Chemotherapy for oesophageal cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. Treatment that reaches the whole body in this way is called systemic treatment.  

You might have chemotherapy before or after surgery for oesophageal cancer. If you have advanced cancer, you might have chemotherapy to relieve symptoms and improve your quality of life.

When you have it

When you have chemotherapy depends on how far it has grown or spread (the stage) and the type of cancer. The 2 main types are squamous cell cancer or adenocarcinoma.

You’re likely to have chemotherapy before surgery if you have stage 2 or stage 3 cancer. You might have chemotherapy if you have stage 1b squamous cell cancer.

Squamous cell cancer 

You usually have chemotherapy combined with radiotherapy (chemoradiotherapy). You either have it before surgery, or as your only treatment.

Adenocarcinoma 

You either have chemotherapy or chemoradiotherapy before surgery. Or you might have chemotherapy before and after surgery.

Chemotherapy before surgery is called neo adjuvant chemotherapy. Chemotherapy before and after surgery is called peri operative chemotherapy.

These treatments aim to:

• reduce the size of the cancer so it’s easier for the surgeon to remove
• lower the risk of the cancer coming back

Advanced cancer

You might have chemotherapy as your main treatment if you have advanced oesophageal cancer. It can’t cure your cancer, but it might:

• relieve symptoms
• control the growth of the cancer
• improve your quality of life

How often do you have it?

You usually have chemotherapy every 2 or 3 weeks depending on what drugs you have. Each 2 or 3 week period is called a cycle. You might have between 2 and 8 cycles of chemotherapy. This depends on what chemotherapy you have, and what other treatment you're having. 

Types of Chemotherapy

If you have early or advanced cancer, you usually have a combination of 2 or 3 drugs (in a regimen). Your oncologist will explain which regimen they think is best for you. The most common types include:

• fluorouracil, oxaliplatin and docetaxel (FLOT)
• cisplatin and capecitabine (CX)
• cisplatin and fluorouracil (CF)
• epirubicin, cisplatin and fluorouracil (ECF)
• carboplatin and paclitaxel
• carboplatin and paclitaxel
• fluorouracil and oxaliplatin and folinic acid (FOLFOX)

Targeted and immunotherapy cancer drugs

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. These are called immunotherapy. 

You might have targeted or immunotherapy drugs after chemotherapy and surgery if you have stage 2 or 3 oesophageal cancer. 

You may have these drugs on their own or with chemotherapy as part of your treatment for advanced oesophageal cancer. This might include:

• pembrolizumab, capecitabine, fluorouracil (pembrolizumab-CAPOX) 
• nivolumab, fluorouracil, oxaliplatin and folinic acid (nivolumab-FOLFOX)
• trastuzumab, cisplatin and capecitabine

First and second line treatment

You might hear the terms first line and second line treatment. The first course of chemotherapy you have is the first line treatment. Your doctor might offer you second line treatment if first line treatment isn't working or your cancer starts to grow again.

How you have it

You have most of the chemotherapy drugs for oesophageal cancer into your bloodstream (intravenously). Capecitabine is a tablet.

Into your bloodstream

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.

Tablets

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test. 

Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.

Before your first chemotherapy, your doctor will explain what drugs you need, how you have them, and what the side effects are. You’ll sign a consent form. This is a good time to ask any questions you might have.

Side effects

Common chemotherapy side effects include:

• feeling sick

• loss of appetite

• losing weight

• feeling very tired

• increased risk of getting an infection

• bleeding and bruising easily

• diarrhoea or constipation

• hair loss

Side effects depend on:

• which drugs you have

• how much of each drug you have

• how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

• take any supplements
• have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

When you're at home