Treatment options for oesophageal cancer
A team of health professionals will discuss the best treatment for you. This depends on factors such as your cancer stage and grade. You might have one or more treatments. The most common treatments are surgery, radiotherapy and chemotherapy.
Deciding which treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
Most people are referred to a specialist oesophago-gastric MDT. You might go to a different hospital if there isn't a specialist MDT at your local hospital.
The team usually includes:
- a specialist surgeon
- cancer specialists (oncologists) who treat cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)
- a specialist cancer nurse (also called clinical nurse specialist)
- a pathologist who examines any cancer or tissue the surgeon removes
- a radiologist who looks at your scans and x-rays
- an endoscopist who looks inside your food pipe (oesophagus) and stomach using a flexible tube
- a dietitian who offers support and advice about eating and drinking
- a palliative care doctor who specialises in controlling cancer symptoms
Your treatment depends on:
- where your cancer is in your food pipe
- how far it has grown or spread (the stage)
- the type of cancer
- how abnormal the cells look under a microscope (the grade)
- whether the cancer has spread to another part of the body (this spread is also called secondary cancer or metastases)
- your general health and level of fitness
Your MDT will discuss your treatment, its benefits and the possible side effects with you.
Treatment overview
The main treatments are:
- surgery
- radiotherapy
- chemotherapy
- combined chemotherapy and radiotherapy (chemoradiotherapy)
- targeted and immunotherapy cancer drugs
- treatments to control symptoms
You have one or more of these treatments depending on the type and stage of your cancer.
Surgery
Surgery is the most common treatment for oesophageal cancer if it hasn't spread. The different operations include the removal of:
- cancer from the lining of the oesophagus (an endoscopic mucosal resection or endoscopic submucosal dissection)
- all or part of your oesophagus (an oesophagectomy)
- part of your oesophagus and the top part of your stomach (an oesophagogastrectomy)
You might have surgery with other treatments.
Chemotherapy
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.
You might have chemotherapy before or after surgery. You sometimes have chemotherapy together with radiotherapy (chemoradiotherapy) either before surgery or as your main treatment.
You might have chemotherapy as your main treatment if your cancer has spread to another part of your body or if you can't have surgery. Chemotherapy for advanced cancer can relieve symptoms. It can also control the cancer and improve your quality of life for a time.
Radiotherapy
Radiotherapy uses high energy rays to destroy cancer cells.
You might have radiotherapy combined with chemotherapy (chemoradiotherapy) either before surgery or on its own as your main treatment. Or you might have radiotherapy to control symptoms of advanced cancer.
Chemoradiotherapy
Chemotherapy combined with radiotherapy is called chemoradiotherapy or chemoradiation. You might have chemoradiotherapy before surgery. Or you might have it on its own as your main treatment.
Targeted and immunotherapy cancer drugs
Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. These are called immunotherapy.
You might have targeted or immunotherapy cancer drugs as part of your treatment for oesophageal cancer. You might have these drugs on their own or with chemotherapy.
Controlling symptoms
You might have treatment for symptoms if you're diagnosed with advanced cancer. For example, the cancer might block your oesophagus and make it difficult to swallow. This can make it hard to maintain your weight and strength.
Your doctor might recommend:
- a tube called a stent that goes into your oesophagus to allow food to pass through
- laser therapy which uses hot beams of light to burn away cancer cells causing the blockage
- heat treatment to burn away cancer cells
- stretching the oesophagus to help it open
Treatment by stage
High grade dysplasia
High grade dysplasia means that there are severely abnormal cells in the inner lining of the oesophagus. Removing the lining of your oesophagus is the main treatment for high grade dysplasia.
You have this surgery through a tube called an endoscope. You are asleep when you have it. The doctor puts the tube down your throat. They can then put a thin wire (snare) through the tube to remove the abnormal area of tissue.
You might also need treatment to destroy any abnormal areas that the doctor has not been able to remove. This treatment is called radiofrequency ablation.
Stage 1 cancer
Surgery is the main treatment. You don't usually need any other treatment before or after your operation.
You have surgery to remove all or part of your oesophagus. This is called an oesophagectomy. If your cancer is in the lower part of your oesophagus you will also have a part of your stomach removed (an oesophagogastrectomy).
For very small, early stage cancers you might be able to have surgery through a thin flexible tube (endoscope). This procedure removes cancer from the lining of the oesophagus. It is called an endoscopic mucosal resection or EMR.
You might have chemoradiotherapy instead of surgery if you:
- have a type of oesophageal cancer called squamous cell cancer
- or you are unable to have surgery
Stage 2 and stage 3 cancer
Your treatment depends on whether you have squamous cell cancer or adenocarcinoma.
For squamous cell cancer you usually have chemoradiotherapy. And then you either have:
- surgery to remove part or all of your oesophagus
- no further treatment and the doctors keep a close eye on you - this is called active surveillance
For adenocarcinoma you either have:
- chemotherapy before surgery
- chemotherapy before and after surgery
- chemoradiotherapy before surgery
Some people might have immunotherapy treatment if there are any cancer cells left after surgery.
Treatment for early cancer of the oesophagus: Wendy’s story - Transcript
Wendy: Things started not being right when I couldn’t eat properly. Um I found that everything I was trying to eat just didn’t want to go down, it went down so far, and then I’d find myself crunching up because it was difficult to get things down
Eventually I went to the doctor’s and she sent me for a scan to um have a camera put down. The next thing I knew I was taken into a room afterwards and sat down and was told ‘I am very sorry but you have cancer of the oesophagus'
[56 seconds ] Nurse: You are going to have your anti sickness for me
Wendy: Because I haven’t been feeling ill at all I kept thinking this isn’t true it’s someone else but now it’s come to reality. I must admit this morning it was a little bit scary, I just hope I don’t get too many other side effects because they can be, they can be really nasty.
I will lose my hair with the type of chemo that I have got this time. But it’s not the end of the world I have got a lovely family and lovely friends and I am sure they will boost me up and hopefully I’ll be fine.
[1 minute 50 seconds] Wendy: I said beforehand that I wouldn’t be upset but I think when it genuinely happened I thought I can’t stand this, this is awful.
Friend: I think that is fine, don’t you?
Wendy: I can wear it out tonight
Friend: Yep
Wendy: And feel human
Friend: Give me a hug
Wendy: Thank you, lovely
Wendy: The chemotherapy started really fine and it just...I didn’t actually realise how hard it was going to be. Basically my body just wasn’t coping with the chemo and eventually I was so ill I just couldn’t do anything. And I just came back into hospital and they kept me in but since then I’ve gradually got better and better because they have taken me off the chemo. And apart from a bit of high blood pressure I, I feel absolutely fine again.
[2 minutes 52 seconds] Wendy: I know it is a big operation, I know it is a serious operation. I am scared but I know it is something I’ve got to do, if I don’t I wouldn’t be here anyway. So, I’ve got to out my trust in the surgeons and I hope it’s just going go alright.
[3 minutes and 33 seconds] Wendy: It’s two weeks since I had the operation. The first two days I was in intensive care so I didn’t really know much about that at all, after that they sent me to high dependency where the staff were really good again, they literally did everything for you. But gradually as time’s gone on they have taken the tubes out. And I am just back to one feeding tube.
I am now on the puree I can’t have anything with lumps or anything in and hopefully in a day or two they can take that down and I will actually start back on proper food. Everything they do they do in stages and it’s brilliant, it has brought me back to life again to be honest.
[4 minutes and 33 seconds] Mr Tim Underwood: Hello Wendy, how you doing?
Wendy: Really good news. They have got all the cancer and I haven’t got to go and have chemotherapy again, because it was confined in one section and it wasn’t in the lymph nodes. And everything’s brilliant
Husband: Brilliant
Wendy: Absolutely brilliant news
Wendy: Looking back over this year it’s been really hard. I am still having a bit of a problem with eating, if I eat one little thing over the top, where I have only got a small stomach, it really does make me ill and I have just got to learn to say no I don’t need that. Um to me this year means that it’s an end to a horrible year and I can start again and hopefully thanks to everybody at the hospital and all my friends I will be able to do that and that is my future, and I hope to live for many years to come, I really do.
Stage 4
Your treatment depends on how far your cancer has spread.
Some stage 4 cancers haven't spread to distant body parts, such as the lungs or liver. You might be able to have:
- chemoradiotherapy on its own or before surgery
- chemotherapy and surgery
- targeted or immunotherapy drugs
Some stage 4 cancers have spread further and you can't have surgery. Treatment aims to control the cancer and maintain a good quality of life. You might have:
- chemotherapy
- radiotherapy
- targeted or immunotherapy drugs
- symptom control, such as treatment to help you swallow food
Clinical trials
Your doctor may ask if you’d like to take part in a clinical trial.
Doctors and researchers do trials to:
- improve treatment
- reduce the side effects of treatment
- develop new treatments
Getting a second opinion
Some people like to get an opinion from a second doctor. This is before they decide on their treatment. Most doctors are happy to refer you to another NHS specialist if you would find this helpful.
