In some cases, the surgeon may not feel he or she can remove all of the tumor, even if the tumor has not spread to distant organs. In this case, a combination of chemotherapy and radiation therapy may be used prior to surgery to help shrink the tumor. In patients who cannot undergo surgery, the combination of chemotherapy and radiation therapy alone may even be curative in some cases. The decision about whether to pursue surgery, chemotherapy and radiation, or chemotherapy and radiation followed by surgery is often a difficult one and the best treatment varies from patient to patient.

If a tumor blocks the esophagus, but cannot be removed, the surgeon may be able to create a bypass, a new pathway to the stomach. Often, surgeons will put in a percutaneous jejunostomy, also called a feeding tube, so that patients can receive nutrition directly into their stomach. In some cases, the surgeon can dilate (expand) the esophagus. This procedure may have to be repeated as the tumor grows. Sometimes, the doctor puts a tube into the esophagus to keep it open (called an esophageal stent). Recently, some surgeons have used a laser to destroy cancerous tissue and relieve blockages. Photodynamic therapy is another treatment that is sometimes used to relieve obstructions.

Patients who have had trouble eating and drinking may need intravenous (IV) feedings and fluids for several days before and after the operation, as well as antibiotics to prevent or treat infection. Patients are taught special coughing and breathing exercises to keep their lungs clear.

Radiation therapy uses X-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from thin plastic tubes containing radioactive material that are placed in the part of the body where cancer cells are found (internal radiation therapy).

Patients receiving radiation therapy may experience fatigue during the course of treatment, and the treated area may become red and dry. Radiation to the chest and neck can cause a dry, sore throat or a dry cough. Some patients experience shortness of breath during radiation therapy.

Chemotherapy uses drugs to kill cancer cells. The drugs are taken orally or given through a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body and can kill cancer cells throughout the body.