Radiotherapy for oesophageal cancer

Radiotherapy uses high-energy rays to treat cancer. It destroys cancer cells in the area where the radiotherapy is given, while doing as little harm as possible to normal cells.

Some normal cells in the area 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.

Radiotherapy to the oesophagus can cause a sore throat and 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 tube – the tube is put into the nose and passed down the oesophagus into the stomach.
• Gastrostomy feeding tube – the tube is 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. They can give you information about the type of tube to be used. You will also have support from a dietitian. A speech and language therapist (SLT) can help you with any swallowing problems you may have.

We have more information about 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 sick (nausea) and tired. It may also make the inside of the oesophagus inflamed, making swallowing painful. These side effects usually get better when treatment finishes. Side effects will depend on the radiotherapy dose and the length of your treatment.

Your cancer doctor, specialist nurse or radiographer can advise you about 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 being treated sometimes gets dry and irritated. During your treatment, you are usually advised to:

• wear loose-fitting clothes made from natural fibres, such as a cotton
• wash your skin gently with mild, unperfumed soap and water and gently pat it dry.

Before your treatment starts, the staff in the radiotherapy department can give you advice on how to look after your skin.

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 can give you medicines to help.

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

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. Brachytherapy is given to help control the cancer and improve symptoms.

There are two ways of giving internal radiotherapy:

• It can be given through an endoscope – a thin, flexible tube (endoscope) is placed through the mouth and down the throat until the tip is in the stomach. A machine then sends radioactive pellets into the tube.
• 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.

Brachytherapy 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. 

We have more information about difficulties with swallowing.