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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 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 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

Targeted cancer drugs are treatments that change the way cells work and help the body to control the growth of cancer. They work by ‘targeting’ the differences that help a cancer cell to survive and grow.

You might have a targeted cancer drug combined with chemotherapy if your advanced oesophageal cancer is:

  • an adenocarcinoma (this is a type of oesophageal cancer)
  • HER2 positive - HER2 stands for human epidermal growth factor receptor 2 which is a protein that makes cells grow and divide

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.