Cancer treatment team
Many primary care trusts (PCTs) have multidisciplinary teams that treat oesophageal cancer (see box, left).
If you have oesophageal cancer, you may see several or all of the healthcare professionals listed here as part of your treatment.
Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.
Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.
Your treatment plan
Your recommended treatment plan will depend on what stage your cancer is at.
Stage 1 and 2 oesophageal cancer is usually treated by surgically removing the cancerous section of the oesophagus and, if necessary, the nearby lymph nodes. This type of surgery is known as an oesophagectomy. Chemotherapy is usually given before surgery to reduce the risk of the cancer returning.
Stage 3 oesophageal cancer is usually treated by surgically removing the cancerous section of the oesophagus, nearby lymph nodes and the upper section of your stomach. This type of surgery is known as an oesophagogastrectomy. As with an oesophagectomy, before surgery it is likely that you will be given chemotherapy and possibly radiotherapy.
In cases of stage 4 oesophageal cancer, the cancer has usually spread too far for a cure to be possible. Radiotherapy and chemotherapy can be used to slow down the spread of the cancer and to relieve symptoms. Surgery may also be used to help relieve the symptoms of dysphagia (difficulty swallowing).
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Surgery
Oesophagectomy
During an oesophagectomy, your surgeon will remove the section of your oesophagus that contains the tumour. The remaining section of your oesophagus will then be reconnected to your stomach. If your stomach cannot be pulled up to meet your oesophagus, a small section of your large intestine may be used to make the connection.
Oesophagogastrectomy
During an oesophagogastrectomy, the cancerous section of your oesophagus will be removed, as well as the upper part of your stomach and surrounding lymph nodes. The remaining section of your oesophagus and your stomach may be reconnected using part of your large intestine.
To access your oesophagus, your surgeon will either need to make an incision (cut) in your abdomen and chest, or in your abdomen and neck.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) is a new type of surgical procedure that can be used to treat oesophageal cancer.
It involves having an injection in your oesophagus with a special type of medication that makes it very sensitive to the effects of light. A laser that is attached to an endoscope is then placed inside your oesophagus and used to burn away cancerous cells.
There are two ways that PDT can be used:
- to treat stage 1 oesophageal cancer in an attempt to cure the cancer
- to help relieve symptoms of dysphagia in stage 4 oesophageal cancer where a cure is not possible
Self-expanding stents
Self-expanding stents are another method of relieving the symptoms of dysphagia. The treatment involves placing a small metal tube into your oesophagus. The stent expands to hold open your oesophagus, which helps to make swallowing easier.
Chemotherapy
Chemotherapy is a type of cancer treatment that uses anti-cancer medicines either to kill the malignant (cancerous) cells in your body or to stop them multiplying. Chemotherapy medicines can either be injected or given to you orally (by mouth).
As well as attacking cancerous cells, chemotherapy can also attack the normal, healthy cells in your body, which is why this form of treatment has many potential side effects.
The most common side effects of chemotherapy include:
- vomiting
- hair loss
- nausea
- mouth sores
- fatigue
These side effects are usually only temporary, and you should find that they improve once you have completed your treatment.
Chemotherapy treatment is often used alongside surgery and radiotherapy (see below) to help ensure that as much of the cancer as possible is treated.
Radiotherapy
Radiotherapy is a form of cancer therapy that uses high energy beams of radiation to help shrink your tumour and relieve pain.
Radiotherapy for oesophageal cancer should make it easier for you to swallow because the radiation decreases the size of the tumour and makes it less obstructive.
The side effects of radiotherapy include:
- fatigue
- skin rashes
- loss of appetite
- sores in your oesophagus
These side effects are usually temporary, and you should find that they improve once you have completed your treatment.
As with chemotherapy, radiotherapy is often used alongside surgery to help make the tumour easier to remove.
Nutritional support
If your dysphagia symptoms are severe, you may find it very difficult to eat and drink in the normal way, which could place you at risk of malnutrition and dehydration.
Another problem that can occur is known as tracheoesophageal fistula. This is when the cancer creates a hole between your oesophagus and your windpipe (trachea). This may cause you to cough and gag, particularly when you try to swallow.
While surgery can be used to treat tracheoesophageal fistula, and relieve the symptoms of dysphagia, you may need to use an alternative method of receiving the nutrients your body requires while waiting for surgery.
A percutaneous endoscopic gastrostomy (PEG) tube is often used to provide your body with the nutrients that it needs. A PEG is a tube that is surgically implanted directly into your stomach. It passes through a small incision (cut) on the surface of your abdomen (stomach).
See the Health A-Z topic about Dysphagia - treatment for more information about PEG tubes.
