What are the treatment options for cancer of the oesophagus?
Treatment options which may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the exact site of the primary tumour in the oesophagus, the stage of the cancer (how large the cancer is and whether it has spread), and your general health.
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the possible treatment options for your type of cancer.
You should also discuss with your specialist the aims of treatment. For example:
Surgery
It may be possible to remove the tumour. To do this, the operation is to remove part or all of the oesophagus, depending on the site and size of the tumour.
There are various ways a surgeon can get to the oesophagus, and various types of operation. If part of the oesophagus is removed it may be possible to sew the stomach back onto the remaining section of oesophagus if the stomach is brought up into the chest area. If all of the oesophagus is removed, the surgeon may use a section of your intestine to create a new 'artificial' oesophagus. These procedures are major operations and carry some risk.
Even if the cancer is advanced and it is not possible to remove it, some surgical techniques may still have a place to ease symptoms. For example, a blockage may be eased by using laser surgery, or by inserting a rigid stent (tube) which allows food and drink to pass through the blockage to the stomach.
Chemotherapy
Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells, or stops them from multiplying. See separate leaflet called chemotherapy for more details.
Chemotherapy may be used in addition to surgery or radiotherapy. For example, following surgery you may be given a course of chemotherapy. This aims to kill any cancer cells which may have spread away from the primary tumour. When chemotherapy is used after surgery it is called adjuvant chemotherapy. In some cases chemotherapy is given before surgery to shrink a large tumour so that surgery is more likely to be successful. This is called neoadjuvant chemotherapy.
Radiotherapy
Radiotherapy is a treatment which uses high energy beams of radiation which are focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. (There is a separate leaflet which gives more details about radiotherapy.) When radiotherapy is used to treat cancer of the oesophagus it is commonly used in addition to either surgery or chemotherapy. The exact combination of treatments advised depends on various factors.
What is the prognosis (outlook)?
Without treatment, a cancer of the oesophagus is likely get larger, and spread to other parts of the body. If it is diagnosed and treated at an early stage (before growing through the wall of the oesophagus or spreading to lymph nodes or other areas of the body) then there is a chance of a cure with treatment. Unfortunately, most cases in the UK are not diagnosed at an early stage. This is because symptoms do not tend to develop until the cancer is already fairly large.
If the cancer is diagnosed when it has grown through the wall of the oesophagus, or spread to other parts of the body, a cure is less likely. However, treatment can often slow down the progression of the cancer.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.
