Chemotherapy for oesophageal cancer
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 is given. A common combination used to treat adenocarcinoma of the oesophagus is the ECF regimen. This contains the drugs epirubicin, cisplatin and 5FU.
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 the EOX regimen and uses the drugs epirubicin, oxaliplatin and capecitabine. EOX is sometimes called the EEX regimen.
Squamous cell carcinoma of the oesophagus is commonly treated with a combination of cisplatin and 5FU.
When chemotherapy is given
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Chemotherapy is commonly 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’s 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 sometimes 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 prolonging a good quality of 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 with radiotherapy
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.
Chemoradiation is mainly used for squamous cell carcinoma, but can be used for adenocarcinoma too.
Chemoradiation 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.
Giving chemotherapy at the same time as radiotherapy increases the risk of side effects, and it can be a demanding treatment. It may not be suitable for everyone, for example people who have other health problems. Your doctors will discuss this with you if it’s appropriate.
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.
How chemotherapy is given
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People often have chemotherapy 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.
You will usually be treated as a day patient. The treatment is generally repeated every 3-4 weeks. Chemotherapy is usually given as a session of treatment.
After each session you’ll usually have a rest period of a few weeks before the next session. This allows your body to recover from the side effects. The chemotherapy session and the rest period make up a cycle of treatment. Your specialist will discuss this with you. The number of cycles you have will depend on how well the cancer is responding to the drugs.
Sometimes chemotherapy can be given to you continuously through a small portable pump that’s 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.
Chemotherapy drugs can cause side effects, but many of these can be well controlled with medicines and will usually go away when your treatment is finished.
If your cancer is causing symptoms, chemotherapy can also make you feel better by relieving them. Your doctor or nurse will tell you more about what to expect. Always mention any side effects you’re having, as there are usually ways they can be controlled. The main side effects are described here, along with some ways to control or reduce them.
Risk of infection
Chemotherapy can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you’ll be more prone to infection. A low white blood cell count is called neutropenia. This begins a few days after treatment. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (your blood count) is still low.
Anaemia (low number of red blood cells)
Chemotherapy can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Bruising and bleeding
The chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn’t controlled or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Your mouth may become sore or dry, or you may notice small ulcers during chemotherapy treatment. Some people find sucking on ice soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Our section on eating well has useful tips on coping with eating problems.
Not all chemotherapy drugs cause hair loss. You can ask your doctor whether the drugs you’re having are likely to cause hair loss. If they are likely to, then hair may be lost completely or it may just thin. If you do lose your hair, you may want to wear a wig – you can ask your doctor or nurse to arrange for you -to see a wig specialist. You may prefer to wear a bandana, hat or scarf.
We have a section on coping with hair loss, which has useful tips on wigs, head coverings and dealing with the emotional effects of hair loss.
Numbness or tingling in the hands or feet
This is due to the effect of chemotherapy on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It’s important to report your symptoms to your doctor, as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly, a few months after the treatment has finished. Sometimes symptoms can persist - talk to your doctor if this happens.
Chemotherapy can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it’s severe or continues. It’s important to drink plenty of fluids if you have diarrhoea.
Soreness and redness of the palms of the hands and soles of the feet
This is sometimes known as palmar plantar or hand and foot syndrome. It can happen when chemotherapy is given. It’s usually temporary and improves when the treatment is finished.
Your doctor may prescribe creams or a vitamin called pyridoxine (vitamin B6), which some people find helpful.
It can also help to keep your hands and feet cool and to avoid tight-fitting clothing, such as socks, shoes and gloves.
Risk of blood clots
Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy can increase this risk further. You may be given medicines to thin your blood and help prevent clots forming.
A blood clot may cause pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you have any of these symptoms.
Our section on chemotherapy has more information about the treatment, how it's given and common side effects.