Treatment with chemotherapy and radiotherapy together is called chemoradiotherapy. You might have this treatment for oesophageal cancer
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
Radiotherapy uses high energy x-rays to treat cancer cells.
Giving these treatments together can cure some early stage oesophageal cancers. Chemoradiotherapy can also shrink a cancer before surgery to make it easier to remove.
When do you have chemoradiotherapy?
Your treatment plan depends on how far your cancer has grown (the stage), what type of oesophageal cancer you have (adenocarcinoma or squamous cell cancer) and how well you are.
Chemoradiotherapy as your main treatment
You might have chemoradiotherapy instead of surgery if you have a squamous cell cancer that hasn't spread. The doctors keep a close eye on you after the treatment. This is called active surveillance.
Chemoradiotherapy before surgery
You might have chemoradiotherapy before surgery if you have adenocarcinoma or squamous cell cancer which hasn't spread to other parts of your body. This is called neoadjuvant chemoradiotherapy. It shrinks the cancer and makes it easier to remove.
Chemoradiotherapy instead of surgery
You might have other health conditions that mean you're not well enough to have surgery. Or you might not be able to have surgery because the cancer has grown into nearby tissues. The doctor might offer you chemoradiotherapy instead.
What chemotherapy will I have?
There are different chemotherapy drugs that doctors can combine with radiotherapy.
The most common drugs to combine with radiotherapy are cisplatin and capecitabine (Xeloda). You might start the chemotherapy before the radiotherapy starts. You continue to have it during the radiotherapy treatment.
- capecitabine as tablets twice a day throughout your treatment
- cisplatin chemotherapy as a drip into your arm once every 3 weeks
There are other chemotherapy drugs you might have instead of capecitabine and cisplatin, including:
- fluorouracil (5FU) instead of capecitabine
- oxaliplatin or carboplatin instead of cisplatin
Doctors also sometimes combine the chemotherapy drugs carboplatin and paclitaxel with radiotherapy. You might have this if you are having chemoradiotherapy before surgery.
You usually have treatment in the chemotherapy day unit or you might need to stay in hospital overnight.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning Iris my name is Clare, I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment, is that ok?
Before you have each treatment you’ll need to have a blood test to check your bloods are ok and you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
You have radiotherapy in short sessions every weekday for about 4 to 6 weeks. You have it in the hospital radiotherapy department.
Before you begin treatment, the radiotherapy team work out how much radiation you need. They divide it into a number of smaller treatments. They call each treatment a fraction. At your planning appointment the radiographers might make pen marks or small tattoos on your skin in the treatment area.
Your treatment starts a few days or up to 3 weeks after the planning session. You have radiotherapy from an external machine as a daily treatment, five days a week for between 4 and 6 weeks.