Oesophageal cancer treatment

Treatment of oesophageal cancer will depend on the size of the cancer, whether it has spread, your age and general state of health.

Oesophageal cancer is best treated if found in its earliest stages, before it has spread to other parts of the body. Unfortunately, oesophageal cancer is a serious condition and the long-term survival rate is often not good, even with treatment.

Treatment options for oesophageal cancer

Surgery

The type of surgery recommended will depend on the size and extent of the tumour. For very small, early stage tumours, the tumour (and a margin or healthy surrounding tissue) may be removed endoscopically (using an endoscope – a long, thin instrument with a camera on the end that can be used to view the oesophagus).

For larger tumours, the section of the oesophagus that contains the cancer is removed: this is called an oesophagectomy. Sometimes the upper part of the stomach is also removed. Nearby lymph nodes and other tissue in the area will also be removed to prevent the cancer spreading.

If a section of the oesophagus is removed, the remaining healthy part of the oesophagus will be connected to the stomach. Sometimes the surgeon will make a tube out of the stomach or a section of bowel and join it to the remaining oesophagus. Surgery for oesophageal cancer is a major operation that will need considerable post-surgery treatment and recovery time.

In cases where the cancer is blocking the oesophagus but it is not possible to remove the cancer, the surgeon may insert an expandable tube (called a stent) to hold open the sides of the oesophagus. Alternatively, the oesophagus can be dilated and widened. A laser may also be used to destroy any cancer blocking the oesophagus.

Radiotherapy (high energy X-rays)

Radiotherapy can be used alone or in combination with surgery or chemotherapy. It can be used to treat the cancer with the intention of cure, or to treat complications from advanced oesophageal cancer, such as obstruction of the oesophagus.

Radiotherapy can be given as an external beam or from radioactive rods placed directly into the oesophagus using an endoscope. Doctors call this brachytherapy.

While radiotherapy is directed so that the cancerous area receives the highest dose, the surrounding tissue is still affected and this is a cause of side effects (such as skin reactions and damage to nearby organs).

Chemotherapy

Chemotherapy uses medications to kill or slow the growth of the cancer cells. The medications may be taken as a pill, or by injection into the body.

Chemotherapy may be used with radiotherapy (chemoradiotherapy) or without radiotherapy. Chemoradiotherapy can be used before or after surgery.

Side effects depend on which chemotherapy medicines you take. Generally speaking, chemotherapy affects some healthy cells as well as cancer cells, especially those that are fast growing (such as those lining the digestive tract and bone marrow) causing side effects such as mouth ulcers, nausea, tiredness and susceptibility to infection.

Prevention of oesophageal cancer

You can help to prevent or minimise the risk of oesophageal cancer by eliminating risk factors from your lifestyle.

  • Smoking is a major risk factor, so if you smoke, you should stop.
  • Heavy alcohol intake is also a major risk, so cutting down or eliminating your intake of alcohol is also recommended.
  • Also, it is always wise to eat a well-balanced diet, including a variety of fruits and vegetables.
  • Lose weight if you are overweight – your doctor can advise you on the best way to lose weight and keep it off.

Longstanding gastro-oesophageal reflux disease can cause Barrett’s oesophagus, which is a major risk factor for oesophageal cancer. If you have been diagnosed with Barrett’s oesophagus, your doctor will need to monitor this condition to detect any changes that may indicate that cancer is developing. This may involve having regular screening endoscopies. People with oesophageal cancer detected in the early stages through screening have a good chance of successful treatment with less invasive procedures.

Last Reviewed: 9 December 2015
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References

1. Cancer Council. Understanding Stomach and Oesophageal cancers, Nov 2013. http://www.cancercouncil.com.au/stomach-oesophageal-cancer/ (accessed Nov 2015).
2. MayoClinic. Esophageal cancer (updated 15 May 2014). http://www.mayoclinic.com/health/esophageal-cancer/DS00500 http://www.mayoclinic.org/diseases-conditions/esophageal-cancer/basics/definition/con-20034316 (accessed Nov 2015).
2. NHS Choices. Oesophageal cancer (updated 30 Jun 2014). http://www.nhs.uk/conditions/cancer-of-the-oesophagus/pages/introduction.aspx (accessed Nov 2015).
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