Find out about how your doctor decides which treatment you need, the types of treatment you might have and treatment by stage.
Deciding which treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
Your treatment depends on
- where your cancer is in your food pipe
- how far it has grown or spread (the stage)
- the type of cancer
- how abnormal the cells look under a microscope (the grade)
- your general health and level of fitness
Your MDT will discuss your treatment, its benefits and the possible side effects with you.
The main treatments are
You have one or more of these treatments depending on the stage of your cancer.
You might also have treatment for symptoms when you’re first diagnosed. This includes treatment to help you swallow because some cancers of the food pipe can block it. Doctors can put a small tube into your oesophagus (stent) to clear the blockage so you can swallow. Treatment for eating problems helps to make you fit enough for your cancer treatment.
If you're not having surgery
Health problems might mean you can’t have surgery, or you could decide you don’t want it. You have tests to check how fit you are before you have any treatment including heart and lung tests.
When surgery isn’t possible, you might have one or more of these treatments
- chemoradiotherapy - chemotherapy with radiotherapy
- symptom control
Treatment by stage
Stage 0 cancer
Removing the lining of your oesophagus is the main treatment.
You have this surgery through a tube called an endoscope. This surgery is endoscopic mucosal resection or EMR.
You might also need treatment to destroy any abnormal areas that the doctor couldn’t remove. This includes photodynamic therapy (PDT), which is also called light treatment.
Stage 1 cancer
Surgery is the main treatment.
You might also need these treatments before and after surgery
Stage 2 and 3 cancers
For cancers in the lower part of the oesophagus you have either
You then have surgery to remove all or part of your oesophagus.
Depending on the results of your surgery, you might need more chemotherapy or chemoradiotherapy. This lowers the chances of the cancer coming back.
For cancers in the upper part of the oesophagus you usually have chemoradiotherapy, without surgery.
In the video below we follow Wendy through her treatment for cancer of the oesophagus.
Treatment for early cancer of the oesophagus: Wendy’s story - Transcript
Wendy: Things started not being right when I couldn’t eat properly. Um I found that everything I was trying to eat just didn’t want to go down, it went down so far, and then I’d find myself crunching up because it was difficult to get things down
Eventually I went to the doctor’s and she sent me for a scan to um have a camera put down. The next thing I knew I was taken into a room afterwards and sat down and was told ‘I am very sorry but you have cancer of the oesophagus'
[56 seconds ] Nurse: You are going to have your anti sickness for me
Wendy: Because I haven’t been feeling ill at all I kept thinking this isn’t true it’s someone else but now it’s come to reality. I must admit this morning it was a little bit scary, I just hope I don’t get too many other side effects because they can be, they can be really nasty.
I will lose my hair with the type of chemo that I have got this time. But it’s not the end of the world I have got a lovely family and lovely friends and I am sure they will boost me up and hopefully I’ll be fine.
[1 minute 50 seconds] Wendy: I said beforehand that I wouldn’t be upset but I think when it genuinely happened I thought I can’t stand this, this is awful.
Friend: I think that is fine, don’t you?
Wendy: I can wear it out tonight
Wendy: And feel human
Friend: Give me a hug
Wendy: Thank you, lovely
Wendy: The chemotherapy started really fine and it just...I didn’t actually realise how hard it was going to be. Basically my body just wasn’t coping with the chemo and eventually I was so ill I just couldn’t do anything. And I just came back into hospital and they kept me in but since then I’ve gradually got better and better because they have taken me off the chemo. And apart from a bit of high blood pressure I, I feel absolutely fine again.
[2 minutes 52 seconds] Wendy: I know it is a big operation, I know it is a serious operation. I am scared but I know it is something I’ve got to do, if I don’t I wouldn’t be here anyway. So, I’ve got to out my trust in the surgeons and I hope it’s just going go alright.
[3 minutes and 33 seconds] Wendy: It’s two weeks since I had the operation. The first two days I was in intensive care so I didn’t really know much about that at all, after that they sent me to high dependency where the staff were really good again, they literally did everything for you. But gradually as time’s gone on they have taken the tubes out. And I am just back to one feeding tube.
I am now on the puree I can’t have anything with lumps or anything in and hopefully in a day or two they can take that down and I will actually start back on proper food. Everything they do they do in stages and it’s brilliant, it has brought me back to life again to be honest.
[4 minutes and 33 seconds] Mr Tim Underwood: Hello Wendy, how you doing?
Wendy: Really good news. They have got all the cancer and I haven’t got to go and have chemotherapy again, because it was confined in one section and it wasn’t in the lymph nodes. And everything’s brilliant
Wendy: Absolutely brilliant news
Wendy: Looking back over this year it’s been really hard. I am still having a bit of a problem with eating, if I eat one little thing over the top, where I have only got a small stomach, it really does make me ill and I have just got to learn to say no I don’t need that. Um to me this year means that it’s an end to a horrible year and I can start again and hopefully thanks to everybody at the hospital and all my friends I will be able to do that and that is my future, and I hope to live for many years to come, I really do.
Stage 4 cancer
Treatment aims to control the cancer and maintain a good quality of life. You might have
- symptom control eg. treatment to help you swallow food
- trastuzumab (Herceptin) biological therapy for cancers in the gastro oesophageal junction area and the cells have HER2 protein
Doctors are always looking to improve treatments for oesophageal cancer, and reduce side effects. As part of your treatment, your doctor may ask you to take part in a clinical trial. This might be to test a new treatment or to look at different combinations of existing treatments.