Treatment for oesophageal cancer

After your test results, you and your doctor start to talk about your treatment. Your doctor usually meets with other specialists to get their opinions too.

A team of specialists meet to talk about the best treatment for you. They are called a multidisciplinary team (MDT).

The MDT reviews national treatment guidelines or the latest evidence for the type of cancer you have. If you have any treatment preferences, your doctor will tell them about this.

The MDT will usually include the following professionals:

• a surgeon who specialises in oesophageal and stomach cancers
• a medical oncologist – a doctor who uses chemotherapy and other anti-cancer drugs to treat people with cancer
• a clinical oncologist – a doctor who uses radiotherapy, chemotherapy and other anti-cancer drugs to treat people with cancer
• a gastroenterologist – a doctor who treats problems with the digestive system
• clinical nurse specialist (CNS) – a nurse who gives information about cancer, and support during treatment
• a dietitian – someone who gives information and advice about food and food supplements
• a radiologist – a doctor who looks at scans and x-rays to diagnose problems
• a pathologist – a doctor who looks at cells or body tissue under a microscope to diagnose cancer.

It may also include other healthcare professionals, including:

• a palliative care doctor or nurse – someone who helps with symptom control
• a physiotherapist – someone who gives advice about exercise and mobility
• an occupational therapist – someone who gives information, support and aids to help people with tasks such as washing and dressing
• a psychologist or counsellor – someone who can talk with you, and help you understand your feelings and find ways of coping with them.

After the MDT meeting, your cancer doctor or specialist nurse will talk to you about your treatment options. You can decide together on the best treatment plan for you.

The treatment you are offered will depend on your individual situation. The cancer multidisciplinary team will meet and discuss the treatment options available to you. Your doctor will talk to you more about these.

If you have very early stage oesophageal cancer, the cancer may be removed using an endoscope. This is called an endoscopic mucosal resection (EMR), or an endoscopic submucosal dissection (ESD). These can be offered if the tumour is very small and only affecting the inner layer of the oesophagus.

For most cancers that have not spread beyond the oesophagus and lymph nodes, doctors recommend combining different types of treatment. How these are combined depends on the type of oesophageal cancer.

Most people diagnosed with squamous cell cancer receive chemotherapy and radiotherapy. This is called chemoradiation. Some people may not need any further treatment. For others, chemoradiation or chemotherapy alone may be used to shrink a cancer so that it can then be removed with an operation.

If you are diagnosed with oesophageal adenocarcinoma, you will usually need an operation. Before this, you will generally be offered either chemoradiation or chemotherapy, which is given both before and after the operation.

The main operation used to treat adenocarcinoma and squamous cell carcinoma in the oesophagus is called an oesophagectomy. This is where a surgeon removes all or part of your oesophagus. This is a major operation, and you need to be well enough to have it. If you are unable to have an oesophagectomy, you may be offered chemoradiation or radiotherapy on its own instead.

If you have had surgery, a pathologist will examine the tissue removed under a microscope. A pathologist is a doctor who studies cells and body tissues. If cancer cells are found in the removed tissue you may be offered further treatment after your operation. This may be chemotherapy. Or if you had chemoradiation before surgery, you may be offered immunotherapy treatment.