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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
Chemotherapy drugs that are commonly used to treat oesophageal cancer are:
Usually a combination of two or more drugs are given. 5FU, cisplatin and epirubicin may be given together and are known as the ECF| regimen.
Capecitabine is a tablet form of 5FU. If this is used instead of 5FU, the combination is known as the ECX| regimen.
Another combination is called EOX| and uses the drugs epirubicin, oxaliplatin and capecitabine. EOX is sometimes called EEX.
Chemotherapy can be given before an operation| to remove an oesophageal cancer. This is sometimes called neoadjuvant chemotherapy. It can shrink the tumour, making it easier to remove. Or, if there is a possibility that there are cancer cells elsewhere in the body, giving chemotherapy sooner rather than later may increase the chance of controlling them.
Chemotherapy can be given after surgery to reduce the chances of the disease coming back. It works by destroying any cancer cells that might be left behind after the operation. This is called adjuvant chemotherapy.
Chemotherapy may also be used if the cancer has spread to other parts of the body. This aims to shrink the tumour, improving symptoms and extending good-quality life. In some people the chemotherapy will achieve this. Unfortunately, for other people the chemotherapy will not shrink the cancer and they will have the side effects of the treatment with little benefit.
Chemotherapy and radiotherapy| can be given at the same time. This is called chemoradiotherapy or chemoradiation. Certain chemotherapy drugs such as fluorouracil (5FU) may improve the effectiveness of radiotherapy treatment. It’s mainly used for squamous cell carcinoma but can be used for adenocarcinoma too. However, giving the two treatments at the same time also increases the side effects.
Chemoradiotherapy can be used as the main treatment when surgery isn’t suitable. It can also be used before an operation to shrink the tumour. As this is a new type of treatment it may be given to you as part of a clinical trial|.
It can help to discuss the benefits and side effects of chemotherapy in your particular situation with your cancer specialist. If you have a cancer that has spread, and you decide that you don’t want to have chemotherapy, your doctor can still prescribe medicines to help control symptoms.
People often have their chemotherapy drugs given by injection into a vein (intravenously). The drugs may be given through a vein in the back of your hand, through a plastic line called a central line| in your chest or through a thin tube inserted into a vein in the crook of your arm (a PICC line|). Sometimes chemotherapy is given in tablet form.
It may mean staying in hospital for a few days, or you may be able to be treated as a day patient. The treatment is generally repeated every three weeks.
Sometimes chemotherapy can be given to you continuously through a small portable pump which is attached to your central or PICC line. A controlled amount of the drug can be given into the bloodstream over a period of time. This means that you can go home with the pump, and spend less time in hospital.
A central line
The PICC line is threaded through the vein until the end is near to your heart The end of the PICC line comes out just below your elbow
Chemotherapy drugs may cause unpleasant side effects, but these can usually be well controlled with medicines. Not all drugs cause the same side effects and some people may have very few. Your doctor will tell you about any problems that your treatment may cause.
While the drugs are acting on the cancer cells in your body, they also temporarily reduce the number of normal white cells in your blood. When these cells are reduced, you’re more likely to get an infection| and you may tire easily. Your blood will be tested regularly during chemotherapy and, if necessary, you’ll be given antibiotics to treat any infection. You may also be given injections called growth factors to stimulate your body to make more white blood cells.
If your temperature goes above 38°C (100.4°F), or you suddenly feel unwell, even with a normal temperature, you may have an infection. Contact your chemotherapy nurse or doctor at the hospital straight away.
While having chemotherapy you may become anaemic. This can make you feel very tired and lethargic| and you may also become breathless|. Anaemia can be treated by blood transfusions|.
The chemotherapy can also reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Some of the drugs used to treat oesophageal cancer can make you feel, or be, sick (nausea and vomiting|), but there are very effective anti-sickness drugs (anti-emetics) to prevent this. If the sickness is not controlled or continues, even with anti-sickness treatment, let your doctor know. They can prescribe other medicines that may be more effective.
Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during treatment, but many find they have to take things much more slowly. Tiredness| can build up over a course of treatment, and can last for several months or more after your treatment has finished.
It can help to cope with tiredness by planning ahead. Keeping a treatment diary can help you record your energy levels and plan activities for when you are feeling stronger. There may be times when you feel less tired. A little activity can sometimes help with the symptoms of fatigue.
Some chemotherapy drugs can make your mouth sore| and cause small ulcers. It’s important to rinse your mouth regularly to keep it clean. Using a child’s soft toothbrush can help. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet.
Our section on eating well| has useful tips on coping with eating problems.
Unfortunately, some chemotherapy drugs can cause hair loss|.
If you lose your hair it will usually start to grow back within three to six months of finishing your treatment. People who lose their hair often cover up by wearing wigs, bandanas, hats or scarves. If you are being treated as an inpatient, or you are on income support, you can get a free wig from the NHS. If not, you can still get a wig at a lower cost from the hospital. If you experience hair loss it’s important to protect your scalp from the sun.
This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy|. Tell your doctor if you notice these symptoms. This problem usually improves slowly over a few months after the treatment is over.
Some of the chemotherapy drugs used to treat oesophageal cancer can cause diarrhoea|. This often starts several days after treatment. If you’re taking chemotherapy tablets or capsules at home, it’s important to let your doctor or nurse know if you have diarrhoea as your treatment may need to be interrupted.
Medicine can be prescribed to help. It’s important to drink plenty of fluids if you have diarrhoea.
5FU or capecitabine may cause soreness of the palms of the hands or soles of the feet. This is known as palmar-plantar syndrome. A vitamin can be prescribed to help control it and non-perfumed moisturising creams can often help to relieve symptoms.
Our section on chemotherapy| has more information about the treatment, how it's given and common side effects.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.