Oesophageal cancer - Treatment

Treatment-Oesophageal cancer




The main treatments for oesophageal cancer are surgery, chemotherapy and radiotherapy.

Your treatment plan

You'll be cared for by a group of different healthcare professionals.
Your team will recommend a treatment plan they feel is most suitable for you, although final treatment decisions will be yours.
Your plan will largely depend on how far your cancer has spread, known as the stage.

Stage 1 to 3

Stage 1 to 3 oesophageal cancer is usually treated with surgery to remove the affected section of oesophagus (oesophagectomy).
Chemotherapy and sometimes radiotherapy may be given before surgery to make it more effective or is sometimes used instead of surgery.

Stage 4

Stage 4 oesophageal cancer has usually spread too far for a cure to be possible, but chemotherapy, radiotherapy and other treatments can slow the spread of the cancer and relieve symptoms.

Surgery

There are 3 main types of surgery for oesophageal cancer.

Oesophagectomy

An oesophagectomy is the main treatment for early-stage oesophageal cancer.
During the procedure, your surgeon will remove the section of your oesophagus that contains the tumour and, if necessary, the nearby lymph nodes. 
A small portion of your stomach may also need to be removed.
The remaining section of your oesophagus is then reconnected to your stomach.
To access your oesophagus, your surgeon will either make cuts in your tummy and chest, or in your tummy and neck.

Endoscopic mucosal resection (EMR)

A procedure called endoscopic mucosal resection (EMR) may sometimes be an option instead of an oesophagectomy if oesophageal cancer is diagnosed very early on.
It involves cutting out the tumour using a loop of wire at the end of a thin flexible tube.
The tube is passed down your throat, so no cuts are made in your skin.
Sometimes radio waves may also be used to destroy the cancerous tissue. This is called radiofrequency ablation (RFA).

Stents

For more advanced oesophageal cancer that's causing swallowing difficulties, a procedure to insert a hollow tube called a stent into the oesophagus may be recommended.
The stent expands once in place and holds the oesophagus open.

Chemotherapy

Chemotherapy involves taking medicines that kill the cancer cells or stop them multiplying.
It may be used:
  • before and sometimes after surgery, either with or without radiotherapy – to shrink the cancer and reduce the risk of it coming back
  • instead of surgery – in combination with radiotherapy (chemoradiation)
  • to relieve your symptoms if curative treatment is not possible
Chemotherapy can be given into a vein or taken as tablets.
You'll usually have the treatment every 3 weeks over 6 to 18 weeks.

Side effects

Common side effects of chemotherapy include:
  • feeling sick
  • loss of appetite
  • losing weight
  • diarrhoea
  • feeling very tired
  • increased risk of infections
  • bleeding and bruising easily
These side effects should improve gradually after treatment stops.

Radiotherapy

Radiotherapy involves using radiation to kill cancer cells and shrink tumours.
It may be used:
  • in combination with chemotherapy before surgery – to shrink the cancer and reduce the risk of it coming back
  • instead of surgery – usually in combination with chemotherapy
  • to relieve your symptoms if it's not possible to cure your cancer
Radiotherapy is most often given using an external machine that directs beams of radiation at your oesophagus, or sometimes by temporarily placing a small piece of radioactive material in your oesophagus (brachytherapy).

Side effects

Common side effects of radiotherapy include:
  • tiredness
  • temporary soreness when swallowing
  • temporary worsening of swallowing difficulties
  • a dry throat
  • feeling or being sick
  • reddening of the skin and loss of body hair in the treatment area
These side effects should improve gradually after treatment stops. 
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