Esophageal & GEJ Cancer — Patient Guide (2025)

The Big Picture

Treatment for esophageal and gastroesophageal junction (GEJ) cancer is no longer “one size fits all.”
Today, care is personalized — using surgery, chemotherapy, radiation, and immunotherapy in different combinations, depending on your cancer’s type, stage, and special lab tests (biomarkers).

How Treatment is Planned

Doctors use a team approach:

  • Medical oncologists (chemo and immunotherapy experts)
  • Radiation oncologists (radiation specialists)
  • Surgeons (remove tumors when possible)

Together, they decide which treatments — and in what order — give you the best chance for cure or long-term control.

Step 1: Neoadjuvant Therapy (Before Surgery)

Goal: Shrink the tumor, make surgery easier, and treat cancer cells early.

  • Chemoradiation (chemo + radiation):
    • Standard for squamous cancers.
    • Also used for adenocarcinoma (tumors near the stomach).
  • Chemotherapy with FLOT regimen:
    • FLOT = four medicines given before and after surgery.
    • Now a preferred treatment for many adenocarcinoma/GEJ cancers.
  • Immunotherapy added to chemo (new in 2025):
    • If the tumor shows PD-L1 positivity (a biomarker), immunotherapy can be combined with chemo before surgery.
    • Example: Durva-FLOT (durvalumab + FLOT).

Step 2: Surgery

  • Surgery (esophagectomy) removes the tumor and nearby lymph nodes.
  • Many surgeries today are done minimally invasively (with small cuts or robotic help).
  • In some squamous cancers, chemoradiation alone (without surgery) can be enough.

Step 3: Adjuvant Therapy (After Surgery)

Goal: Kill any microscopic cancer cells that may remain.

  • Immunotherapy (nivolumab): Recommended if cancer remains after pre-op chemoradiation and surgery.
  • Finishing chemo (FLOT): If you started FLOT before surgery, you usually continue it after surgery.
  • Radiation: Rare after surgery unless cancer is found at the edges of the tissue removed.

Step 4: Advanced or Unresectable Cancer

If surgery is not possible:

  • Systemic therapy (chemo + immunotherapy) is the mainstay.
  • Radiation and stents can relieve swallowing problems or pain.

 

 

Quick Summary Table

Situation Preferred Treatment
Locally advanced adenocarcinoma (EAC/GEJ) FLOT chemo before & after surgery, or chemoradiation + surgery
Locally advanced squamous cell carcinoma Chemoradiation + surgery, or definitive chemoradiation (no surgery)
After surgery with residual disease Adjuvant nivolumab (immunotherapy)
Advanced/metastatic disease Chemo + immunotherapy, plus radiation/stents for swallowing

 

 

Side Effects to Know

  • Chemo: Fatigue, nausea, low blood counts, tingling in hands/feet.
  • Radiation: Sore throat, skin irritation, tiredness.
  • Immunotherapy: Can cause inflammation (thyroid, lungs, colon, skin). Report fever, cough, diarrhea, rash, or unusual fatigue right away.

Recovery & Survivorship

  • Focus on swallowing, nutrition, and reflux control.
  • Dietitian support if weight loss or eating is difficult.
  • Regular follow-up visits, imaging, and scopes.
  • Quitting smoking and controlling reflux improve long-term health.

Our Philosophy at Merrimack

At Merrimack Thoracic & Esophageal Surgery, we work side-by-side with medical oncologists and radiation oncologists to tailor treatment for every patient.
Cancer care is moving into a future of personalized medicine — where your therapy is based on your cancer’s biology and your unique health needs.

Our mission: deliver the most advanced, coordinated, and compassionate care — close to home.

Disclaimer: This guide is for education only. Your actual treatment plan will be personalized after a full evaluation by your care team.