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Esophageal Cancer Treatment in Israel

Esophageal Cancer Treatment in Israel

The esophagus is a hollow tube that connects your throat to your stomach. After you swallow, food moves through this long tube to the stomach, where it is digested. Esophageal cancer is the sixth most common cause of cancer deaths worldwide, and it can develop at any point along the esophagus.

At Sheba Medical Center, our multidisciplinary physicians – including oncologists, gastroenterologists, imaging specialists, surgeons, radiologists, and dietitians – work together to treat every patient diagnosed with esophageal cancer. Full collaboration between different hospital divisions enables us to design individualized, comprehensive, and holistic treatment plans. We are constantly involved in clinical studies to explore new cancer therapies, and our expert team meets with every patient to review the best options for esophageal cancer treatment in Israel.

esophageal cancer treatment

Risk Factors for Esophageal Cancer

Various factors can raise your risk of developing esophageal cancer. Chronic irritation of the esophagus is generally thought to be a major risk factor; the following circumstances may cause irritation in the esophageal cells:

  • Smoking
  • Drinking alcohol excessively
  • Barrett’s esophagus – having precancerous changes in the cells of the lower esophagus
  • Having gastroesophageal reflux disease (GERD)
  • Being male
  • Being obese
  • Being elderly

Stages of Esophageal Cancer

Esophageal cancer is categorized into two main types:
  • Squamous cell carcinoma, which develops in the cells lining the esophageal mucosa.
  • Adenocarcinoma, which develops in the cells of the subcutaneous layer of the esophagus.
The disease is staged according to the extent to which the cancer has spread:

| Stage 0:

Abnormal cells, not yet cancer, are found only in the esophageal lining.

| Stage 1:

Cancer cells are found in the esophageal lining (in the subcutaneous layer and the muscle).

| Stage 2:

The tumor has reached the outer wall of the esophagus or the muscle layer. Also, the cancer may have spread to one or two adjacent lymph nodes.

| Stage 3:

The cancer has penetrated deeper into the inner muscle layer or into the connective tissue wall of the esophagus. It may also have spread to multiple adjacent lymph nodes or to a nearby organ (e.g., diaphragm)

| Stage 4:

The cancer has spread to other organs in the body (metastases), such as the abdominal cavity, liver and lungs, and lymph nodes located far from the esophagus. This is the most advanced stage.

Symptoms of Esophageal Cancer

During the early stages, there are typically no symptoms. In esophageal cancer that is more advanced, the following symptoms may present:

  • Difficulty or pain when swallowing (dysphagia)
  • Unexplained weight loss
  • Chest pain behind the breastbone, pressure or burning
  • Coughing
  • Hoarseness
  • Indigestion and heartburn

Diagnosis

Sheba’s doctors will review your symptoms and medical history and perform a physical exam to diagnose esophageal cancer. To confirm your diagnosis, stage the disease, and plan the best esophageal cancer treatment in Israel, various tests and X-rays may also be performed, including:

  • Barium swallow X-ray: You drink a liquid that coats the esophagus, making it appear more clearly on the X-ray
  • Endoscopy: An endoscope (a thin, lighted tube), is placed down your throat into your esophagus. Endoscopic ultrasound (EUS) may also be done, which uses sound waves to obtain additional information about tumor involvement in adjacent tissues
  • MRI (magnetic resonance imaging): A magnetic field and radio waves are used to generate a detailed 3D image of the tissues
  • CT scan (computerized tomography): This procedure produces 3D images of the tissues that provide precise information on the size, location, and shape of the tumor; it can also locate cancerous lymph nodes
  • PET scan: With positron emission tomography, a radioactive substance is injected into the body, where it binds to tissues that have a faster metabolic rate – such as malignant tumors; the images created show how this substance is dispersed in the body, thereby helping to diagnose the precise location and spread of the tumor
  • Biopsy: During an endoscopy (sometimes with the guidance of an ultrasound or CT), the doctor can excise cells or tissue for further examination under a microscope

Types of Esophageal Cancer Treatment in Israel

Your Sheba doctor will evaluate your health condition, the type of cancer cells, and specific stage of cancer to design the most suitable personalized treatment plan.

Surgery: When the tumor is localized and hasn’t spread to other organs, surgery is often the preferred treatment option. This treatment enables the tumor (and any nearby lymph nodes) to be completely excised. A biopsy will be taken to determine if additional treatment is needed.

Radiation (radiotherapy): Radiation may be administered preoperatively to reduce the tumor, or after surgery to eliminate residual cancer cells. Sometimes it is given along with chemotherapy. Also, our doctors may recommend targeted radiation when the tumor cannot be surgically removed. The Sheba Radiotherapy Institute has highly advanced technology for radiotherapy, which enables us to treat the cancer without damaging the surrounding healthy tissue.

Chemotherapy: Chemotherapy drugs impair the reproduction of cancer cells, thereby inhibiting the growth and spread of the tumor. The most common chemotherapy drugs used for esophageal cancer are cisplatin, oxaliplatin, fluorouracil, capecitabine, taxol, taxotere, and irinotecan.

Biological drugs: These drugs aim to inhibit the growth mechanism of cancer cells, thereby killing off the disease. To select a biological drug against cancer, we perform molecular testing on a tissue sample from the tumor. Currently, there is only a biological drug to target adenocarcinoma of the esophagus with overgrowth of the HER2 receptor cells.

Meet Our Team

Einat Shacham-Shmueli

Einat Shacham-Shmueli, MD

Senior Oncologist, Gastrointestinal Clinic
Dr. Shacham-Shmueli received her medical degree from the Sackler School of Medicine, Tel Aviv University. She specializes in gastrointestinal malignancies – cancers of the stomach, esophagus, liver, pancreas, gallbladder, colon, anus, and rectum. Dr. Shacham-Shmueli has authored more than 25 original scientific articles in international journals. She is a member of the Israel Society of Oncology and Radiotherapy, as well as an investigator for the NCI (National Cancer Institute), RTOG (Radiation Therapy Oncology Group), and CTEP (Cancer Therapy Evaluation Program).
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