Treatment
After having tests to diagnose and assess oesophageal cancer,
your doctor will discuss your treatment options with you. Treatment
options are determined at a weekly meeting of specialists where all
the test results are discussed. A lot of different people are
involved in making these decisions, including surgeons, oncologists
(cancer specialists), radiologists (imaging specialists),
histopathologists (experts in tissue analysis) and cancer nurse
specialists. This meeting is called the 'Multi-Disciplinary Team'
(MDT) meeting. This means that the right decisions can be made with
you based on the specific details of you and your test results.
In general, the treatment options available are explained
below.
Curative-intent vs palliative treatment
Depending upon the results of the tests and the individual
patient, treatment may be planned to try and remove all cancer and
avoid it coming back (curative-intent treatment). Alternatively, it
may not be possible to cure the cancer. For example, it may have
already spread to other organs, or it may be too big near the heart
or main blood vessels. In this case, treatment is called
'palliative', and is designed to give the best combination of
quality and amount of time of survival possible. Even when it is
not possible to cure a person of cancer, there is much that the
team of doctors and nurses can do to help with symptoms and to
support a person and their family.
Chemotherapy
Chemotherapy involves the use of different types of drugs to
target cancer. Some medicines are given into the vein and others
can be taken as tablets. Often a combination is used. Usually
treatment is given over a period of months in a series of cycles,
with short breaks between to allow recovery. Chemotherapy may be
given as part of a curative-intent regime, with other treatments
such as surgery or radiotherapy. It may also be given as treatment
when it is not possible to cure cancer, to prolong survival or to
improve symptoms (palliative chemotherapy). As with any treatment,
there are risks and side effects which your doctor will discuss
with you.
Radiotherapy
Radiotherapy involves the use of targeted radiation to treat
cancer. This is often done as a course of several treatments which
therefore require repeated trips to hospital. As with chemotherapy,
radiotherapy may form part of a curative-intent treatment plan, or
it may be given to help with symptoms when it is not possible to
cure a person's cancer (palliative radiotherapy). Your doctor will
discuss the details as well as the risks and benefits of
treatment.
Surgery
Surgery for oesophageal cancer forms part of a curative-intent
treatment plan, most often in combination with chemotherapy (and
sometimes radiotherapy) before and/or after the operation itself.
The surgery to remove oesophageal cancer is a major operation,
involving surgery on both the abdomen and chest. Only about a third
of patients diagnosed with oesophageal cancer undergo surgery. Many
people cannot have surgery because their cancer has already spread
and it cannot be cured. Other reasons surgery is not possible
include cancer involving other major organs that cannot be removed
(such as the heart), or a patient may not be fit enough to survive
the operation itself.
The operation involves removing most of the oesophagus and part
of the top of the stomach. The remaining part of the stomach is
made into a tube to replace the oesophagus that has been removed.
After the operation, once the new tube has healed in place, you can
eat normal food, but in smaller amounts, such that many people need
to eat 5-6 smaller meals through the day. It can take up to 9-12
months to fully recover from the operation. Your doctor will tell
you more about the risks of the operation, the side effects, and
the likely recovery period.
Oesophageal stenting
An oesophageal stent is a tube that can be inserted to hold open
the oesophagus. This is done using an endoscope, usually with an
injection of a painkiller and sedative (not under a full general
anaesthetic). It is a good treatment to improve swallowing when a
person cannot have curative treatment. Your doctor can explain more
about what is involved as well as any risks of the procedure.
Brachytherapy
Brachytherapy is when radiotherapy is delivered directly into a
cancer. For patients with oesophageal cancer that cannot be cured,
this treatment can be a very good way of helping improve swallowing
if the cancer is suitable. It involves having an endoscopy with
sedation. This allows placement of the device that delivers the
radiotherapy into the oesophagus. Not every cancer is suitable, so
your doctor will explain if this is an option for you. We have
created an information leaflet about brachytherapy, which is
available by clicking here.
