Esophageal cancer is an aggressive type of cancer that’s often difficult to treat. It can potentially be cured without surgery, particularly if the cancer is caught in an early stage, but chances are low.

Esophageal cancer is the 8th most diagnosed cancer and the 6th leading cause of cancer death in the world. It tends to be hard to cure, especially without surgery. Surgery is the main curative technique for cancer contained in the esophagus.

Chemotherapy and radiation therapy can be performed without surgery, but this is usually recommended only for people who are not candidates for surgery. However, in a 2021 review, researchers found some evidence that omitting surgery may improve survival in people who have an initial complete response to chemotherapy.

Most people receive a diagnosis when their esophageal cancer is already advanced. Researchers continue to explore new treatment options for advanced esophageal cancer, such as targeted therapy and immunotherapy, which may prolong survival or increase the chances of curing the cancer.

Read on to learn more about the nonsurgical treatments for esophageal cancer and when they’re used.

Surgery is used to treat all stages of esophageal cancer and can be the main treatment for precancerous tumors and cancer contained in your esophagus.

Surgery is often combined with chemotherapy and radiation therapy. These treatments may be used alone if you’re not eligible for surgery.

Six types of standard treatment, other than surgery, are used to treat esophageal cancer. They are:

The treatment your doctor recommends will depend on factors such as the stage of your cancer and your overall health.

Electrocoagulation and laser therapy

Electrocoagulation and laser therapy are used to treat symptoms of esophageal cancer, but they don’t help cure the cancer.

Electrocoagulation involves using heat from an electric current to kill cancer cells. Laser therapy uses intense beams of light to destroy cancer cells.


Immunotherapy is a relatively new type of treatment that recruits cells in your immune system to attack cancer cells. It’s a promising treatment for late stage esophageal cancer that can’t be treated with surgery or for cancer that returns after treatment.

Doctors use a type of immunotherapy called immune checkpoint inhibitors to treat esophageal cancer. These drugs turn off “checkpoints” that limit immune system activity.

Chemotherapy and radiation therapy

Chemotherapy involves taking drugs, usually through an IV, that contain chemicals that kill cancer cells and other cells that replicate quickly. The amount of chemotherapy that can be administered is often limited by side effects.

Radiation therapy involves using concentrated X-rays or other types of radiation to kill cancer. Doctors are investigating a newer type of radiation therapy called proton therapy that might cause fewer side effects.

Chemotherapy and radiation therapy are used to treat all stages of esophageal cancer, often together with surgery.

Esophageal cancer treatment by stage

Here’s a look at how esophageal cancer treatment varies by stage:

stage 0 (precancerous)• surgery
• endoscopic surgery
stage 1• chemotherapy and radiation combined, followed by surgery
• surgery alone
stage 2• chemotherapy and radiation therapy combined, possibly followed by surgery
• surgery
• chemotherapy followed by surgery
stage 3chemotherapy and radiation therapy, possibly followed by surgery
stage 4• chemotherapy and radiation therapy combined, followed by surgery
• chemotherapy
• immunotherapy
• laser surgery or electrocoagulation to relieve symptoms
• an esophageal stent to relieve symptoms
• radiation therapy to relieve symptoms
• clinical trials of chemotherapy
• clinical trials of targeted therapies with chemotherapy
recurrent cancer• any of the above therapies to relieve symptoms
• immunotherapy, possibly combined with chemotherapy
• clinical trials

Esophageal cancer is rarely curable, especially in people who are not eligible for surgery or whose cancer is too advanced to be treated primarily surgically.

Traditional radiation therapy has high rates of complications due to the proximity of the esophagus to the heart and lungs. The most common complication is pericardial effusion, fluid accumulation in the sac around the heart.

Researchers are investigating new forms of radiation therapy, such as proton therapy, that may be able to lower the risk of toxicity to the heart and lungs. However, research examining the use of proton therapy to treat esophageal cancer is still limited, and few cancer centers have the necessary technology.

In a 2020 study, researchers found that the immunotherapy drug pembrolizumab (Keytruda) was more effective than chemotherapy at extending the overall survival of people with advanced esophageal cancer that had progressed after prior treatment.

In the study, the estimated 1-year overall survival rate was 43% in people who received pembrolizumab and 20% in people who received chemotherapy.

Research is also exploring newer treatments that may improve survival, such as combining targeted therapy drugs with chemotherapy. Targeted therapy drugs are medications that specifically target cancer cells and generally cause fewer side effects than chemotherapy drugs.

The survival rates for esophageal cancer have risen significantly over the past 50 years, but they remain relatively low. The 5-year relative survival rates for a person with esophageal cancer, based on data from 2012 to 2018 in the United States, are:

Stage5-year relative survival rate
all stages21%

In addition to diagnosis at an earlier stage of cancer, factors linked to better survival include:

  • spread to fewer lymph nodes
  • the ability to surgically remove all the cancer
  • positive response to chemotherapy given to shrink cancer before surgery

Esophageal cancer tends to be aggressive and difficult to treat. Surgery, often in combination with chemotherapy and radiation therapy, is generally recommended for cancer that hasn’t spread beyond the esophagus.

Some evidence suggests that surgery may not be necessary for people with early stage esophageal cancer that responds to chemotherapy.

The chances of curing esophageal cancer without surgery are very low. However, the development of new treatments such as immunotherapy and targeted therapies may help improve the outlook in the future.