Radiotherapy for oesophageal cancer

Radiotherapy uses high-energy rays called radiation to treat cancer. It destroys cancer cells in the area where the radiotherapy is given.

Some normal cells in the area being treated can also be damaged by radiotherapy. This can cause side effects. As the normal cells recover, the side effects usually get better.

Radiotherapy for oesophageal cancer can be given as external beam radiotherapy or internal radiotherapy (brachytherapy).

You will have a hospital appointment to plan your treatment.

Sometimes, radiotherapy can lead to difficulty swallowing, which can make it hard to eat. You may have a feeding tube put into the stomach before the radiotherapy starts. This helps make sure you are getting enough to eat. There are different types of feeding tube:

• nasogastric feeding tubes are put into the nose and passed down the oesophagus into the stomach
• gastrostomy feeding tubes are passed through the skin into the stomach.

Liquid food can be given through the tube. You can go home with it in place. You, or any carers, can be shown how to manage the feeding tube at home with support from a dietitian or community nurse.

Your cancer doctor can talk to you about whether you might need a feeding tube.

We have more information about feeding tubes and nutritional support.

Radiotherapy can cause side effects in the area of your body that is being treated. You may also have some general side effects, such as feeling tired.

Sometimes side effects get worse for a time during and after you have finished radiotherapy, before they get better.

Your cancer doctor, specialist nurse or radiographer will tell you what to expect. They will give you advice on what you can do to manage side effects. If you have any new side effects or if side effects get worse, tell them straight away.

The skin in the area that is treated may:

• become dark or red, depending on your skin type
• feel sore or itchy.

Your radiographer or specialist nurse will give you advice on taking care of your skin. If your skin becomes sore or itchy, or changes colour, tell them straight away. They can give you advice and treatments if needed.

Skin reactions should get better within 4 to 6 weeks of treatment finishing.

During your treatment, you are usually advised to:

• wear loose-fitting clothes made from natural fibres, such as cotton
• wash your skin gently with soap and water and gently pat it dry
• avoid rubbing the skin
• avoid very hot things, for example heating pads
• avoid cooling pads but these may be helpful in some situations so speak to your team about using these first
• avoid wet shaving
• avoid hair-removing creams or products, including wax and laser treatment
• follow your radiotherapy team’s advice about using moisturisers and deodorants
• protect the treated area from the sun.

Towards the end of treatment, radiotherapy can make your throat or oesophagus painful. You may not be able to swallow properly for a while. It can help to eat soft foods until the pain improves. Difficulty swallowing and pain can last for a few weeks after radiotherapy finishes. Your cancer doctor or radiographer can give you medicines to help.

If swallowing is painful, it may mean you are not able to eat enough. If this happens, you may need to speak with a dietitian. They can talk to you about how you can supplement your diet with high-calorie, nutritious drinks.

Sometimes, radiotherapy to the upper oesophagus reduces the amount of spit (saliva) the salivary glands make. This does not usually last long, but for some people it may be permanent. It may make your mouth dry, which can make eating difficult.

During radiotherapy, you may not feel like eating very much. But it is important to try to maintain your weight. Your dietitian can give you advice on ways to build up your diet and maintain or gain weight.

Radiotherapy and chemotherapy can cause you to feel sick (nausea) and be sick (vomit). This can usually be treated with anti-sickness drugs (anti-emetics). Your cancer doctor can give you these.

When radiotherapy is used to treat oesophageal cancer, it can affect hair in the area being treated. If you have hair on your chest, some of it may fall out.

Radiotherapy can make you feel tired. In some people, this continues for several months after treatment finishes. During treatment, you will need to rest more than usual, especially if you have to travel a long way for your treatment each day. But gentle exercise, such as short walks, can help with energy levels. After treatment finishes, try to slowly increase your activity.

Brachytherapy uses radioactive implants such as seeds, pellets, wires or plates that are put near or inside the tumour. The radioactivity only affects tissue that is very close to the implant. This means the tumour is treated, but healthy areas around it get much less radiotherapy. Areas of the body that are further away are not affected at all.

The implants are left in place for 10 to 30 minutes, depending on the radiation dose being given.

Brachytherapy is not suitable for everyone. It is usually only given if the cancer has come back in the oesophagus after external radiotherapy or chemoradiation. Sometimes brachytherapy is given to help control the cancer and improve symptoms such as difficulties with swallowing. 

Internal radiotherapy is given through a nasogastric (NG) tube. A thin, flexible, plastic tube is placed up the nose, down the back of the throat, and into the stomach. A machine then sends radioactive pellets into the tube.

Your cancer doctor can explain more about how this treatment is given.

Internal radiotherapy can cause some pain when you swallow. This may start a few days after treatment starts, but usually goes away a few weeks after treatment finishes. Your cancer doctor can recommend liquid medicines to help.