Other treatments for oesophageal cancer (cancer of the gullet)
You might have some of the following other treatments to treat oesophageal cancer (cancer of the gullet)
Endoscopic mucosal resection (EMR)
Back to top
Very early-stage oesophageal cancers that are just in the inner lining of the oesophagus (the mucosa) can be treated using endoscopic mucosal resection (EMR). An endoscopy is carried out. The doctor injects fluid into the layer of cells below the cancer, which raises the tumour up from the muscle layer of the oesophagus. A thin wire is then looped around the cancer and it is removed.
The most common side effects of EMR are bleeding and a narrowing of the oesophagus.
Your doctor may recommend further treatment after EMR, to destroy any cancer cells that might be left. Treatments that may be used in this situation are radiofrequency ablation (RFA), photodynamic therapy (PDT) and argon plasma coagulation (APC).
Radiofrequency ablation (RFA)
Back to top
RFA uses heat to destroy cancer cells. It’s sometimes used to treat very early oesophageal cancers after EMR. RFA uses a probe called an electrode to apply an electrical current (radiofrequency) to the tumour. The electrical current heats the cancer cells to high temperatures, which completely destroys (ablates) them. The cancer cells die and the area that’s been treated gradually shrinks and becomes scar tissue. Some people may need to be treated more than once.
Photodynamic therapy (PDT)
Back to top
Photodynamic therapy (PDT) uses a laser combined with a light-sensitive drug to destroy cancer cells. In the UK it’s only carried out in a few specialist hospitals so if it’s suitable for you, you may have to travel to another hospital to have it. This treatment is most commonly used to help with difficulty swallowing. It can also occasionally be used instead of surgery to treat early-stage (stage one) oesophageal cancer.
PDT is given in two stages. First you’ll be given a drug that makes the cancer cells more sensitive to light (a photosensitiser). This is usually given as an injection into a vein in your arm (intravenously). For the second part of the treatment a laser is shone on to the cancer, using an endoscope. The laser activates the photosensitiser to destroy the cancer cells.
The treatment will make you sensitive to light and you’ll need to take precautions to avoid exposure to sunlight for a few days.
PDT may make the area in the oesophagus become temporarily inflamed and swollen. At first, this can make swallowing more difficult.
The National Institute for Health and Clinical Excellence (NICE) gives advice about which new treatments should be available on the NHS. It reviewed the use of PDT to treat early oesophageal cancer in 2006. It said that it’s safe to use, but that more evidence is needed to know just how effective it is for early oesophageal cancer. It’s not yet known how well it works and how it compares in the long-term with surgery.
You may be offered PDT if you have stage 1 oesophageal cancer. Your doctor should discuss with you the possible risks and benefits, as well as other treatments that may be available. NICE suggests that doctors use PDT within research trials if possible, and also that they make sure that patients are followed up to check their progress.
The Scottish Intercollegiate Guidelines Network (SIGN) is a similar organisation to NICE, but it gives advice to the NHS in Scotland. It recommends PDT as a possible treatment following EMR or to treat difficulty swallowing.
Argon plasma coagulation (APC)
Back to top
APC is sometimes recommended after EMR or as a treatment if swallowing is difficult. Using an endoscope, a probe is placed close to the area to be treated. Using a combination of argon gas and electricity, the doctor can destroy the cancer.
Your doctor or specialist nurse can give you more information about APC.
Back to top
Trastuzumab is one of a newer group of drugs called monoclonal antibodies. It works by attaching to a protein called HER2 on the surface of certain cancer cells. This stops the cancer cells dividing and growing. Herceptin is mainly used to treat breast cancer, but it can also be used to treat some advanced oesophageal cancers in the area where the oesophagus joins to the stomach (the gastro-oesophageal junction). It’s used in combination with chemotherapy.
About a quarter (25%) of people with oesophageal cancer have tumours that are positive for HER2 receptors, so Herceptin is only suitable for a small number of people.
This treatment has not been approved by NICE for use in England and Wales, or by the Scottish Medicines Consortium (SMC) for use in Scotland. So it may not be generally available on the NHS. Your specialist can discuss this with you further.