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Chemotherapy treatment

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

You might have chemotherapy before or after surgery for oesophageal cancer.  Common chemotherapy drugs for oesophageal cancer are fluorouracil, capecitabine, cisplatin, epirubicin and docetaxel. You usually have a combination of 2 or 3 of these drugs.

This page is about chemotherapy for oesophageal cancer that hasn’t spread to another part of the body.

When you have it

You’re likely to have chemotherapy before surgery if you have stage 2 or stage 3 cancer. You don’t usually need chemotherapy for stage 1 oesophageal cancer.

Your treatment plan depends on whether you have squamous cell cancer or adenocarcinoma.

For squamous cell cancer you usually have chemotherapy combined with radiotherapy (chemoradiotherapy). You either have it before surgery, or you can have chemoradiotherapy as your only treatment.

For adenocarcinoma, you either have chemotherapy or chemoradiotherapy before surgery. Or you might have chemotherapy before and after surgery.

Chemotherapy before surgery is called neoadjuvant chemotherapy. Chemotherapy before and after surgery is called peri operative chemotherapy.

These treatments aim to:

  • reduce the size of the cancer so it’s easier for the surgeon to remove
  • lower the risk of the cancer coming back

You might also have chemotherapy if your cancer has spread to another part of your body (advanced oesophageal cancer).

How often do you have it?

You usually have chemotherapy every 2 or 3 weeks depending on what drugs you have. Each 2 or 3 week period is called a cycle. You might have between 2 and 8 cycles of chemotherapy.  This depends on what chemotherapy you have, and what other treatment you're having. 

Types of Chemotherapy

Usually you have a combination of 2 or 3 drugs. The most common drugs are:

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

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)
  • carboplatin and paclitaxel
  • fluorouracil, oxalipatin and docetaxel (FLOT)

How you have it

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

Into your blood stream

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

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

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 your first chemotherapy, your doctor 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 any signs of infection such as a temperature higher than 37.5C 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.

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. Talk to your doctor if you are worried and about whether you need to have a test to check for it. 

Some people have severe side effects from capecitabine or fluorouracil even if they don't have low DPD levels. Contact your doctor or nurse if your side effects are severe.

When you're at home

Chemotherapy for oesophageal 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: 
09 Oct 2019
  • Oesophago-gastric cancer: assessment and management in adults  [NG83]
    National Institute for Health and Clinical Excellence (NICE)
    Published January 2018

  • Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    F. Lordick and others
    Ann Oncol. 2016 27 Suppl 6: v50-v57

  • Oesophageal cancer
    J Lagergren and others
    The Lancet Vol 390, November 25th 2017

  • Oesophageal cancer
    E.C.Smith and others
    Nature Reviews Disease Primers Volume 3: 17048 (2018)

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