Chemotherapy drugs for oesophageal cancer

Doctors use several different drugs and combinations of drugs to treat oesophageal cancer. They often use combinations of drugs because chemotherapy tends to work better when several drugs are given together. They attack cancer cells at different points in their life cycle. So the theory is that if one drug doesn't get them, another will.

Which drugs you have will depend on why you are having the treatment and on the type of cancer you have. Through research, doctors have discovered that particular combinations of chemotherapy work better for adenocarcinomas and other combinations work better for squamous cell cancers of the oesophagus. If you are having chemotherapy for advanced oesophageal cancer, you may have treatment designed to cause as few side effects as possible.

Your doctor or nurse should give you written information about the drugs you are to have.

ECF is one of the commonest drug combinations doctors use for adenocarcinoma of the oesophagus. This contains the drugs epirubicin, cisplatin and fluorouracil.

You have ECF by injection into a vein and through a pump. To have this treatment, you need to have a central line put in. You can usually have this done in the outpatient department.

You have the epirubicin and cisplatin every 3 weeks by injection and drip into your central line. You often need to go to the outpatient department at the hospital for this. You have the fluorouracil continuously through a pump. The pump is set up in the outpatient department and stays connected to your central line when you go home. You have to take bags of fluorouracil to refill the pump at home. Your chemotherapy nurse can show you how to do this before you leave the hospital with the pump fitted. In some hospitals, you may have to stay in for 5 days while you have this treatment. There is a page on the specific side effects of ECF in our chemotherapy side effects section.

Doctors sometimes now use a tablet form of fluorouracil. This drug is called capecitabine (Xeloda). If it is used instead of intravenous fluorouracil the combination is called ECX, rather than ECF. There is information about capecitabine for oesophageal cancer in the what's new in oesophageal cancer section.

Sometimes instead of cisplatin and fluorouracil you may have oxaliplatin and capecitabine.  This combination is called EOX. A trial called REAL2 showed that capecitabine worked as well as fluorouracil, and oxaliplatin worked as well as cisplatin for oesophageal and stomach cancer that had spread.  

MCF is another combination of chemotherapy drugs doctors use for adenocarcinoma of the oesophagus. This includes the drugs mitomycin C, cisplatin and fluorouracil.

For squamous cell cancer of the oesophagus, a common combination of drugs is cisplatin and 5FU every 3 to 4 weeks. There are different schedules for giving the drugs depending on your situation. Generally, you have the cisplatin as an outpatient in hospital, and the 5FU chemotherapy through a pump, as described above for adenocarcinoma.

You may have radiotherapy at the same time as having cycles of chemotherapy. This is called chemoradiation. You have your radiotherapy daily for 5 weeks. So you may have chemotherapy treatments during the first week and the fifth week of radiotherapy. Or you may have a couple of cycles of chemotherapy before you start your radiotherapy. There is information below about the side effects of combined radiotherapy and chemotherapy.

Chemotherapy does have side effects. Which ones you get depend on

• Which drugs you are given
• How much of each drug you are given
• How you individually react

Not everyone gets every side effect with every drug. Some people react more than others. And different drugs have different side effects. So we can't tell you exactly what will happen to you. Most side effects only last for the few days that you are actually having the drugs. And there is quite a bit that can be done to help. Here is a list of some common side effects. You can find more information about these in our section on the general side effects of chemotherapy drugs

• A drop in the number of blood cells
• Feeling sick
• Diarrhoea
• Hair loss or thinning
• Sore mouth and mouth ulcers
• Feeling tired and run down

Ask your doctor or nurse which of these side effects are most common with the chemotherapy drugs you will be having. Click on the links above for more about each side effect and how to deal with it.

Tell your doctor or nurse about any side effects you have straight away so that they can help you as much as possible. If you would like more information about anything to do with the side effects of chemotherapy, contact one of the cancer information organisations in help and support. They will be happy to help. They often have free factsheets and booklets, which they can send to you.

You can also contact our cancer information nurses. They would be happy to help.

Chemotherapy courses can seem to go on for ever. Particularly if you are getting very tired towards the end of your course. But they do finish. And the side effects will go once your treatment has ended.

There is more detailed information on the specific side effects of 5FU, epirubicin, cisplatin and mitomycin C, in the main chemotherapy section of CancerHelp UK.

Other drugs that may be used in treating oesophageal cancer include taxol, irinotecan, vinorelbine and oxaliplatin. Generally the side effects are similar as for the drugs above. The links will take you to information on the particular side effects of these drugs.

Having radiotherapy and chemotherapy together can be quite intensive. You will have the general side effects from chemotherapy, such as a drop in your blood counts. And side effects from radiotherapy, such as tiredness and reddening of the skin in the treatment area. You are also likely to have

• Sickness
• A very sore throat, which may become worse as the course of treatment goes on
• Weight loss

There are very good anti sickness drugs available these days. Do tell your nurse or doctor if you don't think your sickness drugs are working well enough. There are several different types and another type may work better for you.

Most people having this treatment get an increasingly sore throat. You may find swallowing more and more difficult as your course of treatment goes on. Your doctor will give you painkillers and may suggest you only drink liquids for the time being. Some people need to have painkillers through a pump when they are having this treatment. This gives you a constant dose and helps to make sure you are as comfortable as possible throughout the treatment.

Because of difficulty swallowing, many people having this treatment lose a bit of weight. Try not to worry about this, even if you had lost weight before you were diagnosed. You can build yourself up once you have got over the treatment. If your doctor is concerned about your weight, he or she may suggest you come into hospital to be fed through a tube until you have recovered from your treatment and can eat normally again.

There is more about the particular side effects of radiotherapy for cancer of the oesophagus in CancerHelp UK.