Treatment for oesophageal cancer (cancer of the gullet)
Cancer of the oesophagus (gullet) can be treated using surgery, chemotherapy or radiotherapy. The treatments can be used alone or in combination. The treatment you have will depend on the type of cancer, its stage and where it is, and on your general health.
Treatment may be given to cure the cancer, or if a cure isn’t possible, it can be given with the aim of controlling the cancer and relieving your symptoms.
When planning treatment, the doctors consider the oesophagus in three sections: upper, middle and lower.
If you have an early oesophageal cancer that hasn’t spread (stage 1), you may be offered surgery to remove the cancer or a combination of chemotherapy and radiotherapy (chemoradiation). In some circumstances you may be offered endoscopic mucosal resection.
If the cancer has begun to spread (stage 2 or 3), you may be offered chemotherapy before an operation, or sometimes chemotherapy on its own. Sometimes radiotherapy is used after an operation, or occasionally on its own. If the tumour is difficult to remove with an operation you may be offered chemoradiation, which can sometimes make surgery easier to do.
If you have advanced oesophageal cancer, you may still be offered chemotherapy and radiotherapy to help control the cancer and improve symptoms.
We have more information about the different stages of oesophageal cancer.
Other treatments may be used to help with any swallowing difficulties you may have. These treatments include:
intubation or stenting (inserting a tube into the oesophagus to keep it open)
dilatation (stretching the oesophagus)
laser treatment and photodynamic therapy (PDT).
You may be offered one or more of these treatments, which are described in our Other treatments section.
Planning your treatment
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In most hospitals a team of specialists will talk to you about the treatment they feel is best for your situation.
This multidisciplinary team (MDT) will include:
a surgeon who specialises in oesophageal cancers
a clinical oncologist (a radiotherapy and chemotherapy specialist)
a radiologist who analyses scans and x-rays
a medical oncologist (a chemotherapy specialist)
a nurse specialist.
The team may also include other healthcare professionals, such as a dietitian, physiotherapist, occupational therapist, psychologist or counsellor.
If two treatments are equally effective for the type and stage of cancer you have, your doctors may offer you a choice.
If you have to decide between treatments, make sure that you have enough information about the different options.
You might want to ask more about what’s involved in each treatment, and about possible side effects, before you decide what’s right for you. It often helps to make a list of the questions you want to ask and to take a relative or close friend with you. You may also find it helpful to keep notes about what has been said.
Giving your consent
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you’re asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual for people to need explanations repeated.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
The benefits and disadvantages of treatment
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Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. However, these can usually be controlled with medicines. Treatment can be given for different reasons and the potential benefits will vary depending on your individual situation.
Early-stage oesophageal cancer
People with early-stage cancer of the oesophagus may be given treatment with the aim of curing the cancer. Occasionally additional treatments are given to reduce the risk of it coming back. This is called adjuvant treatment.
Advanced-stage oesophageal cancer
If the cancer is advanced and has spread to other parts of the body, treatment may only be able to control it, improving symptoms and quality of life. However, for some people in this situation the treatment will have no effect on the cancer and they will get the side effects without any of the benefit.
If you have early-stage cancer and have been offered treatment that aims to cure it, it may be easy to decide whether to accept the treatment.
However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead. Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms.
It’s important that you ask your doctors and nurses any questions you have about your treatment. The more you understand about your treatment, the easier it will be for you and them.
Your multidisciplinary team uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, to make sure your concerns are covered during the discussion.
Watch our video explaining the benefits and disadvantages of getting a second opinion.