Treating oesophageal cancer

During an oesophagectomy your surgeon will remove the section of your oesophagus that contains the tumour and the nearby lymph nodes.

There are different ways of performing an oesophagectomy. Most patients will have a cut in the upper part of the abdomen as well as one either in the left or right side of the chest. Occasionally we also make a cut on the left side of the neck.

The object of the operation is to remove the cancer with surrounding tissue to ensure that it’s all removed. The stomach is then used to replace the oesophagus and is connected to the remaining oesophagus in the chest or neck.

These details will be discussed with you before the operation. During the operation we also insert a tube used for feeding afterwards. This tube will go directly into the small bowel through the abdominal wall.

For very early oesophageal cancers that are just in the inner lining of the oesophagus (mucosa), these can sometimes be treated by endoscopic mucosal resection (EMR). For this procedure an endoscopy is performed. This either is done under sedation or sometimes a general anaesthetic (GA)

During the endoscopy the cancer is raised from the muscle layer of the oesophagus so that it can be removed. Your specialist will explain how this is done when they decide EMR is suitable for you. You will also be given information on the procedure.

The most common side effects of EMR are potential bleeding and narrowing of the oesophagus. There is a very small risk of a tear (perforation) in the wall of the oesophagus.

Your doctor may recommend further treatment after EMR; this is to destroy any remaining cancer cells. Your specialist will explain this to you once you are seen again in the hospital.

Chemotherapy is a specialist treatment for cancer that uses medicines, called cytotoxic medicines, to stop cancer cells dividing and multiplying. As it circulates through your body, the medicine can target cancer cells in your stomach and any that may have spread to other parts of your body.

You may have chemotherapy for oesophageal cancer before surgery. You may also have chemotherapy after surgery to treat any remaining cancer cells and prevent the cancer from coming back.

Chemotherapy can also be used to slow the progression of cancer and ease the symptoms of more advanced oesophageal cancer, which may not be suitable for surgery.

If you do require chemotherapy, it may be given as tablets or intravenously (by injection or a drip through a vein directly into your bloodstream), or a combination of both.

Chemotherapy is often given in cycles, each usually lasting about three weeks.

Alternatively, chemotherapy may be administered through a small pump, which gives you a constant low dose over a few weeks or months. The pumps are portable and can be worn at home, which means fewer trips to hospital.

Sometimes swallowing can be difficult because the cancer is blocking your oesophagus. There are treatments available at UCH that can be done to make it easier for you. Your specialist may suggest one of more of the following treatments. You may require a repeat of these treatments.

For this procedure an endoscopy is performed. Stretching the oesophagus is done to increase the space for food and fluid to go down. You may need the procedure repeated. Stretching is also used after radiotherapy or surgery if a stricture has occurred.

Laser treatment can sometimes be used to remove enough cancer to allow food and fluid to pass down the oesophagus. The specialist will use a powerful beam of light which helps burn away some of the cancer, this is useful if there are nodules which are blocking the oesophagus. This is performed during an endoscopy.

You may require the procedure repeating two to three times to clear a passage down the oesophagus. You’re unlikely to feel any pain after the procedure but there may be some temporary swelling for a few days. If you have pain following your treatment you must inform your specialist team.

A wire mesh tube (stent) can be placed into the oesophagus using an endoscope. This is performed during an endoscopy. Once the stent is inserted it expands over a few days so this then allows you to eat soft food and fluids. It is important to be careful with your diet to make sure the stent does not become blocked. Drinking fizzy drinks after eating helps prevent the stent from blocking. You will be provided with information on diet and how to look after the stent. Occasionally when the stent is expanding there can be some discomfort. Your specialist team may prescribe some pain killers (analgesia) to help with this.

Radiotherapy is a form of cancer therapy that uses high energy beams of radiation to help shrink your tumour and relieve dysphagia (difficulty in swallowing)

External radiotherapy is usually given in combination with chemotherapy to treat oesophageal cancer. This is known as chemoradiation. We offer this for squamous cell carcinoma of the oesophagus as this type of cancer usually responds very well to radiation. This form of treatment can potentially cure the cancer.

If you are not suitable for surgery then this treatment may be offered instead of surgery.

The treatment is usually given over five weeks; treatment is given every day Monday to Friday with a break at the weekend.

Your specialist team will discuss your treatment and the possible side effects with you.

If the cancer is more advanced, radiotherapy can be given on its own to shrink the tumour and help control symptoms. This is usually given over one to two weeks, every day Monday to Friday.

Brachytherapy is usually used to control the symptoms of oesophageal cancer. It is often used following laser treatment which is given via endoscopy.

Brachytherapy is given by inserting a radioactive source into the cancer which gives a high dose of radiotherapy to the tumour. As the radiation is given in a specific area it does not affect the surrounding organs.

The treatment is given through a nasogastric tube (NG tube) which is inserted via an endoscope. The nasogastric tube is a thin flexible plastic tube which is passed through your nose down the back of your throat and into your stomach.

This treatment is usually a one off treatment as opposed to external radiotherapy which is given over a course of several days.

Research is continuing into new ways of treating oesophageal cancer. Most of the research has focused on a type of treatment known as targeted therapy. Targeted therapy involves using medication that specifically targets the biological functions that cancer needs to grow and spread.

Initial research has been encouraging, but further research is required to see how effective and safe these new types of medication are.

If you are interested in taking part in a clinical trial (medical research that studies the effect of new treatments), see our research page.