What is radiotherapy?

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).

External beam radiotherapy for oesophageal cancer

External beam radiotherapy is usually given in combination with chemotherapy to treat oesophageal cancer. This is called chemoradiation.

Chemoradiation is sometimes given:

  • instead of surgery, if you are not well enough to have surgery or with the aim of curing the cancer
  • before surgery, to shrink the tumour
  • as part of a clinical trial.

If the cancer is more advanced, you may have radiotherapy on its own to shrink the tumour and help control symptoms.

Chemoradiation for oesophageal cancer

Certain chemotherapy drugs make the cancer more sensitive to radiotherapy. These include:

Chemoradiation is used to treat squamous cell carcinoma and adenocarcinoma. These are the two main types of oesophageal cancer.

Having chemotherapy and radiotherapy together can make the side effects of treatment worse. It may not be suitable for people who have other health problems. Your cancer doctor or specialist nurse can give you more information about chemoradiation and its possible side effects.

Planning your radiotherapy

You will have a hospital appointment to plan your treatment.

Feeding tube

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.

Having external beam radiotherapy

Radiotherapy is normally given as a number of short, daily treatments in a hospital radiotherapy department. You usually have it every day from Monday to Friday, with a rest at the weekend. Each treatment takes 10 to 15 minutes. Your radiotherapy team will explain how many treatments you will have and when you will have them. Your course of treatment may last up to a few weeks.

The person who operates the machine is called a radiographer. They give you information and support during your treatment.

They will tell you how long your treatment will take. The treatment itself is not painful. It does not make you radioactive. You will not be a risk to anyone during your treatment.

We have more information about having external beam radiotherapy.

Side effects of radiotherapy for oesophageal cancer

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.

Skin changes

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.

Sore throat and difficulty swallowing

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.

Dry mouth

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.

Loss of appetite

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.

Feeling sick

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.

Hair loss

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.

Tiredness

Radiotherapy can make you feel tired. This can continue 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.

Late effects of radiotherapy to the oesophagus

Sometimes radiotherapy for oesophageal cancer can cause long-term side effects. These are side effects that:

  • start during treatment but do not go away
  • develop months or years after treatment finishes.

Most people do not get late effects. But if you notice any symptoms, always tell your cancer doctor or specialist nurse.

Difficulty swallowing

Radiotherapy can cause some damage to the tissue in the oesophagus. This can make it difficult to swallow. You may be offered treatment to stretch the oesophagus to make it easier to swallow.

Effects on the lungs

The lungs may become inflamed, or the tissue can become scarred (fibrosis). Tell your cancer doctor or specialist nurse if you have a cough or are short of breath.

We have more information about late effects of cancer treatment.

Internal radiotherapy (brachytherapy) for oesophageal cancer

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

How we can help

Macmillan Grants

If you have cancer, you may be able to get a Macmillan Grant to help with the extra costs of cancer. Find out who can apply and how to access our grants.

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