Treatment options for oesophageal cancer
Your treatment options for oesophageal cancer will depend upon the size, location, and stage of the tumour, as well as your general health and fitness. You should be fully informed and involved in decisions about treatment options.
The choice of treatments will be discussed with you and your preferences will be considered. Your treatment will be discussed by a multidisciplinary team (MDT), which means that experts in different areas of cancer treatment (e.g. surgeons, gastroenterologists, radiologists, oncologists and nurses) come together to share their expertise in order to provide the best patient care.
Once the diagnosis is made, cancer removal, when possible, would be the best treatment option in the majority of cases.
Treatment for oesophageal cancer depends on the stage. In the instance where an operation is not possible or beneficial, insertion of an oesophageal stent may be utilised for palliation of dysphagia.
Surgery and other treatment options
Surgery is the most common treatment for oesophageal cancer. There are two surgical techniques:
Open radical oesophagectomy
The cancerous portions of the oesophagus, top portion of the stomach and neighboring lymph nodes are removed.
Minimally invasive oesophagectomy
Keyhole operation to achieve similar results to the standard open radical approach.
Endomucosal resection can be an option for very early tumors, particularly in patients unlikely to tolerate major surgery.
Laser-sensitive chemicals are injected into the tumor site. A laser beam then targets the chemicals to destroy the tumor. This therapy is more commonly utilised for treatment of more pre-cancers in high risk regions or when surgery is not possible for palliative purposes.
This utilises a radio frequency generator via a probe (device), the energy is transmitted to the target tissue causing it to heat up. The heat destroys the target tissue and the body replenishes it with normal cells.
This therapy involves direct thermal injury to precancerous cells. The body then recovers and replenishes the area of injury with normal cells.
Depending on the type of tumor, chemotherapy which involves the use of drugs to kill cancer cells, is most often combined with radiation therapy.
Adjuvant chemotherapy for resectable oesophageal cancer
Following surgical resection of oesophageal cancer, most patients will be offered adjuvant chemotherapy to reduce the risk of recurrence after surgery. Adjuvant chemotherapy has been shown to improve outcomes in patients with resected oesophageal cancer compared with no adjuvant treatment.
Chemotherapy for unresectable oesophageal cancer
Chemotherapy is typically used in the first-line treatment of oesophageal cancer that can’t be surgically removed. Patients with unresectable oesophageal cancer and who are in good general health, are typically offered chemotherapy as a treatment.
Radiotherapy uses ionising radiation to damage the deoxyribose nucleic acid (DNA) of cancerous cells, causing them to die. Radiotherapy is not commonly used in the treatment of oesophageal cancer but may be considered for some patients.
Radiotherapy can be given to treat symptoms related to cancer that are causing problems. These can happen because the growth of the tumour narrows the gullet, causing swallowing difficulties, or it can cause pain or bleeding. Radiotherapy can relieve this pressure by shrinking the tumour.
External beam radiotherapy is given from a radiotherapy machine outside the body.
This treatment is normally given as a number of short, daily treatments in a radiotherapy department. These are called treatment sessions
Internal radiotherapy (brachytherapy)
Brachytherapy is where radioactive implants such as seeds, pellets or wires that are put near or inside the tumour. The radioactivity only affects tissue that is very close to the implant. This means the tumour is treated, but healthy areas around it get much less radiotherapy. Areas of the body that are further away are not affected at all
Sometimes patients will begin treatment for oesophageal cancer with radiation therapy along with chemotherapy. This combination treatment is called chemoradiation. Having chemotherapy and radiotherapy together can make the side effects of treatment worse. It may not be suitable for people who have other health problems. Your cancer doctor or specialist nurse can give you more information about chemoradiation and its possible side effects.
If a tumour is blocking the oesophagus, it can make it hard to swallow, this is called dysphagia. In order to make it easier for you to swallow, your doctor may recommended that you get an oesophageal stent. The stent is a hollow tube that’s placed in your oesophagus in the area of the tumour to hold the area open. The stent expands to allow fluid and food to pass into the stomach more easily. A stent also prevents food and saliva going into the lungs and causing infection.
On the day of the procedure your doctor will use an endoscope to look into your oesophagus. An endoscope is a flexible tube with a camera that goes through your mouth into your oesophagus. The doctor will place the stent with a fluoroscopy (a real-time X-ray). After the stent is in the right position, you will be recovered and sent home. It is important to follow the instructions given to you when you leave hospital about slowly introducing food. The stent does not treat the cancer but will allow you to eat and drink more normally.
You may be eligible to take part in a clinical trial, which is a type of research study that investigates new or specialised therapies or treatments. While you are discussing therapy options with your care team, it is a good idea to ask about clinical trials that may be suitable for your condition and discuss whether participating may be right for you.
Being involved in a clinical trial may be beneficial in that you may access the latest treatments before they become generally available. Additionally, clinical trial participation is often associated with closer monitoring of your care and condition and potentially improved outcomes.
For further information on the latest upper GI cancer trials visit the Australian Gastro-Intestinal Cancer Trials Group (AGITG) website or visit the Australian Cancer Clinical trials website.
Being referred to a specialist centre
Anyone diagnosed with oesophageul cancer should have their case reviewed at a centre where there is a specialist multidisciplinary team of doctors and allied health professionals, who are able to assess and treat the disease.
Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
- General Practitioner – your GP looks after your general health and works with your specialists to coordinate treatment.
- Gastroenterologist – specialises in diseases of the digestive system, can also perform endoscopy procedures.
- Upper gastrointestinal (UGI) surgeon – specialises in surgery to treat diseases of the upper gastrointestinal system.
- Medical oncologist – prescribes and coordinates chemotherapy treatment.
- Radiation oncologist – prescribes and coordinates radiation therapy.
- Cancer nurses – assist with treatment and provide information and support throughout your treatment.
- Other allied health professionals – such as dietitians, exercise physiologists, social workers, pharmacists, speech pathologists and counsellors.