Oesophageal cancer - Treating oesophageal cancer

Treatment options for oesophageal cancer depend on what stage the cancer is at, but may include chemotherapy, radiotherapy and surgery.

Cancer treatment team

Many clinical commissioning groups (CCGs) have multidisciplinary teams that treat oesophageal cancer. If you have oesophageal cancer you may see several specialists as part of your treatment, including:

• surgical oncologists (specialists in the surgical treatment of cancer)
• clinical oncologists (specialists in the non-surgical treatment of cancer)
• pathologists (specialists in diseased tissue)
• radiologists (specialists in radiotherapy)
• social workers
• psychologists
• specialist cancer nurses, who will usually be your first point of contact

Deciding which treatment is best for you can be difficult. Your cancer team will make recommendations but the final decision will be yours.

Before going to hospital to discuss your treatment options you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Your treatment plan

Your recommended treatment plan will depend on what stage your cancer is at.

• Stage 1 to 3 oesophageal cancer is usually treated with a type of surgery known as an oesophagectomy (removing the section of oesophagus containing the tumour). Chemotherapy and radiotherapy are usually given before surgery to reduce the risk of the cancer returning. Very early-stage oesophageal cancer may be treated with an endoscopic mucosal resection (EMR).
• In cases of stage 4 oesophageal cancer, the cancer has usually spread too far for a cure to be possible. Chemotherapy and radiotherapy can be used to slow down the spread of the cancer and to relieve symptoms.

These treatments are described in more detail below.

Want to know more?

• Cancer Research UK: treating oesophageal cancer
• Macmillan: treating oesophageal cancer

Surgery

Endoscopic mucosal resection (EMR)

If your oesophageal cancer is at a very early stage, or you have Barrett's oesophagus, endoscopic mucosal resection (EMR) may be an option instead of an oesophagectomy.

EMR involves a throat endoscopy and injection of fluid below the tumour. This raises the tumour up and it can be removed with a thin wire.

You may need further treatment after an EMR to ensure the cancer is gone. This can include:

• radiofrequency ablation – radiowaves are used to destroy any remaining cancerous cells
• photodynamic therapy – light-sensitive drugs and low-powered lasers are used to destroy any remaining cancerous cells

Oesophagectomy

During an oesophagectomy your surgeon will remove the section of your oesophagus that contains the tumour and, if necessary, the nearby lymph nodes. The remaining section of your oesophagus will then be reconnected to your stomach.

To access your oesophagus your surgeon will either need to make an incision (cut) into your abdomen and chest, or into your abdomen and neck.

Self-expanding stents

Self-expanding stents are another method of relieving the symptoms of dysphagia. The treatment involves placing a small metal tube into your oesophagus. The stent expands to hold open your oesophagus, which helps to make swallowing easier.

Chemotherapy

Chemotherapy is a type of cancer treatment that uses anti-cancer medicines to either kill the malignant (cancerous) cells in your body or stop them multiplying. Chemotherapy medicines can be injected or given to you orally (by mouth).

As well as attacking cancerous cells, chemotherapy can also attack normal, healthy cells in your body, which is why this form of treatment has many potential side effects.

The most common side effects of chemotherapy include:

• vomiting
• hair loss
• nausea
• mouth sores
• fatigue

These side effects are usually temporary and you should find they improve on completion of your treatment. 

Chemotherapy treatment is often used alongside surgery and radiotherapy (see below) to help make sure as much of the cancer as possible is treated.

Read more about how chemotherapy is performed.

External radiotherapy

Radiotherapy is a form of cancer therapy that uses high energy beams of radiation to help shrink your tumour and relieve pain.

Radiotherapy for oesophageal cancer should make it easier for you to swallow because the radiation shrinks the tumour and therefore makes it less obstructive.

The side effects of radiotherapy include:

• fatigue
• skin rashes
• loss of appetite
• sores in your oesophagus

These side effects are usually temporary and you should find that they improve once you have completed your treatment. 

As with chemotherapy, radiotherapy is often used alongside surgery to help make the tumour easier to remove.

Read more about how radiotherapy is performed.

Internal radiotherapy (brachytherapy)

In some cases, radiotherapy may need to be delivered from inside the body, rather than from an outside source. This is known as brachytherapy.

Brachytherapy is usually used to control the symptoms of oesophageal cancer, rather than cure it completely.

Brachytherapy for oesophageal cancer may be performed in two ways, by using either:

• a nasogastric tube – a thin tube that goes up your nose and down the throat into the stomach
• an endoscopy – a thin tube with a light and a camera that goes down your throat

Once the source of the radiotherapy is placed, it is left there for a period of time. This can range from a few hours to a few days depending on the treatment you require.

Nutritional support

If your dysphagia symptoms are severe you may find it difficult to eat and drink in the normal way, which could place you at risk of malnutrition and dehydration.

Another problem that can occur is a tracheoesophageal fistula. This is when the cancer creates a hole between your oesophagus and your windpipe (trachea). This may cause you to cough and gag, particularly when you try to swallow.

While surgery can be used to treat a tracheoesophageal fistula and relieve the symptoms of dysphagia, you may need to use different ways of receiving the nutrients your body needs while you are waiting for surgery.

A percutaneous endoscopic gastrostomy (PEG) tube is often used to provide your body with the nutrients it needs. A PEG is a tube placed directly into your stomach surgically. It passes through a small incision on the surface of your abdomen (tummy).

Read about how dysphagia is treated for more information about PEG tubes.