Radiotherapy for oesophageal cancer (cancer of the gullet)
Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy is directed at specific parts of the body and may be given externally or, more rarely, internally.
External radiotherapy is usually given in combination with chemotherapy to treat oesophageal cancer.
This is known as chemoradiation and may sometimes be offered if surgery isn’t possible or if you don’t want an operation. Chemoradiation is also sometimes given before an operation to shrink the tumour.
If the cancer is more advanced, radiotherapy may be given on its own to shrink the tumour and help control symptoms.
The treatment is given in the hospital radiotherapy department. Each treatment takes 10-15 minutes and is usually given every day from Monday-Friday, with a rest at the weekend. Your doctor will discuss your treatment and the possible side effects with you.
Dr Vincent Khoo explains what to expect if you're having radiotherapy.
Planning your radiotherapy
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Radiotherapy has to be carefully planned to make sure it’s as effective as possible. It’s planned by a cancer specialist (clinical oncologist), and it may take a few visits.
On your first visit to the radiotherapy department, you’ll be asked to have a CT scan or to lie under a machine called a simulator, which takes x-rays of the area to be treated.
You may need to have some small marks made on your skin to help the radiographer (who gives you your treatment) position you accurately and to show where the rays will be directed. These marks must stay visible throughout your treatment, and permanent marks (like tiny tattoos) are usually used. These are extremely small, and will only be done with your permission. It may be a little uncomfortable while they’re being done.
Sometimes if the cancer is in the upper part of your oesophagus, a shell (or mask) may be made. The shell is usually made from perspex (a type of plastic) or from a type of mesh plastic, which is moulded to fit you.
A radiotherapy shell keeps you as still as possible during treatment. This is to make sure that exactly the right area is treated. Your shell will be made before your treatment is planned. You will only have it on for a few minutes at a time and most people soon get used to it. It shouldn’t be uncomfortable to wear.
At the beginning of each session of radiotherapy, the radiographer will position you carefully on the couch and make sure you’re comfortable. During your treatment you’ll be alone in the room, but you can talk to the radiographer, who will watch you from the next room. Radiotherapy isn’t painful, but you have to lie still for a few minutes during the treatment.
Side effects of radiotherapy
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Radiotherapy can cause general side effects such as feeling sick (nausea) and tiredness, but it’s also likely to make the inside of your oesophagus inflamed, causing short-term soreness when you swallow. These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment.
It’s not unusual to feel worse before you start to feel better. Some people can find this a very difficult time and they may feel low or even depressed for a while. The clinical oncologist can advise you about what to expect.
The skin in the area being treated sometimes gets dry and irritated. Avoid using perfumed soaps or body wash during treatment, as they could irritate the skin. You’ll be given advice on looking after your skin. Your doctor can prescribe cream to soothe it if it becomes sore.
Sore throat and difficulty swallowing
Radiotherapy can make your throat very sore towards the end of the treatment, and you may not be able to swallow properly for a while. Your doctor can prescribe medicines to help.
Some people have a feeding tube put into their stomach before the radiotherapy starts. Your doctor can advise you whether this is necessary. The feeding tube is known as a PEG tube. PEG stands for percutaneous endoscopic gastrostomy, and is carried out under local anaesthetic.
A flexible tube with a light at the end (endoscope) is passed down the throat and oesophagus into the stomach, to find a suitable area to insert the tube. A cut is then made in the skin and muscle over the stomach, and the PEG tube is passed through a cut made in the stomach itself. The tube is usually held in place with a rubber or silicon disk (flange). Liquid feeds can be given through the tube.
Our section on nutritional support discusses PEG tubes and feeding in detail.
If the radiotherapy is given to the upper end of the oesophagus, it may reduce the amount of saliva your salivary glands produce. This effect may be temporary, but occasionally can be permanent. This may make your mouth dry, which can make eating difficult. We have a section about coping with a dry mouth, which you may find helpful.
Loss of appetite
If you don’t feel like eating, you can replace meals with nutritious, high-calorie drinks, which are available from most chemists. Our section on diet and cancer also has some helpful hints on how to eat well if you have a low appetite. You can discuss any problems with your doctor or specialist nurse.
If nausea and vomiting occur, they can usually be effectively treated with anti-sickness drugs (called anti-emetics). Your doctor can prescribe these.
When radiotherapy is used to treat the oesophagus, men may find that some of the hair on their chest falls out.
Radiotherapy can cause tiredness. In some people this continues for several months after treatment.
During your treatment you’ll need to rest more than usual, especially if you have to travel a long way for treatment each day. But it’s good to do gentle exercise, such as walking, when you feel able to.
Once your treatment is over, gradually increase your activity and try to balance rest periods with exercise, such as walking. This will help build up your energy levels.
These side effects should disappear gradually once your course of treatment is over, but it’s important to let your doctor know if they continue.
Radiotherapy doesn’t make you radioactive and it’s perfectly safe for you to be with other people, including children, throughout your treatment.
Internal radiotherapy (brachytherapy)
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This is given by inserting a radioactive source into the cancer, which gives a high dose of radiotherapy to the tumour. As the radiation dose doesn’t travel far, surrounding organs are not affected. The source is left there for between 30 minutes and a couple of days, depending on the amount of radiation that’s needed. In this way, more focused treatment is given directly to the tumour over a short time, rather than a course of external radiation given to a wider area over a longer time.
There are two ways of giving internal radiotherapy:
through an endoscope
through a nasogastric (NG) tube - a thin flexible, plastic tube that goes up your nose, down the back of your throat and into your stomach.
Your doctor can explain more about this treatment. As with external radiotherapy, internal radiotherapy causes temporary soreness when you swallow, which may develop a few days after treatment and last for a few days. Your doctor will recommend liquid medicines to help.
If you have to stay in hospital for a few days while the radioactive source is in place, your family or close friends will only be able to visit you for short periods each day.
It’s not advisable to allow children or pregnant women to visit while you’re having this type of radiotherapy. The hospital staff will advise you on who can visit.
Our section on radiotherapy gives detailed information about this treatment and its side effects.