About chemotherapy for oesophageal cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. They work by stopping the growth of cancer cells. These drugs circulate in the blood and can reach cancer cells almost anywhere in your body.

You may have chemotherapy for oesophageal cancer as

• An injection
• Through a drip into a vein in your arm (intravenous infusion)
• Through a pump as a slow continuous infusion
• Tablets

How you have your chemotherapy treatment will depend on the particular drug or combination of drugs you are having. There is more information about the different ways of having chemotherapy in the main chemotherapy section of CancerHelp UK.

Doctors call chemotherapy before surgery neoadjuvant chemotherapy. This is the usual treatment for most people who are able to have surgery to completely remove their cancer. Results from clinical trials show that this treatment can help to lower the risk of your cancer coming back if you have a stage 2 or 3 oesophageal cancer. In 2004 a review of trials of neoadjuvant chemotherapy found that overall people did live longer if they had treatment before surgery with cisplatin chemotherapy. Another review in 2007 said that either chemotherapy before surgery, or combined chemotherapy and radiotherapy before surgery, were helpful for adenocarcinomas of the food pipe. Results from one trial in this review suggested that, for squamous cell cancers, it may be better to have both chemotherapy and radiotherapy before surgery.

There is a risk of the cancer coming back even if your surgeon is able to completely remove it. Cancer cells may have broken away from the tumour before you had the operation. If not treated, these could grow into new tumours.

If your surgeon thinks your cancer is likely to be too large to be completely removed, your doctors may suggest chemotherapy to try to shrink it. In some people, chemotherapy can shrink the cancer so that a surgeon can operate and completely remove it. You may have this treatment as part of a clinical trial.

Doctors carry out clinical trials to see if different types of treatment can cure a cancer, just slow it down, or whether the treatment being tested makes no difference. You can search the CancerHelp UK clinical trials database for trials for cancer of the oesophagus.

You may have chemotherapy after surgery if your surgeon could not remove all of your oesophageal cancer. You may have radiotherapy along with the chemotherapy. The aim of the treatment is to shrink the cancer that was left behind after the operation. This may slow the growth of the cancer. Even if chemotherapy shrinks it completely, there is a risk that the cancer will come back sometime in the future.

Doctors use combined chemotherapy and radiotherapy (chemoradiation) in particular situations for cancer of the food pipe. 

If you aren't well enough to have surgery to remove the cancer, chemoradiotherapy can shrink the cancer and keep it under control for some time. 

If your cancer hasn't spread but could be difficult to remove, chemoradiotherapy may be able to shrink the cancer. The surgeon can then remove the cancer more easily. A paper published in 2007 looked at all the research into chemoradiotherapy for oesophageal cancer. It showed that some people who had combined chemoradiotherapy before surgery did better than those having surgery as their first treatment. The combined treatment seemed to help both adenocarcinomas and squamous cell cancers of the food pipe.

If you don't want to have an operation, combined chemoradiotherapy can shrink the cancer and control it for a while. 

You are particularly likely to have this treatment if you have a squamous cell cancer in the top third of your gullet. Many specialists think the results of this treatment are as good as surgery for this type of oesophageal cancer.

Combined chemotherapy and radiotherapy is quite intensive. The whole course of treatment is quite hard going, and side effects could be more severe. You and your doctor will need to take into account your overall health when deciding whether this is a suitable type of treatment for you.

If you have advanced oesophageal cancer, you may have chemotherapy to try to shrink the cancer, slow it down or relieve any symptoms that you have, such as difficulty swallowing. You usually have this type of treatment through a drip or chemotherapy pump. But you might be able to have some treatment as tablets or capsules. As the aim of the treatment is to make you feel better, rather than as a cure, it is important that the chemotherapy itself doesn’t make you too ill and that you do not have to make too many trips to the hospital.

Your doctor may ask you to take part in a clinical trial. This is because it is important for doctors to find out which treatments work best. Trials also look at the side effects of chemotherapy for cancer of the gullet. And at giving treatment in different ways, such as continuously through a chemotherapy pump. If you are asked to go on a trial, it is entirely your decision whether or not to do so. If you decide not to take part in a trial, you will receive the standard treatment that we have at the moment.

If the chemotherapy doesn't work, or stops working, you might need to have another treatment such as laser treatment or a tube put in to allow food to pass down the oesophagus (a stent).

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed them by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section of CancerHelp UK.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

For more about chemotherapy, look at the main chemotherapy section in CancerHelp UK. It explains the treatment in more detail, including

• How it works
• How doctors plan chemotherapy
• Different ways you can have chemotherapy
• General side effects
• Living with chemotherapy

If you would like more information about chemotherapy, ask your chemotherapy nurse or contact our cancer information nurses. They would be happy to help.