Treatment decisions for advanced cancer

Advanced oesophageal cancer means cancer that began in the food pipe (gullet) has spread to another part of the body.

Deciding about treatment can be difficult when you have advanced oesophageal cancer.

Treatments such as chemotherapy or radiotherapy can help to reduce symptoms and might make you feel better. But they also have side effects that can make you feel unwell for a while.

You need to understand:

  • what treatment can do for you
  • how it might affect your quality of life
  • what side effects it has

Your doctor or specialist nurse can talk to you about the benefits and possible side effects. You can ask them questions. You might also find it helps to talk things over with a close relative, a friend or a counsellor at the hospital.

We're here for you if you or someone close to you has cancer. You can call our Cancer Research UK nurses on 0800 800 4040, 9am to 5pm.

Types of treatments

Your treatment depends on:

  • the size and type of your cancer and where it is in your body
  • your symptoms
  • the treatment you have already had
  • your general health

To shrink your cancer, slow its growth and relieve your symptoms your doctor might recommend:

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.

Chemotherapy for advanced oesophageal cancer can relieve symptoms. It can also control the cancer and improve your quality of life for a time. 

Radiotherapy

Radiotherapy uses high energy waves like x-rays to destroy cancer cells. You might have radiotherapy to shrink your cancer and help relieve symptoms. 

You might have external or internal beam radiotherapy. External beam radiotherapy directs radiotherapy beams at the cancer from a machine. Internal radiotherapy (brachytherapy) gives radiotherapy to the cancer from inside the body.

Targeted cancer drugs and immunotherapy

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. They are called immunotherapies.

You might have a targeted or immunotherapy drug such as trastuzumab or nivolumab for advanced oesophageal cancer. You might have these drugs on their own or with chemotherapy. 

Other treatments to make swallowing easier

Swallowing can be difficult for some people with oeosphageal cancer. Treatments include:

  • a stent, which is a small metal or plastic tube put into the oesophagus to keep the food pipe open
  • oesophageal dilation, which means stretching the food pipe to open it up again so that you can swallow food and drink more easily
  • laser therapy, which means using hot beams of light to burn away cancer cells in the food pipe
  • photodynamic therapy (PDT), which uses a combination of a light sensitising drug and a very bright light to destroy cancer cells

Your choices

Your doctor might offer you a choice of treatments. Discuss the advantages and disadvantages of each treatment with them and ask how they can control any side effects. This helps you make the right decision for you.

You also need to think about the other factors involved in each treatment, such as:

  • whether you need extra appointments
  • if you’ll need more tests
  • the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time.

You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You can have medicines to help control symptoms such as sickness or pain. Your doctor or nurse can let you know what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.

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