you are seeking oesophageal cancer treatment in Delhi, ask your team to explain the exact tumour location, the biopsy subtype, and which of those findings determines the first step.
1. What are the symptoms and risk factors for oesophageal cancer?
The oesophagus is the tube that carries food from the throat to the stomach. A common symptom of oesophageal cancer is progressive difficulty swallowing, also called dysphagia. It may begin with solid foods such as roti or meat. As swallowing becomes more difficult, softer foods and liquids may also be affected. Other symptoms include painful swallowing, unexplained weight loss, discomfort behind the breastbone, or a persistent cough or hoarse voice. [2, 4]
| Subtype | Where it commonly starts | Risk factors |
|---|---|---|
| Squamous cell carcinoma | Often in the upper or middle oesophagus, although it can occur anywhere along it | Tobacco and alcohol use are important risk factors. |
| Adenocarcinoma | Usually in the lower oesophagus, often near the junction with the stomach | Long-standing acid reflux, Barrett’s oesophagus, and obesity are associated with higher risk. |
Swallowing difficulty has several possible causes. New or worsening difficulty swallowing warrants prompt assessment, even in someone with a history of reflux. Inability to swallow liquids or saliva requires urgent medical assessment. [2, 4, 5]
2. How is oesophageal cancer diagnosed and staged?
An upper gastrointestinal endoscopy with biopsy usually confirms the diagnosis. The endoscopy report records where the tumour starts, how far it extends, and how much it narrows the food pipe. The pathology report identifies whether it is squamous cell carcinoma or adenocarcinoma. For a tumour near the stomach, the team also establishes where it is centred because that can affect staging and treatment. [1, 2]
A contrast CT scan looks for involvement of nearby structures, lymph nodes, and distant organs. PET-CT may help detect spread that would change a plan for surgery or definitive chemoradiation. Endoscopic ultrasound can assess how deeply the cancer extends into the wall and evaluate nearby lymph nodes when that information would affect treatment and the procedure is feasible. [1, 2]
The assessment also includes weight loss, current food and fluid intake, and fitness for treatment. If someone is already struggling to swallow, nutrition support may need to start while staging is underway. The choice of feeding support depends partly on whether surgery is being planned. [1, 2]
3. How is early-stage oesophageal cancer treated?
A very superficial tumour confined to the inner lining of the oesophagus can sometimes be removed during endoscopy. The removed tissue is examined to determine the depth of invasion, whether the edges are clear, and whether cancer cells are present in small blood or lymphatic vessels. These findings help the team decide whether endoscopic treatment is sufficient or additional treatment should be discussed. [1, 2]
In early adenocarcinoma associated with Barrett’s oesophagus, the team may also recommend treating the remaining Barrett’s tissue after removing the visible lesion. If the tumour extends deeper into the wall, the chance of lymph node involvement generally increases. Oesophagectomy, an operation to remove the affected part of the oesophagus and nearby lymph nodes, may be appropriate for selected patients with early disease who are fit for surgery. [1, 2]
4. When are chemotherapy, radiation, and surgery used for locally advanced disease?
For locally advanced oesophageal cancer, the team considers the subtype, the tumour’s position, whether complete removal is feasible, and whether the patient can tolerate a major operation. These factors determine whether chemotherapy or chemoradiation comes first and whether surgery is planned. [1–3]
| Clinical situation | Treatment commonly discussed |
|---|---|
| Resectable, locally advanced adenocarcinoma of the oesophagus or oesophagogastric junction | Perioperative FLOT, a combination chemotherapy regimen given before and after surgery, is preferred for most patients fit enough to receive it. Chemoradiation before surgery remains an option in selected cases, including when FLOT is unsuitable. |
| Resectable, locally advanced squamous cell carcinoma | Chemoradiation followed by surgery is a standard approach for suitable patients. The team reassesses for distant spread and reviews fitness before operating. |
| Cervical oesophageal cancer, medically inoperable disease, or selected unresectable tumours without distant spread | Definitive chemoradiation may be the main treatment. This means chemotherapy and radiation are given together as the planned treatment, with no routine operation afterward. |
Why treat before surgery? Chemotherapy given before an operation starts treating cancer cells that may have travelled beyond the visible tumour. When radiation is combined with chemotherapy, it also treats the tumour and selected nearby areas. The subtype and location help determine which approach offers the most appropriate balance of cancer control, surgical feasibility, and side effects. [1–3]
When is immunotherapy considered after surgery? For eligible patients who receive chemoradiation before surgery, have a complete resection with clear margins, and still have cancer cells in the removed oesophagus or lymph nodes, adjuvant nivolumab may be considered. This evidence comes from CheckMate 577 and applies to that specific treatment sequence. [2, 6]
5. How is metastatic oesophageal cancer treated?
When oesophageal cancer has spread to distant organs, systemic treatment is usually the main approach. Treatment may include chemotherapy, immunotherapy, or targeted therapy. The choice depends on the cancer subtype, biomarker results, prior treatment, and overall health. The team also considers how much difficulty the patient is having with swallowing and whether that needs a separate intervention. [1–3]
| Test or treatment | How it can affect the plan |
|---|---|
| PD-L1 testing | Can help guide the use of immunotherapy in advanced squamous cell carcinoma and adenocarcinoma. The scoring method and relevant threshold depend on the regimen and applicable prescribing indication. |
| HER2 testing | Can identify some advanced adenocarcinomas, particularly at the oesophagogastric junction, for which HER2-directed treatment may be appropriate. Eligibility depends on the exact tumour site, test result, and regimen. |
| MSI or mismatch repair testing | Can identify a subgroup of advanced cancers for which immunotherapy may be particularly relevant. |
| Radiation, stenting, or nutrition support | Radiation can help relieve swallowing symptoms in selected patients. A stent may provide more immediate relief when appropriate. The choice depends on the severity of the blockage, how quickly relief is needed, and what other treatment is planned. |
For patients with severe dysphagia, a plan for fluids and nutrition is needed alongside the cancer treatment plan. Chemotherapy or immunotherapy can take time to improve swallowing. The team may discuss dietetic support, a feeding tube, radiation, or stenting based on the situation. [1, 2]
What I look for clinically before recommending treatment
I start with the endoscopy and biopsy reports. I want to know where the tumour is centred, whether it is squamous cell carcinoma or adenocarcinoma, and whether the scans show any finding that would change a plan for cure. I also ask what the patient can swallow today and how much weight they have lost. Those answers can determine whether the immediate priority is nutrition support, further staging, or starting cancer treatment.
How the next step is decided
| If the reports show… | The next discussion is about… |
|---|---|
| A superficial lesion that appears confined to the inner lining | Whether endoscopic removal can establish the full stage and provide treatment |
| Resectable, locally advanced adenocarcinoma | Chemotherapy around surgery and whether preoperative chemoradiation is appropriate |
| Locally advanced squamous cell carcinoma | Chemoradiation followed by surgery versus definitive chemoradiation |
| Residual cancer on pathology after preoperative chemoradiation and complete surgery | Eligibility for postoperative nivolumab |
| Distant spread | Biomarker testing, systemic treatment, and a plan to support swallowing and nutrition |
What to bring to an oesophageal cancer consultation in Delhi
- Upper GI endoscopy report, including the tumour’s location and any endoscopy images.
- Biopsy or surgical pathology report and details for obtaining the slides or tissue block.
- CT, PET-CT, or endoscopic ultrasound reports and the original scan images, if available.
- HER2, PD-L1, or MSI/MMR reports, if testing has already been done.
- Details of any previous chemotherapy, radiation, surgery, feeding tube, or oesophageal stent.
- A note of recent weight changes and which foods or liquids you can swallow comfortably.
Frequently asked questions
Can oesophageal cancer be treated without surgery?
Yes. Selected superficial cancers can be treated endoscopically. Definitive chemoradiation can be given with the aim of cure in selected patients, particularly in squamous cell carcinoma. The choice depends on the location, stage, and overall health. [1–3]
Why might I need chemotherapy before surgery if the cancer can be removed?
For many locally advanced tumours, treatment before surgery addresses cancer cells that may already be present beyond the visible tumour. The biopsy subtype helps determine whether chemotherapy alone or chemotherapy with radiation is used before the operation. [1–3]
Does a cancerous lymph node mean I have stage IV disease?
Involvement of a regional lymph node can occur in disease that is still treated with the aim of cure. The location of the nodes and whether there is distant spread determine the stage and treatment plan. [1, 2]
Should I have a stent if I cannot eat properly?
A stent may help selected patients swallow, especially when rapid symptom relief is the priority. If surgery or curative chemoradiation is being planned, the team should review the feeding options before placing a stent. [1, 2]
Before treatment, ask your team to write down the tumour location, biopsy subtype, stage, and treatment goal. If surgery is planned, ask what needs to happen before it. If swallowing is already difficult, ask how your nutrition and hydration will be supported while treatment takes effect.
This page is for general education. Individual treatment decisions require review of your pathology, scans, nutritional status, and overall health by your treating team.
Clinical references
- European Society for Medical Oncology. ESMO Living Guideline for Gastric and Oesophageal Cancer. Sections on diagnosis, molecular testing, and local and locoregional disease.
- SEOM–GEMCAD–TTD. Clinical Guideline for the Diagnosis and Treatment of Esophageal Cancer, 2025 Update.
- European Society for Medical Oncology. Clinical Practice Guideline Interim Update on Locally Advanced Oesophageal and Oesophagogastric Junction Adenocarcinoma and Metastatic Squamous-Cell Carcinoma.
- National Cancer Institute. Esophageal Cancer Symptoms.
- National Cancer Institute. Esophageal Cancer Prevention (PDQ), Health Professional Version.
- Kelly RJ and colleagues. Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer.CheckMate 577, New England Journal of Medicine, 2021.