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Chemotherapy for advanced cancer

You might have chemotherapy if you have advanced oesophageal cancer. Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells.  The drugs circulate throughout your body in the bloodstream. 

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

When do you have chemotherapy?

You might have chemotherapy for advanced cancer if your doctor thinks you might benefit from the treatment and you are well enough.

Chemotherapy for advanced oesophageal cancer can relieve symptoms. It can also control the cancer and improve your quality of life for a time. But it can’t cure the disease. Your doctor or specialist nurse can talk with you about the benefits and possible side effects. 

You usually have chemotherapy every 3 weeks depending on what drugs you have. Each 3 week period is called a cycle. Your doctor will tell you how many cycles they plan to give you.

Types of chemotherapy

You might have a single drug or a combination of 2 or 3 chemotherapy drugs. The most common drugs are:

  • fluorouracil (5FU) or capecitabine (Xeloda)
  • cisplatin, oxaliplatin or carboplatin
  • paclitaxel or docetaxel
  • epirubicin
  • irinotecan

Common combinations include:

  • cisplatin and capecitabine (CX)
  • cisplatin and fluorouracil (CF)
  • epirubicin, cisplatin and capecitabine (ECX)
  • epirubicin, cisplatin and fluorouracil (ECF)
  • epirubicin, oxaliplatin and capecitabine (EOX)
  • fluorouracil, oxalipatin and docetaxel (FLOT)
  • oxaliplatin and capecitabine (OX)

You might hear the terms first line and second line treatment. The first course of chemotherapy you have is the first line treatment. Your doctor might offer you second line treatment if your cancer starts to grow again or first line treatment isn't working. 

Targeted cancer drugs for adenocarcinoma

Targeted cancer drugs are treatments that change the way cells work and help the body to control the growth of cancer. 

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

  • an adenocarcinoma, which is a type of oesophageal cancer
  •  HER2 positive

HER2 stands for human epidermal growth factor receptor 2. This is a protein that makes cells grow and divide. Some cancers have large amounts of HER2 protein and are called HER2 positive cancers. 

The targeted drug trastuzumab (Herceptin) works by locking onto HER2 in the cancer cells. You might have:

  • trastuzumab (Herceptin) and CF (cisplatin and fluorouracil)
  • trastuzumab  and CX (cisplatin and capecitabine)

How you have chemotherapy

You have most of the chemotherapy drugs for oesophageal cancer into your bloodstream (intravenously). Capecitabine is a tablet.

Into your bloodstream

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

Diagram showing a central line

Taking tablets

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Before you start chemotherapy

COVID swab test

Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.

To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.

At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.

This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.

Check with your team about when you’ll have the test as there are some differences between hospitals.

Blood tests

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.

Before you start treatment, your doctor will talk to you about the risks and benefits of your treatment. They will explain what drugs you need, how you have them, and what the side effects are. You’ll sign a consent form. This is a good time to ask any questions you might have.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

When you're at home

Chemotherapy can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

Last reviewed: 
30 Oct 2019
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