Coronavirus and cancer

We know it’s a worrying time for people with cancer, we have information to help. If you have symptoms of cancer contact your doctor.

Read our information about coronavirus and cancer

Decorative image

Decisions about your treatment

A team of health professionals decides what treatment you need. This depends on factors such as your cancer stage and grade. The most common treatments are surgery, radiotherapy and chemotherapy.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

Most people are referred to a specialist oesophago-gastric MDT. You might go to a different hospital if there isn't a specialist MDT at your local hospital.

The team usually includes:

  • a specialist surgeon
  • cancer specialists (oncologists) who specialise in treating cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)
  • a specialist cancer nurse (also called clinical nurse specialist)
  • a pathologist (an expert who examines any cancer or tissue the surgeon removes)
  • a pharmacist
  • a radiologist (who looks at your scans and x-rays)
  • a dietician  (who offers support and advice about eating and drinking)

Your treatment depends on:

  • where your cancer is in your food pipe
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your MDT will discuss your treatment, its benefits and the possible side effects with you.

Treatment overview

The main treatments are:

  • surgery
  • radiotherapy
  • chemotherapy
  • combined chemotherapy and radiotherapy (chemoradiotherapy)
  • treatments to control symptoms

You have one or more of these treatments depending on your situation.

Surgery

Surgery is the most common treatment for oesophageal cancer if it hasn't spread. Doctors remove:

  • cancer from the lining of the oesophagus (an endoscopic mucosal resection or EMR)
  • all or part of your oesophagus (an oesophagectomy)

You might have surgery with other treatments. 

Radiotherapy

Radiotherapy uses high energy rays to destroy cancer cells.

You might have radiotherapy combined with chemotherapy (chemoradiotherapy) either before surgery or on its own as your main treatment. Or you might have radiotherapy to control symptoms of advanced cancer. 

Chemotherapy

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

You might have chemotherapy before or after surgery. You sometimes have chemotherapy together with radiotherapy (chemoradiotherapy) either before surgery or as your main treatment.

 Or you might have chemotherapy as your main treatment if your cancer has spread to another part of your body and you can't have surgery. 

Chemoradiotherapy

Chemotherapy combined with radiotherapy is called chemoradiotherapy or chemoradiation. You might have chemoradiotherapy before surgery.  Or you might have it on its own as your main treatment. 

Controlling symptoms

You might have treatment for symptoms if you're diagnosed with advanced cancer. This includes treatment to help you swallow because some cancers of the food pipe can block it. Doctors can put a small tube into your oesophagus (stent) to clear the blockage so you can swallow. 

Treatment by stage

Stage 0 cancer

The main treatment is surgery to remove the lining of your oesophagus .

You have this surgery through a tube called an endoscope. This surgery is usually endoscopic mucosal resection or EMR.

You might also need treatment to destroy any abnormal areas that the doctor couldn’t remove. This includes photodynamic therapy (PDT), which is also called light treatment.

Or you might have a treatment called radiofrequency ablation (RFA). This uses heat to kill cancer cells.

Stage 1 cancer

Surgery is the main treatment. You don't usually need any other treatment before or after your operation. 

You have surgery to remove part or all of your oesophagus. This is called an oesophagectomy.

For very early, small stage cancers you might be able to have surgery through a thin flexible tube (endoscope) to remove cancer from the lining of the oesophagus. This is called an endoscopic mucosal resection or EMR.

You might have chemoradiotherapy instead of surgery if you have squamous cell cancer or you are unable to have surgery. 

Stage 2 and stage 3 cancer

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

For squamous cell cancer you usually have chemoradiotherapy. And then you either have:

  • surgery to remove part or all of your oesophagus
  • no further treatment and the doctors keep a close eye on you - this is called active surveillance

For adenocarcinoma you either have:

  • chemotherapy before surgery
  • chemotherapy before and after surgery
  • chemoradiotherapy before surgery

Stage 4 cancer

Your treatment depends on how far your cancer has spread.

Stage 4a cancer has spread to organs, body structures or lymph nodes next to the oesophagus. But it hasn't spread to distant body parts, such as the lungs or liver. You might be able to have:

  • chemoradiotherapy on its own
  • chemoradiotherapy before surgery
  • chemotherapy before surgery
  • chemotherapy before and after surgery

Stage 4B cancer has spread to distant body parts such as the liver or lungs. Treatment aims to control the cancer and maintain a good quality of life. You might have:

  • chemotherapy
  • radiotherapy
  • symptom control, such as treatment to help you swallow food
  • targeted cancer drugs

Clinical trials

Doctors are always looking to improve treatments for oesophageal cancer, and reduce side effects. As part of your treatment, your doctor may ask you to take part in a clinical trial. This might be to test a new treatment or to look at different combinations of existing treatments.

Last reviewed: 
27 Sep 2019
  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer
    Springer, 2017

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

  • Current management of oesophageal cancer
    N Rashid and others
    British Journal of Medical practicioners 2015 Volume 8, Issue 1, page 804

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

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

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

Information and help