Types of treatment for oesophageal cancer

A team of doctors and other professionals will work together to decide on the best treatment and care for you. The team is called a multidisciplinary team (MDT) and includes

• Surgeons
• Doctors who specialise in drug treatments for cancer (oncologists)
• Specialist nurses
• Dieticians
• Speech therapists
• Social workers

The team will meet together with your test results and case notes to discuss the best treatment options for you. They will take many factors into account, including

• Where your cancer is
• How far your cancer has grown or spread (the stage)
• The type of oesophageal cancer
• Your general health and level of fitness

As with many cancers, the most common treatment options are surgery, radiotherapy and chemotherapy. You may have surgery on its own for a very early cancer. Otherwise you may have surgery either after chemotherapy or combined chemotherapy and radiotherapy (chemoradiation). There are other treatments for advanced cancers, such as laser therapy or stents to relieve a blockage in your oesophagus.

The earlier your cancer is diagnosed, the easier it is to get under control and possibly cure it. If your cancer hasn't spread, you are most likely to be offered surgery to remove part or all of your oesophagus. Surgery for oesophageal cancer is a major operation, so it is important that your doctor makes sure you are fit enough to make a good recovery. You may have to travel to a regional centre where specialist surgeons can carry out your operation. If you cannot have surgery for any reason, you may have chemotherapy with radiotherapy or radiotherapy alone.

If the cancer has spread to other areas of your body you may have chemotherapy to help control its growth. You may also have radiotherapy to shrink the tumours and reduce symptoms.

Your doctor is likely to offer you surgery for early stage oesophageal cancer, as long as you are fit enough. The amount of surgery you have depends on the exact size and position of your cancer. The tests you have had will help your specialist decide if surgery is an option for you. But your doctor may not be able to tell you exactly what stage your cancer is until after surgery. 

If it is possible to try to cure your oesophageal cancer, you will have part or all of your oesophagus removed. This operation is called an oesophagectomy. How much is removed will depend on where in the oesophagus the cancer is. 

During your operation, your surgeon will examine the oesophagus and surrounding area. Some of the lymph nodes will be removed from around your oesophagus. The doctor will send the lymph nodes to the laboratory to check to see if they contain cancer cells. This helps your doctor to know the stage of your cancer. There is more about surgery to remove oesophageal cancer in this section.

If you have high grade Barrett's oesophagus, or a very early stage cancer which is only on the lining of the oesophagus (the mucosal layer), it may be possible to remove it using endoscopic mucosal resection (EMR). High grade Barrett's oesophagus means that some of the cells are very abnormal. If left untreated, these cells may develop into an invasive cancer.

For this procedure, the doctor puts a tube called an endoscope down your throat. The endoscope contains a camera so the doctor can see inside your body. The endoscope can be used to inject fluid into the layer of cells below the cancer or abnormal area, which makes it stand out from the rest of the tissue. Then a thin wire (snare) is used to remove the area. 

The most common side effects are bleeding and a narrowing of the oesophagus, which can happen some time after the procedure. There is a very small risk of tearing the oesophageal wall. Your doctor may call this perforation. You might have photodynamic therapy or radiofrequency ablation after EMR, to try to destroy any abnormal areas or cancer cells that may be left.

Your doctors may suggest chemotherapy on its own or before surgery to treat oesophageal cancer. 

Giving chemotherapy before surgery is called neo adjuvant chemotherapy. This is commonly used in the UK for treating oesophageal cancer. The chemotherapy can shrink the cancer, making it easier to remove. And helps reduce the chances of the cancer coming back.

If you have cancer of the lower oesophagus or where the oesophagus meets the stomach (gastro oesophageal junction) you may have chemotherapy after surgery, as well as before. This also helps to lower the chances of your cancer coming back.

If you have oesophageal cancer that has spread to other parts of your body (advanced oesophageal cancer) you may have chemotherapy on its own. This may help to control or shrink the cancer and reduce symptoms.

There is more about chemotherapy for oesophageal cancer in this section.

In some cases, you may have chemotherapy and radiotherapy together. This is called chemoradiation. You may have it before surgery to help shrink the cancer, making it easier to remove. You may have this as part of a clinical trial.

If you are unable to have surgery, or you do not want it, you may have chemoradiation on its own. Particularly if you have squamous cell cancer near the top of your oesophagus. Some studies have shown that chemoradiation can be as good as surgery for this type of cancer.

Chemoradiation is quite an intensive treatment and there are side effects. Your doctor will consider your general health before deciding if this treatment is an option for you.

There is information about chemoradiation for oesophageal cancer in this section.

You may have radiotherapy alongside chemotherapy (chemoradiation) before or instead of surgery. Or in some cases, you may have radiotherapy on its own if you are unable to have chemotherapy or surgery. You are most likely to have radiotherapy on its own for advanced oesophageal cancer. This may help to control the cancer and relieve symptoms.

Radiotherapy is painless to have, although it may make your throat sore as the course of treatment goes on. It is usual to have this treatment as an outpatient. The length of your course of radiotherapy treatment will depend on the size and type of oesophageal cancer you have. You usually have treatment for a few minutes every day, over a few weeks.

Sometimes radiotherapy is given from inside the body. This is known as internal radiotherapy or brachytherapy. For oesophageal cancer, this means having a radioactive source put down your throat and into the food pipe. The doctor may use a flexible tube known as an endoscope to get the radioactive source in the right place. You are most likely to have this treatment if you have an advanced cancer that is making it difficult to swallow.

There is more about radiotherapy for cancer of the oesophagus, including information on internal radiotherapy in this section.

Biological therapy is not often used. But if the tumour is in the area where the oesophagus joins the stomach (oesophago gastric junction), doctors sometimes use a biological therapy drug called trastuzumab (Herceptin).

There is information about biological therapy for oesophageal cancer in this section.

If the cancer is blocking your oesophagus and making it difficult to swallow, you may need treatment to clear the blockage. Sometimes laser treatment is used to burn away the tumour. Or you may have a tube called a stent put in to allow food and drink to pass through. There is detailed information about laser treatment and stents in this section. 

Even if your oesophageal cancer cannot be cured, your doctor may still offer you treatment with chemotherapy or radiotherapy to relieve symptoms and give you a good quality of life for as long as possible.

If you have high grade Barrett's oesophagus, you may have RFA either on its own or after an endoscopic mucosal resection (EMR). RFA uses heat made by radiowaves to destroy the abnormal cells.

Radiofrequency is a type of electrical energy. And ablation means destroying completely. A tube with a camera (endoscope) is passed down your throat into your oesophagus. A small balloon or probe is then guided to the area of abnormal cells. You have a few quick pulses of electrical energy, which destroys the abnormal cells on the inside of your oesophagus.

RFA may also be used after EMR for a very early stage oesophageal cancer.

This treatment involves the use of low powered lasers combined with a light sensitive drug to destroy cancer cells. PDT is a relatively new treatment, and you may need to have it repeated a number of times. You may have it

• As a treatment to try to prevent high grade Barrett's oesophagus developing into cancer, if you are unable to have an endoscopic mucosal resection (EMR) or surgery
• After EMR for high grade Barrett's or very early oesophageal cancer, to treat any abnormal or cancerous cells left behind
• To destroy part of a tumour and improve swallowing when advanced oesophageal cancer is making this difficult

There is information about PDT to treat advanced oesophageal cancer in this section.