Oesophageal cancer

Often you will have chemoradiation (chemotherapy and radiotherapy together) to reduce the size of the tumour before surgery. The chemotherapy drugs make the cancer cells more sensitive to radiation. 

Surgery aims to remove the part of the oesophagus that contains the tumour. It’s the most common treatment when the cancer is in just one section of the oesophagus. 

In many cases, chemotherapy and radiotherapy (called chemoradiation) are given before surgery to shrink the tumour and improve results.

Read more about oesophageal cancer surgery.

Chemotherapy is the use of drugs to cure or control cancer.

Chemotherapy can be given before surgery to shrink the tumour and make it easier to remove or after, to lower the risk of the cancer coming back. You may also have chemotherapy both before and after your surgery. This is common with adenocarcinoma.

Most patients are given a combination of two or three drugs, either as injections or tablets. Your nurse will explain which drugs you’re having and what side-effects to expect.

Read more about chemotherapy.

This uses high-energy rays to kill or shrink cancer cells. The rays are aimed directly at the tumour in your oesophagus. It can be given before surgery to shrink the tumour or after surgery to kill any cancer cells left behind to prevent the cancer coming back. 

With advanced cancer, radiotherapy can also help to relieve symptoms like pain or difficulty swallowing. 

Read more about radiotherapy.

The radiation source is placed into your oesophagus for several minutes. It will release radiation and kill the cancer cells. It causes little or no damage to the nearby healthy tissue. 

Your doctor will spray the back of your throat with local anaesthetic. A fine tube is then placed in your oesophagus through your nose. Then your doctor will take an X-ray to help him plan the treatment.  

Once the planning has been done, the radioactive source will be put into the tube. It will travel to the area to be treated, gives the treatment and then returns safely to the machine. The planning X-ray lasts about 1 hour and the treatment itself takes about 10 minutes. Once the tube is removed, you can return home. No radioactivity will be left in your body so it is safe for you to mix with family and friends. Usually, only one or two treatments are needed.

Side-effects of brachytherapy

• The treatment may cause nausea and soreness when swallowing. These may happen a few days after treatment and last for a few days. Your doctor can prescribe medication to help with swallowing and ease any nausea and soreness. You will not have any hair loss with this treatment.
• If you feel unwell or have any other side-effects or symptom – during or at any time after treatment – tell your doctor, nurse or radiation therapist.

Read more about internal radiotherapy.

Oesophageal dilatation is a treatment that stretches and widens a narrowed area in your oesophagus so food and drink can pass through again. It uses an instrument called a dilator and it can be done quickly under general or local anaesthetic.

The dilatation may last only a short time and need to be repeated a few weeks or months later. A different type of dilator might be used instead. Your doctor and dietitian can advise you on the best consistency of food to take after the dilatation. 

A hollow tube called a stent is put into your oesophagus under local or general anaesthetic. The stent is made of plastic or wire mesh. Once in place, it expands to keep your oesophagus open so you can swallow more easily.

Once you are awake, you can start taking fluids. Gradually you will be given small amounts of soft food to eat. Your dietitian will advise you on the type of foods you should eat. You will need to chew your food thoroughly before swallowing so the stent does not get blocked. Foods that are soft and moist are generally the most suitable. But you may need to blend your food too. Having drinks with your food and after food can help to keep the stent clean.