Treatment options

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Your diagnosis will be discussed at a multi-disciplinary team (MDT) meeting, which involves specialists across your hospital medical team. They will consider the type of oesophageal cancer you have, it’s stage, location and your health, in order to determine the best course of treatment for you.

You will meet with your Consultant and Clinical Nurse Specialist (CNS), so they can fully explain your diagnosis and the treatment plan with you and answer any questions you may have.

Treatment of cancer of the oesophagus is likely to involve one or a combination of the following: surgery, chemotherapy, radiotherapy or chemoradiotherapy. 

When a cure is not possible, a number of treatments are available to relieve symptoms. 

Treatments offered may involve a combination of some of the following:

Surgery

If the cancer is at an early stage, surgery may be used with the aim of curing the cancer. There are different types of operations used to treat oesophageal cancer. The operation will depend on the size and position of the tumour and your doctor will talk to you about the most appropriate type of surgery for your situation. It’s important to discuss the operation fully with your doctor before it happens. It may help to make a list of any questions you want to ask.

You may need to stay in hospital for up to a few weeks for some types of surgery.

Sometimes in the weeks/months after the operation, you may again have difficulty/pain swallowing. Unfortunately, this can be a sign the cancer has reoccurred, but it is often because of scarring (stricture) where the new join in the oesophagus was made. An endoscope can be used to stretch the stricture, to improve this.

For more information on surgery for oesophageal cancer, visit: https://www.cancerresearchuk.org/about-cancer/oesophageal-cancer/treatment/surgery

Systemic Anti-Cancer Treatment (SACT)

This term can include a large number of medications which could be chosen to treat oesophageal cancer. This can include chemotherapy and also hormonal (endocrine) therapy, antibody treatments (including immunotherapy) and targeted treatments.

Quite often a combination of medications will also be used either together or in sequence (one after another). These are chosen after discussion depending on the type of cancer you have and any other medical conditions you may have.

For information on the different medications used to treat oesophageal cancer, visit Macmillan Cancer Support’s website where you will be able to find information on the medication you have been prescribed via their ‘A to Z list of cancer drugs’, which is available here: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs

For full information on the Oncology Department at Salisbury District Hospital, please click on the following link:  Oncology

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Cytotoxic means toxic to cells. These drugs disrupt the way cancer cells grow and divide, but they also affect normal cells, which may cause side effects. Chemotherapy may be chosen as a course of treatment on its own, or alongside surgery and/or radiotherapy.

It’s important to discuss the benefits and side effects of chemotherapy with your cancer specialist. If you have a cancer that has spread, and you decide that you don’t want to have chemotherapy, your doctor can still prescribe medicines to help control symptoms. 

Neoadjuvant chemotherapy:

Chemotherapy is often given before an operation to remove an oesophageal cancer as it can shrink the tumour, making it easier to remove. This is sometimes called neoadjuvant chemotherapy.

Adjuvant chemotherapy:

Chemotherapy can sometimes be given after surgery to reduce the chances of the disease coming back. It works by destroying any cancer cells that might be left behind after the operation. This is called adjuvant chemotherapy. 

Palliative chemotherapy:

Unfortunately, in some cases when the cancer cannot be cured or has spread to other parts of the body, treatment is then focused on shrinking the tumour/s and relieving symptoms rather than curing the cancer. This is called palliative chemotherapy. 

For more information on chemotherapy for oesophageal cancer, visit: https://www.cancerresearchuk.org/about-cancer/oesophageal-cancer/treatment/chemotherapy-treatment

For information on the different medications used to treat breast cancer, visit Macmillan Cancer Support’s website where you will be able to find information on the medication you have been prescribed via their ‘A to Z list of cancer drugs’, which is available here: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs

For full information on the Oncology Department at Salisbury District Hospital, please click on the following link: Oncology

What if I am unwell after receiving cancer treatment?

If you are an existing patient receiving chemotherapy treatment and you have a temperature, feel unwell, or need advice on chemotherapy side effects or complications – please contact the 24-hour hotline on 01722 341930.

Please visit the Acute Oncology section, for more information: Acute Oncology

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. Radiotherapy can be given in two ways: 

from outside the body as external beam radiotherapy. This is the most common way of giving radiotherapy for oesophageal cancer.

by putting a radioactive material into, or close by, the tumour. This is known as internal radiotherapy or brachytherapy. It isn’t used very often to treat oesophageal cancer.

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

We are unable to offer radiotherapy in Salisbury, so patients will need to go to University Hospital Southampton for radiotherapy treatment.

Radical radiotherapy:

If it is an early tumour, radiotherapy may be used alongside surgery or as an alternative to surgery, depending on the patient’s general health and their specific diagnosis.

When radiotherapy is given on its own, to try to cure the cancer – this is known as radical radiotherapy.

Palliative radiotherapy:

Unfortunately, in some cases the cancer cannot be cured so treatment is then focused on relieving symptoms rather than treatment.

If the tumour is unable to be safely removed by surgery, then radiotherapy (sometimes with chemotherapy) is used in smaller doses. This is known as palliative radiotherapy which aims at treating the symptoms rather than the cancer.

For more information on radiotherapy for oesophageal cancer, visit: https://www.cancerresearchuk.org/about-cancer/oesophageal-cancer/treatment/radiotherapy

Chemoradiotherapy

External radiotherapy is usually given in combination with chemotherapy to treat oesophageal cancer. This is known as chemoradiotherapy and may sometimes be given instead of surgery. It is also sometimes given before an operation to shrink the tumour.

Chemoradiotherapy is not suitable for everyone, it is mainly used for squamous cell carcinoma, but can be used for adenocarcinoma too. Your doctor or specialist nurse will give you more information about chemoradiotherapy and the possible side effects.

For more information on chemoradiotherapy for oesophageal cancer, visit: https://www.cancerresearchuk.org/about-cancer/oesophageal-cancer/treatment/chemoradiotherapy-about

Targeted therapies

Targeted therapies (sometimes known as biological therapies) are drugs that mimic substances that occur naturally in the body to destroy cancer cells. They work by changing the way that cells interact with, or signal to each other. 

Trastuzumab (Herceptin®) is a type of targeted therapy called a monoclonal antibody. It works by attaching to a receptor called HER2 (a hormone receptor) on the surface of certain cancer cells. This stops the cancer cells dividing and growing. 

Herceptin is mainly used to treat breast cancer. But it can also be used to treat some advanced oesophageal cancers, found in the area where the oesophagus joins the stomach (the gastroesophageal junction). It’s used in combination with chemotherapy. 

Herceptin is only suitable for people with oesophageal cancers that have HER2 receptors. 

Other targeted therapy drugs may also be used to treat oesophageal cancer. 

For more information on targeted therapies for oesophageal cancer, visit: https://www.cancerresearchuk.org/about-cancer/oesophageal-cancer/treatment/targeted-immunotherapy

Endoscopic mucosal resection (EMR)

EMR is the removal of abnormal areas in the lining of the oesophagus using an endoscope which is inserted down your throat.

Argon plasma coagulation (APC)

APC is sometimes recommended as a treatment after EMR, or if swallowing is difficult. Using an endoscope, a probe is placed close to the area to be treated. A combination of argon gas and electricity is used to destroy the cancer. 

Your doctor or specialist nurse can give you more information about APC. 

Radiofrequency ablation (RFA)

RFA uses heat to destroy cancer cells. It’s mainly used to treat pre-cancerous changes to the cells in the oesophagus (Barrett’s oesophagus). It’s sometimes used after EMR. RFA uses a probe called an electrode to apply an electrical current (radiofrequency) to the tumour.

The electrical current heats the cells to high temperatures, which destroys (ablates) them. The cells die and the area that’s been treated gradually shrinks and becomes scar tissue. Some people may need to be treated more than once. 

Photodynamic therapy (PDT)

PDT uses a laser and a light-sensitive drug to destroy cancer cells. PDT is only used in a few specialist hospitals in the UK. If the treatment is suitable for you, you may have to travel to another hospital to have it. 

This treatment is most commonly used to help with difficulty swallowing. It’s also sometimes used instead of surgery to treat very early-stage (stage 1) oesophageal cancer found in the mucosal layer. 

PDT is given in two stages. First, you’ll be given a drug that makes the cells more sensitive to light (a photosensitiser). This is usually given as an injection into a vein in your arm (intravenously). 

A laser is then directed on to the cells, using an endoscope. The laser activates the drug to destroy the cells. 

The treatment will make you sensitive to light so try to avoid being in the sun for a few days. 

PDT may make the area in the oesophagus temporarily inflamed and swollen. At first, this can make swallowing more difficult, but this will improve.

The National Institute for Health and Care Excellence (NICE) gives advice about which new treatments should be available on the NHS. It reviewed the use of PDT to treat early oesophageal cancer in 2006. The review said that PDT is safe to use, but that more evidence is needed to know how effective it is. It’s not yet known how well it works and how it compares with surgery. 

Talk to your doctor about the possible risks and benefits of PDT, and of other treatments that may be available. NICE suggests that doctors use PDT in clinical research trials if possible. NICE also suggests that patients are followed up to check their progress. 

Endoscopic intubation (stenting)

Where surgery isn’t possible, endoscopic intubation (stenting) can be used to ease swallowing difficulties. Patients are sedated or given anaesthetic, before a stent (tube) is inserted into the oesophagus (gullet) which allows the oesophagus to remain open so food/fluids can be more easily swallowed.

The stent is made of either plastic or springy metal coils. The stent can still be blocked by food particles, so patients are given guidelines on diet. Occasionally stents can cause heartburn and regurgitation, but there are acid suppressing medicines which can be taken to relieve these.

For more information on oesophageal stents, visit: https://www.cancerresearchuk.org/about-cancer/oesophageal-cancer/treatment/making-swallowing-easier/oesophageal-stent

Endoscopic laser treatment

Is where a laser is used to destroy a tumour within the oesophagus. This procedure is performed by an endoscopic specialist and some patients will have this procedure, alongside the above endoscopic intubation.

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