Treatment overview for oesophageal cancer

The treatment you will be offered will depend on your individual situation as well as the type and where the oesophageal cancer is. Oesophageal cancer can be treated with surgery, chemotherapy, or radiotherapy. These may be used alone or in combination.

You may be concerned about the side effects of cancer treatments. The potential benefits depend on your individual situation. Your doctor can tell you what the main aim of treatment is. They can also tell you the possible side effects of each treatment and whether these are likely to be temporary or permanent.

In most hospitals, a team of specialists called a multidisciplinary team (MDT) will meet to plan your treatment. You will see a dietitian once you have been diagnosed for advice on how to build up your diet before you start treatment.

Treatment overview

The treatment you have will depend on several things. These include the type of oesophageal cancer you have, its stage, where it is in the oesophagus, and your general health.

It is important you understand why your doctors have suggested a particular treatment for you. They will discuss the treatment options with you, and together you can decide on your treatment plan.

Oesophageal cancer can be treated with surgery, chemotherapy, or radiotherapy. The treatments can be used alone or in combination.

Treatment may be given to cure the cancer. If a cure is not possible, the aim of treatment is to control the cancer and relieve symptoms.

When planning treatment, the doctors consider the oesophagus in three sections: upper, middle, and lower.

Write down any questions you need answers to, so you don’t forget to ask the doctor. Make sure you understand all you are told and if not, ask again!

Christine, Online Community member


Diet before treatment

You should see a hospital dietitian soon after you have been diagnosed. They will give you advice to help you prepare for the treatment ahead.

Many people with oesophageal cancer have difficulty eating. You may lose weight. While you are waiting for treatment, it is important to eat as well as possible, using food supplements if needed. Your GP can give these to you. Increasing the amount of calories you have, may help to slow down weight loss. This is very important to help you to cope better with the treatment and maintain your physical fitness and strength.

If you are finding swallowing difficult, you may have to change the consistency of your food. Small, soft, regular meals are better than 2 or 3 larger meals each day. Foods like soup, ice cream, jelly, and custard are easy to swallow. You can also use a food blender to blend foods you like, to help you eat more. If you are not able to swallow anything, you should tell the hospital straight away.

I made healthy food with protein, veg and rice but put extra butter, olive oil and full-fat milk in, to give it extra calories.

Anna


Treating early-stage oesophageal cancer

The treatment you are offered will depend on your individual situation.

You may be offered a type of surgery which is done through an endoscope if you have a very early-stage oesophageal cancer. This is where the tumour is very small and has not spread to the surrounding area. The surgery may be an endoscopic mucosal resection (EMR) or an endoscopic sub-mucosal dissection (ESD).

An EMR may also be offered if there are very abnormal cell changes to the lining of oesophagus (pre-cancerous changes).

Your doctor will discuss with you, which type of operation might be best for you.

If you have an early-stage oesophageal cancer that has not spread and you are well enough, you may be offered surgery to remove the cancer. You may be offered chemotherapy before the operation. You may have the chemotherapy together with a course of radiotherapy. This is called chemoradiotherapy.

For some people, the tumour may have spread nearby (locally advanced) or may be too large to do an operation. In this case, you may be offered a course of chemoradiotherapy. This can sometimes shrink the tumour enough for it to be removed in an operation.

If you are not able to have surgery for any other reason, you may be offered chemoradiotherapy instead.

If you are not fit enough to have chemotherapy, you might be offered radiotherapy alone.


Treating advanced-stage oesophageal cancer

Advanced-stage oesophageal cancer is when the cancer has spread to lymph nodes and other parts of the body, such as the liver, lungs, or stomach. If you have advanced oesophageal cancer, or are not fit enough to have other treatments, you may be offered chemotherapy. This can help control the cancer and improve symptoms. Some people may be given radiotherapy to help relieve symptoms such as pain.

In some situations, you might be offered treatment as part of a research trial. Your doctor will be able to tell you if there are any trials you can enter.

If you have swallowing difficulties, putting a tube into the oesophagus to keep it open can help. This is called stenting. Other treatments that may be used to help with this are stretching the oesophagus and laser treatment.


How treatment is planned (MDT)

In most hospitals, a team of specialists called a multidisciplinary team (MDT) will meet to plan your treatment.

This multidisciplinary team may include:

  • a surgeon, who specialises in oesophageal cancer
  • a medical oncologist, who is a doctor specialising in chemotherapy
  • a clinical oncologist, who is a doctor specialising in radiotherapy and chemotherapy
  • a gastroenterologist, who is a doctor specialising in diagnosing and treating problems with the digestive system
  • a nurse specialist, who can provide information and support
  • radiologists, who help to analyse x-rays and scans
  • pathologists, who are doctors specialising in studying tissue samples and cells
  • a dietitian, who can advise you if you have problems with eating, drinking, or weight loss.

It may also include other healthcare professionals including:

  • a palliative care doctor or nurse, who specialises in symptom control
  • a physiotherapist
  • an occupational therapist
  • a psychologist or counsellor.

The MDT will take many factors into account when advising you on the best course of action, including your general health, the type and size of the tumour, and if it has begun to spread.


The benefits and disadvantages of treatment

You may be frightened of having cancer treatments because of their side effects. Although treatments for oesophageal cancer can cause side effects, your healthcare team will help you control and manage these.

Treatment can be given for different reasons. The potential benefits depend on your individual situation. Your doctor can tell you if the main aim of treatment is to try to cure the cancer, to control the cancer for a time, or to reduce symptoms and improve your quality of life. They can also tell you the possible side effects of each treatment. They can also tell you if the side effects may be temporary or permanent.

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