Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health professionals, called a multidisciplinary team.
Treatment of oesophageal cancer depends on:
- the stage of the disease
- the location of the cancer
- the severity of symptoms
- your general health and wishes.
Treatment may involve the following.
Surgery
Surgery is commonly used to treat oesophageal cancer. This involves removing the affected part of the oesophagus, called an oesophagectomy. Often the upper part of the stomach and some nearby lymph nodes are removed as well. The healthy part of the oesophagus is joined back to the remaining part of the stomach. Rarely, the oesophagus may need to be reconnected to the small or large bowel instead of the stomach.
Risks of oesophageal surgery include pneumonia, infection, bleeding, blood clots, and leaking from the connection between the oesophagus and the stomach. Surgery will affect your eating and digestion – for example, you might need to eat small meals more often throughout the day. A period of adaptation, often with help from a dietitian, will be needed to adjust to these changes.
In cases where the cancer has spread, surgery may also be done to prevent or relieve problems caused by the cancer. This is called palliative surgery. Examples of palliative surgery include the placement of a feeding tube to allow nutrition to be administered directly into the stomach or intestine or creation of a bypass to avoid the blockage if a tumour cannot be removed.
Endoscopic treatments
Several types of treatment can be given by passing a thin tube (endoscope) down the throat into the oesophagus. These are localised therapies to treat very early stage cancers, prevent or relieve symptoms. Types of endoscopic treatments include:
- endoscopic mucosal resection for very early stage cancers
- dilation to expand the oesophagus
- stent placement to expand and keep the oesophagus open
Chemotherapy
Along with surgery, some people may receive chemotherapy.
Chemotherapy might be used as the main treatment for oesophageal cancer, especially for advanced disease. It may also be used after surgery to treat cancer cells that may remain but cannot be detected (adjuvant chemotherapy), or before surgery to shrink the tumour (neoadjuvant chemotherapy).
Chemotherapy and/or radiation therapy is usually used before surgery to try to shrink the tumour and kill microscopic cells. These treatments might also be used after surgery in some circumstances to kill any remaining cancer cells. They might also be used as palliative treatments to relieve symptoms, such as difficulty swallowing, and improve quality of life.
Radiation therapy
Along with surgery, some people may receive radiation therapy.
Radiation therapy might be used either as the main treatment for oesophageal cancer, after surgery to treat cancer cells that remain, before surgery to shrink the tumour, or to relieve symptoms of advanced oesophageal cancer such as difficulty swallowing or pain, and improve quality of life.
Targeted therapy
Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells with less harm to normal cells.
One type of medicine targets proteins that help tumours form new blood vessels. This type includes the medicine ramucirumab.
Immunotherapy
Immunotherapy involves treatment with medicines that boost the ability of the immune system to attack cancer cells. Immunotherapy can be used to treat oesophageal cancer.
Immunotherapy can be used after surgery and chemotherapy and radiation therapy or for the treatment of advanced disease.
For example, nivolumab is an immunotherapy that can stimulate the immune response against cancer cells by targeting a protein on immune system cells (T cells) that normally stops these cells attacking the body’s normal tissues.
Research is ongoing to find new ways to diagnose and treat different types of cancer. You may be invited to participate in a clinical trial to test new ways of treating oesophageal cancer.
