General information on treatment for cancer of the oesophagus

Treatment types

Cancer of the oesophagus can be treated using surgery, chemotherapy or radiotherapy. The choice of treatment will depend upon the exact type of oesophageal cancer, its stage, position and size, as well as your age and general health. The treatments can be used alone or in combination. When diagnosing and treating cancer doctors consider the oesophagus in three sections: upper, middle and lower.

Other treatments may be used to ease any swallowing difficulties you may have. These include: intubation or stenting (inserting a tube into the oesophagus to keep it open), dilatation (stretching the oesophagus), laser treatment and photodynamic therapy. You may be offered one or more of these treatments, which are described in greater detail on the Difficulty in swallowing page.

How treatment is planned

In most hospitals a team of specialists will discuss with you the treatment that they feel is best for your situation. This multidisciplinary team (MDT) will include a surgeon who specialises in oesophageal cancers, a medical oncologist (chemotherapy specialist), a clinical oncologist (radiotherapy specialist) and may include a number of other healthcare professionals such as a:

• nurse specialist
• dietitian
• physiotherapist
• occupational therapist
• psychologist or counsellor.

Together the doctors will be able to advise you on the best course of action and plan of treatment, taking into account a number of factors. These include your age, general health, the type and size of the tumour, and whether it has begun to spread.

If two treatments are equally effective for your type and stage of cancer, your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved and the side effects you might have, so that you can decide what is the right treatment for you.

Remember to ask questions about any aspects that you do not understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your cancer specialist, nurse specialist or with the nurses at CancerBACUP.

If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a close friend or relative with you.

Second opinion

Even though a number of cancer specialists work together as a team to decide the most suitable treatment, you may want to have another medical opinion. Most doctors will be pleased to refer you to another specialist for a second opinion, if you feel that this will be helpful. The second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will provide useful information.

If you go for a second opinion, again it may be a good idea to take a friend or relative with you, and to have a list of questions ready, so that you can make sure your concerns are covered during the discussion.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any other possible treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need their treatment to be explained more than once.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

People may often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

If you feel unable to make a decision about the treatment when it is first explained to you, you can always ask for more time. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it.

The benefits and disadvantages of treatment

Many people are frightened at the thought of having cancer treatments, particularly because of the potential side effects that can occur. Some people ask what would happen if they do not have any treatment.

Although many of the treatments can cause side effects, knowledge about how treatments affect people, and improved ways of reducing or avoiding many of these problems, have made most of the treatments easier to cope with.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation.

Early-stage oesophageal cancer

In people with early-stage cancer of the oesophagus, treatment may be given with the aim of curing the cancer. Occasionally additional treatments are given to reduce the risk of it coming back.

Advanced-stage oesophageal cancer

If the cancer is at a more advanced stage, treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. Unfortunately, for some people the treatment will have no effect upon the cancer and they will get the side effects without any of the benefits.

Treatment decisions

If you have been offered treatment that aims to cure your cancer, deciding whether or not to accept the treatment may be simple. However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether or not to go ahead.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether or not you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to help control any symptoms.