Types of treatment for oesophageal cancer

A team of doctors and other professionals will work together to decide on the best treatment and care for you. The team is called a multidisciplinary team (MDT) and includes surgeons, doctors who specialise in drug treatments for cancer (oncologists), specialist nurses, dieticians, speech therapists and social workers.

The team will meet together with your test results and case notes to discuss the best treatment options for you. They will take many factors into account, including

• How far your cancer has grown or spread (the stage)
• Your general health
• Your age and level of fitness

As with many cancers, the most common treatment options are surgery, radiotherapy and chemotherapy. You may have surgery on its own, or with chemotherapy or radiotherapy. There are other treatments you can have, such as photodynamic therapy or laser therapy, to relieve a blockage in your oesophagus.

The earlier your cancer is diagnosed, the easier it is to get under control and possibly cure it. If your cancer hasn't spread, you will almost certainly be offered surgery to remove your oesophagus. Surgery for oesophageal cancer is a major operation, so it is important that your doctor makes sure you are fit enough to make a good recovery from the operation. You may have to travel to a regional centre where specialist surgeons can carry out your operation. If you cannot have surgery for any reason, you may be able to have combined chemotherapy and radiotherapy instead.

If the cancer has spread into the tissues around the oesophagus you may have chemotherapy to shrink the tumour and possibly surgery. If the cancer has spread to other areas of the body you may have chemotherapy. You may also have radiotherapy to shrink the tumours and reduce symptoms.

Surgery is a common type of treatment for early stage oesophageal cancer. The amount of surgery you have depends on the exact size and position of your cancer. The tests you have had will help your specialist decide if surgery is an option for you. But your doctor may not be able to tell you exactly what stage your cancer is until after surgery. If it is possible to try to cure your oesophageal cancer, you will have all or part of your oesophagus removed. This operation is called an oesophagectomy. How much is removed will depend on where in the oesophagus the cancer is. During your operation, your surgeon will examine the oesophagus and surrounding area. Some of the lymph nodes will be removed from around your oesophagus. The lymph nodes will be sent to the laboratory and checked to see if they contain cancer cells. This helps your doctor to determine the stage of your cancer. There is more about surgery to remove oesophageal cancer in this section of CancerHelp UK.

If you have high grade Barrett's oesophagus, or a very early stage cancer which is only on the lining of the oesophagus (the mucosal layer), it may be possible to remove it using this technique. 'High grade' Barrett's oesophagus means that some of the cells are very abnormal. They are not cancer cells, but they are getting close to becoming cancer cells.

For this procedure, the doctor puts a tube called an endoscope down your throat. The endoscope contains a camera so the doctor can see inside your body. The endoscope can be used to inject fluid into the layer of cells below the cancer or abnormal area, which makes it stand out from the rest of the tissue. Then a thin wire (snare) is used to remove the area. The most common side effects are bleeding and a narrowing of the oesophagus, which can happen some time after the procedure. There is a very small risk of tearing the oesophageal wall. Your doctor may call this 'perforation'. You might have photodynamic therapy or radiofrequency ablation after EMR, to try to destroy any abnormal areas or cancer cells that may be left.

If your cancer is blocking your oesophagus and making it difficult to swallow, you may need treatment to clear the blockage. Sometimes laser treatment is used to burn away the tumour. Or you may have a tube called a stent put in to allow food and drink to pass through. There is detailed information about laser treatment and stents in this section of CancerHelp UK. Even if your oesophageal cancer cannot be cured, you may need treatment to get rid of the blockage to relieve symptoms and give you a good quality of life for as long as possible.

Your doctors may suggest chemotherapy on its own or with surgery to treat oesophageal cancer. If you have a cancer that is only in the oesophagus but cannot be removed, you will probably have chemotherapy to try and shrink it. In some people, this can shrink the cancer so that it can be removed with surgery.

If your doctor suspects you have cancer that has spread into surrounding tissues or lymph nodes (stage 2 or 3), you will probably have chemotherapy before surgery. This is called neoadjuvant chemotherapy. A large UK trial showed that giving chemotherapy before surgery can help reduce the risk of oesophageal cancer coming back in the future.

If you have oesophageal cancer that has spread to other parts of the body you may have chemotherapy to control or shrink the cancer and reduce symptoms.

There is more about chemotherapy for oesophageal cancer in this section of CancerHelp UK.

You may have radiotherapy, either on its own, or to help stop your cancer coming back after surgery. This treatment is painless to have, although it may make your throat sore as the course of treatment goes on. It is usual to have this treatment as an outpatient. The length of your course of radiotherapy treatment will depend on the size and type of oesophageal cancer you have. You usually have treatment for a few minutes every day, over a few weeks.

Sometimes radiotherapy is given from inside the body. This is known as internal radiotherapy or brachytherapy. For oesophageal cancer, this means having a radioactive source put down your throat and into the oesophagus. This is a bit like having the tube down your throat when your cancer was diagnosed. The doctor uses a flexible tube known as an endoscope to get the radioactive source in the right place. You are most likely to have this treatment if you have an advanced cancer that is making it difficult to swallow.

There is more about radiotherapy for cancer of the oesophagus, including information on internal radiotherapy in this section of CancerHelp UK.

If your cancer is only in the oesophagus but it may be too difficult to remove, or you are not fit enough for surgery, your doctors may suggest you have combined chemotherapy and radiotherapy. This treatment can shrink the cancer and control it for some time. It is quite an intensive treatment and there are side effects. But it has proved to be particularly successful and as good as surgery for squamous cell cancers that are nearer the top of the oesophagus.

You may also have this combined treatment before or after surgery. But it is still considered experimental in the UK. If you are going to have surgery, you are more likely to have chemotherapy on its own before the operation.

Your doctor may suggest combined chemotherapy and radiotherapy if you have a cancer that is too far advanced to be removed with surgery.

If you have high grade Barrett's oesophagus, you may have RFA either on its own or after an EMR. RFA uses heat made by radiowaves to destroy the abnormal cells.

Radiofrequency is a type of electrical energy. And ablation means destroying completely. A tube with a camera (endoscope) is passed down your throat into your oesophagus. A small balloon or probe is then guided to the area of abnormal cells. You have a few quick pulses of electrical energy, which destroys the abnormal cells on the inside of your oesophagus.

The National Institute for Health and Clinical Excellence (NICE) issued guidance in 2010 to say that RFA for high grade Barrett’s oesophagus is safe and works well enough to use in the NHS. But your progress must be followed up in the long term.

RFA may also be used after EMR for a very early stage oesophageal cancer.

This treatment involves the use of low powered lasers combined with a light sensitive drug to destroy cancer cells. PDT is a relatively new treatment, and you may need to have it repeated a number of times. There are two situations where your doctor may suggest it

• As a treatment to try to prevent high grade Barrett's oesophagus developing into cancer, if you are unable to have surgery
• To destroy part of a tumour and improve swallowing when advanced oesophageal cancer is making this difficult

The National Institute for Health and Clinical Excellence (NICE) have issued guidance to doctors about using PDT to treat high grade Barrett's oesophagus. NICE say that PDT is safe and works well enough to use in the NHS. But you should be followed up in the long term.

There is information about PDT to treat advanced oesophageal cancer in this section of CancerHelp UK.