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Which treatment for advanced oesophageal cancer?

Men and women discussing non oesophageal cancer

This page is about the different treatments available for advanced cancer of the food pipe (oesophagus). You can find the following information

 

A quick guide to what's on this page

Types of treatment for advanced oesophageal cancer

To treat advanced oesophageal cancer, doctors use drug treatment (chemotherapy), treatment with high energy X-rays (radiotherapy) and other procedures like laser treatment and tubes (stents) to unblock the food pipe. Shrinking the cancer will relieve some of the symptoms that it is causing. The treatment you have will depend on the size of the cancer and where it is, whether the cancer has spread to another part of the body, and where. Your treatment will also depend on the treatment you have already had, and on your general health.

Treatments to help with difficulty swallowing

It is quite common for people with advanced cancer of the oesophagus to have increasing trouble swallowing. There are several ways to relieve this. Unfortunately, they will only help for a while but you can have some treatments more than once. Your doctor may offer you radiotherapy or chemotherapy to help shrink the cancer. They may also suggest treatments such as laser treatment, using an electric current to cut away some of the tumour (diathermy) or light sensitising treatment (photodynamic therapy). Or you may have a procedure to widen the oesophagus (dilatation) or have a tube (stent) put in to keep it open. There is more information about these treatments further down this page.

Deciding about treatment

It can be difficult to decide which treatments to try, or whether to have treatment at all when you have advanced cancer. It can be helpful to talk to someone who is outside your circle of family and friends. You may want to contact your clinical nurse specialist. If you would like to talk to a counsellor, look in the coping with cancer section for more information.
 

CR PDF Icon View a summary of treating advanced oesophageal cancer.

 

 

The treatments available

Doctors use chemotherapy, radiotherapy and other procedures like laser treatment or stents to treat advanced oesophageal cancer. These links take you to a section of information on each treatment and how they are used in oesophageal cancer. Shrinking the cancer stops it blocking the oesophagus or pressing on other body tissues and so can relieve symptoms.

It is quite common for people with advanced cancer of the food pipe to have increasing trouble swallowing. There are local treatments to help with these swallowing difficulties. Doctors can cut or burn away part of the tumour so that there is more space in your food pipe. There is some information further down the page about treatment for difficulty swallowing, and more in depth information on other pages in this section.

What your doctor takes into account when deciding treatment

Which treatment is best for you depends on

  • The size of the cancer and where it is
  • Whether the cancer has spread to another part of the body, and where
  • The treatment you have already had
  • Your general health

It is a good idea to talk with your doctor about the aim of any treatment you have. Your doctor may be trying to slow the cancer down, helping to relieve symptoms, or both. Radiotherapy and chemotherapy can both be used to help control symptoms by shrinking a cancer so that it does not cause pressure and pain. Shrinking secondary tumours in the lung may help relieve breathlessness.

The treatment you have already had matters because there is a maximum amount of radiotherapy you can have to any one part of the body. If you've already had radiotherapy to your oesophagus, you may not be able to have any more. But you will be able to have it to other parts of your body if necessary. If you've had chemotherapy before, you can have more. But usually with different chemotherapy drugs. Whether your doctor thinks chemotherapy is a good idea or not will depend on how the cancer responded last time and how well you are now.

 

Treatments to help with difficulty swallowing

The most common symptom of advanced oesophageal cancer is difficulty swallowing. There are a number of ways of relieving this. Unfortunately, they will only help for a while. The cancer is likely to grow back to block the oesophagus again. But some of these treatments can be repeated.

Your doctor may offer you radiotherapy or chemotherapy to help shrink the cancer. But there are other treatments that will help the blockage directly. Your doctor may suggest

All of these treatments will help you to eat and drink more easily for a time. You have them done during an endoscopy. Which treatment is most suitable for you will depend on a number of factors - for example, how quickly your cancer is growing and the treatment you have had before. You will need to discuss this with your specialist.

Laser treatment or diathermy

A laser is a very thin, focused beam of light which heats the tissue where it is directed. Doctors can use a laser beam to cut, in a similar way that they can with a scalpel. Laser treatment can cut away a cancer that is blocking your oesophagus. There is more about laser treatment in this section.

Stent

A tube called a stent can be put inside the oesophagus to help keep it open and allow you to swallow more easily. There is more information about stents for oesophageal cancer in this section.

Photodynamic therapy (PDT)

Photodynamic therapy is a relatively new type of treatment that doctors sometimes use. It uses light to kill cancer cells. There is more information about PDT for advanced oesophageal cancer in this section.

Dilatation

If you have a narrowing of the oesophagus, rather than a blockage, your doctor may offer you dilatation. The oesophagus can become narrowed after surgery or radiotherapy. Dilatation involves stretching or widening the oesophagus. You usually have this done under sedation or anaesthetic. You may need to have it repeated every 2 to 3 months. There is a very small risk of tearing the wall of the oesophagus during dilatation, particularly if you've already had radiotherapy. But generally, you can have the treatment repeated over again with no problems. Your doctor will refer you to an oesophageal surgeon in a specialist cancer centre.

 

Making your decision on treatment

It can be difficult to decide which treatment to try, or whether to have treatment at all when you have an advanced cancer. You may want to take into consideration your quality of life while you are having the treatment. This includes side effects as well as stresses such as travelling back and forth to the hospital. Most importantly, you will need to understand what can be achieved with the treatment your doctor is offering you.

Your doctor will discuss the options for treatment with you. It can be helpful to talk over difficult decisions with someone who is outside your circle of family and friends. You may want to contact your clinical nurse specialist or a counsellor at the hospital.

You can contact a counselling organisation to find out more about counselling and how to find a counsellor in your area. We have information about what counselling is in our coping with cancer section.

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Updated: 23 April 2014