Treating oesophageal cancer

The treatment you receive for oesophageal cancer will depend on many factors, including the stage of your cancer, the type of cancer you have, where it is located, and your overall health and preferences.

Treatment for oesophageal cancer usually involves a combination of different approaches. You might have surgery, chemotherapy and/or radiotherapy.

Your healthcare team will create a treatment plan tailored to your individual situation. They will explain each treatment option, what to expect, and answer any questions you have.

This section provides information about the different treatment options available, your treatment team, how to make treatment decisions, and what to expect during and after treatment.

Treatment options for oesophageal cancer

Treatment goals

Treatment for oesophageal cancer depends on several factors, including the stage of your cancer, where it's located, your overall health, and your preferences.

When discussing treatment, your doctor will explain what the treatment aims to achieve. Understanding this intent helps you make informed decisions about your care.

Treatment for oesophageal cancer generally has one of three goals:

1. To cure the cancer

When oesophageal cancer is found early and hasn't spread, the aim of treatment is to remove or destroy all the cancer cells. This usually involves surgery, often combined with chemotherapy and radiotherapy before or after surgery. 

2. To control cancer growth and help you live longer

If the cancer cannot be completely removed, treatment may aim to control its growth and spread. This may include chemotherapy and radiotherapy. 

3. To manage symptoms and improve comfort

When the cancer has progressed, the focus may shift to helping you feel as well as you can. This might involve pain relief, help with eating or swallowing, and emotional or practical support.

Supportive (palliative) care can be given on its own or alongside cancer treatment.

Common treatments

Common treatments for oesophageal cancer include surgery, chemotherapy and radiotherapy. You may need to have just one of these or a combination of treatments, depending on your diagnosis.

Your treatment team will explain what's recommended for you. 

• Surgery is often the main treatment for early-stage oesophageal cancer (cancer that has not spread toother organs).
• Chemotherapy uses special medicines to kill cancer cells. You might get these medicines through a drip or as tablets. They can be given before surgery to shrink the cancer, after surgery to kill any leftover cancer cells, or on their own if surgery isn’t possible.
• Radiotherapy (also called radiation therapy) uses strong X-ray beams to damage cancer cells. It is used in oesophageal cancer to shrink the cancer before surgery and to reduce the risk of the cancer coming back after surgery.
• Clinical trials test new treatments to see if they work better than current ones. Joining a trial can give you access to new medicines and extra care from your health team.

Emerging treatment options

Targeted therapies are drugs that target specific genes and proteins involved in cancer growth. Immunotherapies are one type of targeted therapy.

Targeted therapies are only effective for some cancers, so you may need to undergo pathology testing to see if they will benefit you.

Immunotherapy has been shown to work well with chemotherapy for certain types of oesophageal cancer. Immunotherapies are usually delivered as a single injection or infusion per session, and often there are several sessions.

Immunotherapies and other targeted therapies are rapidly evolving, with the Therapeutic Goods Administration (TGA) approving new therapies all the time. The costs of these therapies are also changing, as some get listed on the Pharmaceutical Benefits Scheme (PBS).

Your doctor will let you know which therapies are available at the time of your treatment, and which might suit you.

Getting ready for treatment (prehabilitation)

Getting ready for treatment means helping your body and mind be as strong as possible before you start. It’s like training for a big event — the better prepared you are, the better you’ll cope.

People who prepare often recover faster, have fewer problems after treatment, and feel better overall.

Here are some ways to get ready:

• Move your body: Try to be active in ways that feel safe for you. Even short walks each day can help. An exercise expert (called an exercise physiologist) can make a plan that suits your fitness level.
• Eat well: A dietitian can help you make sure your body has the energy and nutrients it needs. You might need smaller meals more often or use supplements if eating is hard.
• Healthy habits: If you smoke, try to quit. Cutting down on alcohol also helps your body heal and makes treatment easier.
• Look after your mind: It’s normal to feel worried or scared. Talking to a counsellor, practising mindfulness, or learning ways to relax can help you feel calmer.

Your healthcare team can connect you with people who can help with each part of your plan. The most important thing is to start as soon as you can after being diagnosed.

Your treatment team

Oesophageal cancer requires expertise from multiple specialists working together. You'll be cared for by a multidisciplinary team of professionals from different fields who meet regularly to discuss your case and coordinate your care.

Your main doctor

One doctor takes responsibility for coordinating your treatment. Depending on your situation, this might be:

• a gastroenterologist who may have diagnosed your cancer through endoscopy
• an upper gastrointestinal surgeon if you're having an operation to remove the cancer
• a medical oncologist if chemotherapy is your main treatment

This doctor acts as your main point of contact and ensures all aspects of your care work together smoothly.

The multidisciplinary team

The rest of your multidisciplinary team will be made up of a mix of medical specialists, allied health professionals and supportive care professionals.

Each team member brings special skills to make sure all parts of your care are looked after. They meet regularly to talk about your case and agree on the best treatment approach.

The make-up of this multidisciplinary team may change at different stages of your treatment, but may include:

Making treatment decisions

Deciding on treatment for oesophageal cancer can feel overwhelming. Your healthcare team is there to support you and help you make informed decisions about your care.

Your healthcare team provides expert advice, but ultimately you decide what treatment aligns with your goals.

Getting the information you need

To make an informed decision, it helps to know as much as you can about your treatment choices. Your treatment team will explain:

• the different treatment options available to you
• the goals of each treatment (for example, cure, control, or symptom relief)
• the benefits and risks of each option
• possible side effects and how they might affect you
• what treatment involves, including how long it takes, where it happens, and how often
• how it might affect your daily life.

Things to think about

Everyone’s situation is different. When making treatment decisions, you might want to think about:

• your personal goals and what matters most to you
• your overall health and how fit you feel
• the side effects and how they could affect your quality of life
• practical issues such as travel, time off work, or caring for family
• your own values, beliefs and preferences.

Questions to ask

It can help to write down your questions before appointments. You might like to ask:

• Based on my specific cancer, what treatment gives me the best chance of long-term survival?
• If surgery is recommended, how much of my oesophagus will be removed? How will this affect eating and digestion?
• What's the typical recovery time for each treatment option?
• How will treatment impact my ability to work, care for family, or maintain other responsibilities?
• What happens if I don't have treatment, or if I delay treatment?
• Are there clinical trials I should consider?
• What supportive care is available to manage side effects?
• Can I get a second opinion?
• What are the costs involved, and what financial assistance is available?

Taking your time

While oesophageal cancer requires prompt attention, you typically have time to:

• absorb information and ask follow-up questions
• discuss options with family or trusted friends
• seek a second opinion if desired
• research and reflect on what feels right for you

Your team will indicate if any decision needs urgency. Otherwise, taking days or even a couple of weeks to consider major treatment decisions is reasonable and expected.

Surgery for oesophageal cancer

Surgery is often recommended for oesophageal cancer that has not spread to other organs. The goal of surgery is to remove the cancer while keeping as much healthy tissue as possible.

 
Is surgery an option for me?

If you have been diagnosed with oesophageal cancer that has not spread to other organs and is not significantly attached to major blood vessels, then surgery may be an option for you.

Doctors use certain words to describe whether surgery is possible:

• resectable (operable): The cancer can be removed with surgery.
• borderline resectable: Surgery might be possible after chemotherapy to shrink the tumour.
• locally advanced or metastatic: The cancer has spread too far, so surgery isn’t an option.

Surgery may be done on its own or combined with chemotherapy and radiotherapy (given before or after surgery).

 
Types of surgery

The type of surgery you have depends on where the cancer is in your oesophagus. Your surgeon will choose the operation that gives you the best chance of recovery.

Endoscopic resection

If the oesophageal cancer is quite small when detected and has not spread, the surgeon may be able to do an endoscopic resection.

This is where the surgeon removes the tumour through endoscopy. This type of surgery does not need as much recovery time as an oesophagectomy.

Oesophagectomy

Surgery to remove part or all of the oesophagus is called an oesophagectomy. The amount your surgeon removes will depend on where the cancer is and how large it is. During the operation, nearby lymph nodes are also taken out so they can be checked for any signs of cancer.

If a large section of the oesophagus needs to be removed, or if the cancer is high up near the throat, it might be difficult to reconnect the remaining oesophagus to the stomach. In this case, the surgeon may use a piece of your intestine to bridge the gap and join the oesophagus to the stomach.

An oesophagectomy is a major operation, and recovery takes time. You’ll usually stay in hospital for about one to two weeks, and it may take six to twelve months to get back to your usual strength and routine.

Oesophago-gastrectomy

When surgery involves removing the lower part of the oesophagus and the upper part of the stomach, it’s called an oesophago-gastrectomy. 

During this operation, the surgeon reconnects the remaining healthy part of the oesophagus to the lower part of the stomach. This creates a new pathway for food to pass from your throat to your stomach.

An oesophago-gastrectomy is a major and complex operation. You’ll usually stay in hospital for about one to two weeks, and it can take six to twelve months to fully recover.

When the cancer can’t be removed with surgery

If the cancer can’t be removed with surgery, other procedures can significantly improve your quality of life by maintaining your ability to eat and drink comfortably.

Stent placement

If you have a blockage in your oesophagus, you might need to have an oesophageal stent placed.

A stent won’t treat the cancer, but it will help to relieve blockage of the food passage caused by the cancer so that you are more comfortable.

A stent is a flexible tube that sits in the oesophagus. It helps keep your oesophagus open so you can eat, drink and swallow better.

Stents can be temporary or permanent. While you are sedated, your doctor will use a gastroscope to insert the stent.

A stent might be used:

• if your doctor thinks surgery is not an appropriate option for you, but the cancer is causing a blockage
• after surgery, when there is a narrowing of your oesophagus (called a stricture) or your oesophagus is leaking.

What to expect when having surgery
Before surgery

• You’ll have several tests to check you’re ready for the operation.
• You’ll meet your surgical team to talk about the benefits, risks and what recovery will look like.
• You might start prehabilitation to improve your fitness and nutritional state.

 During your hospital stay

• Most people stay in hospital for 1–2 weeks after surgery for oesophageal cancer.
• You may start your recovery in an intensive care or high-dependency unit.
• You will likely have a feeding tube to help with nutrition before you gradually return to eating normally.
• Your team will help manage pain and watch for any problems.

 Recovery at home

• Healing after oesophageal surgery takes time and patience. You’ll need to give your body a chance to rest and get stronger.
• It may take 6 to 12 months for you to fully recover from the procedure. Try to move a little more each day but listen to your body. You’ll have some good days and some harder ones.
• It can also take time to get used to the changes in your body and how you eat. It’s normal to feel frustrated, sad, or worried. Talking with a counsellor or joining a support group an really help. You’ll meet others who understand what you’re going through.

 
Getting support

Recovery from oesophageal surgery isn't something to navigate alone. Lean on:

• your surgical team for medical concerns
• a specialist dietitian for nutritional guidance
• family and friends for practical help and companionship
• Pancare's Support service to connect with others who've had similar surgeries

Remember, recovery takes time. Most people gradually find their new normal, though it may look different from life before surgery.

Chemotherapy for oesophageal cancer

Chemotherapy uses special medicines to kill cancer cells or stop them from growing.
It is one of the main treatments for oesophageal cancer.

The doctor in charge of your chemotherapy is called a medical oncologist.

Will I have chemotherapy?

Your oncologist may recommend chemotherapy:

• before surgery (called neoadjuvant therapy) to shrink the tumour and make surgery easier.
• after surgery (called adjuvant therapy) to lower the chance of the cancer coming back.
• as your main treatment when surgery isn’t possible.

 
Types of chemotherapy

Chemotherapy can be given in two main ways.

• Through a drip (IV chemotherapy). The medicine goes into a vein through a drip, usually in a hospital or cancer clinic. Each session can take a few hours, depending on your treatment plan.

• As tablets or capsules (oral chemotherapy). Some chemotherapy medicines come as tablets or capsules you take at home. Your oncologist will explain exactly when and how to take them.

What to expect during chemotherapy
Your chemotherapy plan

Your oncologist will design a plan based on:

• the stage of your cancer
• your overall health
• whether you’ve had surgery
• previous treatments
• clinical trials that might be suitable.

Most plans use a combination of drugs that work together to fight cancer cells.

Chemotherapy is usually given in cycles. This means you’ll have a period of treatment followed by a rest period so your body can recover.

A full course of chemotherapy often lasts several months. Your care team will explain the exact schedule for you.

Access devices

If you’re having IV chemotherapy through a drip, your doctor may recommend a device to make treatment easier. This might be:

• a PICC line: a soft tube placed in a vein in your arm and threaded near your heart. It stays in during your treatment so you don’t need needles each time.
• a Port (Port-a-Cath): a small device placed under the skin of your chest that connects to a vein. It’s accessed with a special needle and can stay in for months. 

These devices help protect your veins and make treatment more comfortable.

 
Monitoring during treatment

You’ll have regular check-ups to make sure chemotherapy is working safely.
 These may include:

• blood tests to check your blood counts and organ function
• scans to see how the cancer is responding
• check-ins to talk about how you’re feeling and any side effects

 
Side effects and how to manage them

Chemotherapy can affect healthy cells too, which causes side effects. Not everyone gets the same effects, and most can be managed well.

Common side effects include:

• feeling tired or weak
• feeling sick (nausea) or vomiting
• loss of appetite or changes in taste
• hair thinning or loss
• diarrhoea or constipation
• mouth sores
• numbness or tingling in your hands and feet
• higher risk of infections.

Your team can help by:

• prescribing anti-sickness or infection-preventing medicines
• adjusting your chemotherapy dose if needed
• providing nutrition and pain-management advice
• offering emotional and practical support.

Always tell your nurse or doctor about any side effects. There are often ways to make you feel more comfortable.

 
Getting support

Chemotherapy can be physically and emotionally tough. You don’t have to go through it alone.

Your care team, a dietitian, or Pancare's Support service can help you manage side effects, plan meals, and find emotional support.

Radiotherapy for oesophageal cancer

Radiotherapy (also called radiation therapy) uses strong X-rays to destroy cancer cells.

In oesophageal cancer, radiotherapy may be used to shrink the cancer before surgery or to destroy any cancer cells that are left over after surgery.

The doctor in charge of your radiotherapy is called a radiation oncologist.

Will I have radiotherapy?

Your radiation oncologist may recommend radiotherapy:

• before surgery (called neoadjuvant therapy) to shrink the tumour and make surgery easier.
• after surgery (called adjuvant therapy) to lower the chance of the cancer coming back.

How radiotherapy works

Radiotherapy is given by a machine that directs beams of radiation at the cancer from outside your body.

You won’t see or feel the radiation, but it works inside your body to damage the DNA of cancer cells so they can’t keep growing.

Radiotherapy might be given in combination with a small dose of chemotherapy. This is called chemoradiation. The chemotherapy makes cancer cells more sensitive to radiation, helping the treatment work better.

Your radiation oncologist will discuss whether this approach is suitable for you.

What to expect during radiotherapy

Before treatment

• You’ll have a planning session to prepare for radiotherapy
• You might have a CT scan to help your team map out the exact treatment area
• Small dots or tattoos may be placed on your skin so the radiation can be aimed accurately each time
• Your team will explain how many treatments you’ll need and what to expect

During treatment

• Treatment usually happens once a day, Monday to Friday.
• Each visit lasts about 15–30 minutes, but the radiation itself takes only a few minutes.
• You’ll lie still on a treatment bed while the machine moves around you.
• You won’t feel the radiation, and you’ll be able to go home afterwards.
• Most people have treatment for several weeks.

Side effects and how to manage them

Side effects usually appear slowly during treatment and improve a few weeks after it finishes. Everyone reacts differently, but common effects include:

• feeling tired
• skin redness or irritation in the treated area
• nausea or loss of appetite
• diarrhoea or softer bowel motions
• discomfort or a warm feeling in the abdomen

Your radiation oncology team will help you manage side effects. They can give advice about:

• gentle skin care
• anti-nausea or diarrhoea medicines
• eating well and maintaining energy
• when to contact your doctor if you’re worried.

Getting support

It’s normal to feel tired or emotional during treatment.

Your healthcare team can help with symptom control, nutrition, and emotional wellbeing.

You can also reach out to Pancare's Support for practical advice, counselling, and connections with others living with oesophageal cancer.

Clinical trials

Clinical trials are research studies that test new treatments or new ways of using existing ones.

Clinical trials for oesophageal cancer look at different treatment options, with the aim of finding more effective treatments to improve survival and quality of life.

For some people, joining a clinical trial can offer access to promising new treatments and specialised care before these options become widely available.

Why consider a clinical trial

Taking part in a clinical trial can give you the chance to try a new approach that may work better than standard care. You’ll be closely monitored by expert doctors and nurses who specialise in oesophageal cancer.

Even if the treatment being tested doesn’t benefit you directly, your participation helps researchers learn more about the disease and improve care for future patients. Many people find this sense of contributing to progress reassuring and empowering.

What kinds of trials exist

There are many different types of clinical trials.

Some test new chemotherapy drugs or combinations, while others explore targeted therapies that act on specific changes in cancer cells.

Researchers are also studying new ways to use immunotherapy to help the body’s own immune system fight cancer.

Other trials look at surgical techniques, how to better manage symptoms or side effects, or how to detect oesophageal cancer earlier.

Each trial has its own entry requirements, called eligibility criteria. These might include the type and stage of your cancer, your previous treatments, your general health, and sometimes genetic features found in your tumour.

Your healthcare team can explain which kinds of studies are currently running and whether one may be right for you.

Finding clinical trials

If you’d like to explore current oesophageal cancer trials, speak to your oncologist or visit trusted websites such as australiancancertrials.gov.au or the Australasian Gastro-Intestinal Trials Group.

You can also contact the Pancare Foundation for guidance and information about studies in Australia.

Complementary and alternative therapies

Many people with oesophageal cancer look for ways to feel better and support their wellbeing during treatment.

Complementary and alternative therapies are two types of approaches people sometimes use. It’s important to understand how they differ, and how they can safely fit into your care.

Understanding the difference

• Complementary therapies are used alongside standard medical treatments such as chemotherapy, surgery or radiotherapy. They aim to help you relax, manage symptoms, and improve your quality of life. Examples include meditation, yoga, massage, acupuncture, and relaxation techniques.
• Alternative therapies, on the other hand, are used instead of standard medical treatments. These approaches have not been proven to treat cancer and can sometimes be harmful or interfere with your care. For this reason, alternative therapies are not recommended as a replacement for evidence-based treatment.

Complementary therapies that may help

Some complementary therapies can be safely used to help with relaxation or symptom relief, as long as your healthcare team agrees.

• For relaxation and wellbeing: Gentle exercise, yoga, meditation, mindfulness, aromatherapy, massage (with your doctor’s approval), music therapy, and art therapy can help reduce stress and improve mood.
• For specific symptoms: Acupuncture and acupressure wristbands may help reduce nausea or pain. Some people find ginger tea or tablets helpful for nausea.
   Simple breathing and relaxation exercises can ease anxiety and support sleep.

Dietary supplements

It’s common to wonder whether vitamins, minerals, or herbal products could help.
Some may be safe, but others can interfere with chemotherapy or other cancer treatments.

Always tell your healthcare team about any supplements you’re taking or thinking about taking. They can check for possible interactions and advise what’s safe.

Remember:

• High doses of some vitamins can be harmful.
• ‘Natural’ doesn’t always mean safe.
• Many products make claims that are not supported by science.

If in doubt, ask your doctor, pharmacist or dietitian before starting anything new.

Making informed choices

Before starting any new therapy, take time to check that it’s safe and worthwhile.

Talk to your healthcare team. They need to know everything you’re using. You can also ask:

• Is this safe to use with my cancer treatment?
• What are the possible risks or side effects?
• What evidence supports this therapy?
• How much will it cost and how often would I need it?

Follow-up care

After your initial treatment is complete, you'll enter a phase of follow-up care. This is an important part of your cancer journey.

Follow-up care involves:

• regular check-ups with your healthcare team
• watching for signs of cancer coming back
• managing ongoing side effects
• supporting your recovery and wellbeing
• coordinating care between specialists and your GP.

Your follow-up care plan

Every person’s recovery is different. Your healthcare team will create a personalised follow-up plan that explains:

• Who your main contact person is (such as a nurse or specialist)
• How often you’ll need check-ups and who you’ll see
• Which tests you may need and how often they’ll be done
• What to expect at each visit

You may have blood tests and CT or MRI scans from time to time to check for any changes.

These tests help your doctors see how you’re healing and detect any possible signs of the cancer returning early.

Managing ongoing issues

Some people continue to experience side effects after treatment, such as fatigue, digestive changes, or problems with appetite.

Your care team will support you to manage these issues and maintain your strength.

What to watch for

Your doctor will tell you about symptoms that may need to be checked quickly.

These might include:

• new or worsening pain in your chest or back
• unexpected weight loss or loss of appetite
• new difficulty swallowing
• persistent vomiting that stops you from eating
• Black or bloody poos
• vomiting blood
• new lumps, swelling or discomfort anywhere in your body.

If you notice any of these symptoms, or anything that worries you, contact your healthcare team or GP as soon as possible.

Looking after yourself

Recovery takes time, both physically and emotionally. Keep communicating with your care team and let them know how you’re feeling.

Gentle physical activity, a balanced diet, rest, and emotional support from friends, family, or a counsellor can all make a big difference.

If you’d like extra support, Pancare’s Support service can connect you with nurses, counsellors, dietitians and others who understand what you’re going through.