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Stomach and oesophageal cancers


Treatment for oesophageal cancer


The most important factor in planning treatment for oesophageal cancer is the stage of the disease. Your treatment will also depend on your age, nutritional needs, medical history and general health. Treatment will be tailored to your specific situation.

Your guide to best cancer care

A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for oesophagogastric cancer can help you make sense of what should happen. It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.

Read the guide

Surgery

When oesophageal cancer is inside the oesophageal wall, surgery is often recommended as long as you are well enough. Surgery aims to remove all of the cancer while keeping as much normal tissue as possible. The surgeon will also remove some healthy tissue around the cancer to reduce the risk of the cancer coming back.

You may have an endoscopic resection or an oesophagectomy depending on where the tumour is growing and how advanced the cancer is.

The surgery can be done in two ways – open or laparoscopic surgery (minimally invasive or keyhole surgery). Laparoscopic surgery usually means a smaller scar, which means the hospital stay is shorter and the recovery faster, but it’s not always possible to have this type of surgery. Open surgery may be considered a better option in many situations. 

Endoscopic resection

Very early-stage tumours in the lining of the oesophageal wall (mucosa) may be removed with an endoscope through endoscopic resection (ER). For some people, an endoscopic resection may be the only treatment they need.

This procedure is often done as a day procedure but occasionally needs an overnight stay in hospital. Preparation and recovery are similar to an endoscopy, but there is a slightly higher risk of bleeding or getting a small tear or hole in the oesophagus (perforation).

Oesophagectomy (surgical resection)

Surgery to remove part or all of the oesophagus is called oesophagectomy. Nearby affected lymph nodes are also removed. It is common to have chemotherapy and/or radiation therapy before surgery, as this approach has been shown to have better results.

Depending on where in the oesophagus the cancer is, the surgeon may also remove part of the upper stomach. This is the preferred option for cancer that has spread deeper into the wall of the oesophagus or to nearby lymph nodes.

Once the parts with cancer have been removed, the stomach is pulled up and re-joined to the healthy part of the oesophagus. This will allow you to swallow and, in time, eat relatively normally. If the oesophagus cannot be re-joined to the stomach, the oesophagus will be connected to the small bowel, or a part of the bowel will be used to replace the part of the oesophagus that was removed. These procedures will help you swallow.

As with any major surgery, oesophageal surgery has risks. Your surgeon will discuss these risks with you before surgery, and you will be carefully monitored for any side effects.

What to expect after oesophageal surgery 

  • You will probably be in hospital for 7–10 days, but you may stay longer if you have any complications.
  • It may take 6–12 months to feel completely better after an oesophagectomy.
  • Immediately after oesophageal surgery, you will not be able to eat or drink. You’ll have a feeding tube to get the nutrition you need and another tube (nasogastric tube) to drain fluids from the stomach. The tubes will be removed before you leave hospital.
  • Once you begin eating, it is common to start with fluids such as soup, and then move onto puréed and then soft foods for a few weeks. It is best to eat 5–6 small meals or snacks throughout the day. 
  • Controlling pain will help avoid problems with breathing that can lead to pneumonia. A physiotherapist can teach you breathing or coughing exercises to help keep your lungs clear.
  • You may be taught how to use an incentive spirometer, a device you breathe into to help your lungs expand and prevent a chest infection.
  • Surgical scars can narrow the oesophagus and make it difficult to swallow. If the oesophagus becomes too narrow, your doctor may need to stretch the walls of the oesophagus (dilatation). For some people, this procedure may need to be repeated several times.

 

Getting support

Surgery for oesophageal cancer is complex. Surgeons that regularly perform this type of surgery have better outcomes, which means you might need to travel to a specialist centre to have surgery. Call us on 13 11 20 to ask about patient travel assistance that may be available. You can also ask about our financial and legal services.

Talk to a cancer nurse

Radiation therapy

Radiation therapy is used as the main treatment for oesophageal cancer that has not spread to other parts of the body and cannot be removed surgically. 

You will usually have treatment as an outpatient once a day, Monday to Friday, for 4–5 weeks. If radiation therapy is used palliatively, you may have a short course of 1–10 sessions. Each treatment takes about 20 minutes and is not painful.

Radiation therapy may be given alone or combined with chemotherapy (chemoradiation). Oesophageal cancer may be treated with chemoradiation before surgery to shrink the cancer and make it easier to remove. Chemoradiation may also be used as the main treatment when the tumour can’t be removed safely with surgery, or if the doctor thinks the risk with surgery is too high.

If you have chemoradiation, you’ll have a break of 4–12 weeks between radiation therapy and surgery to allow the treatment to have its full effect. 

Side effects of radiation therapy 

Some people will develop temporary side effects during or shortly after treatment. The lining of the oesophagus can become sore and inflamed (oesophagitis). This can make swallowing and eating difficult. In rare cases, you may need a temporary feeding tube to help you get enough nutrition.

Other possible side effects include fatigue, skin redness, loss of appetite and weight loss. Most side effects improve within four weeks of treatment finishing.

Very rarely, long-term side effects can develop. The oesophagus can develop scar tissue and get narrower (known as oesophageal stricture). Stretching the walls of the oesophagus (dilatation) can make it easier to swallow food and drink. Radiation therapy can also cause irritation and swelling (inflammation) in the lungs, causing shortness of breath.

 

Chemotherapy

Chemotherapy for oesophageal cancer may be given alone or it may be combined with radiation therapy. It may be used:

  • before surgery (neoadjuvant chemotherapy) – to shrink a large tumour and destroy any cancer cells that may have spread
  • after surgery (adjuvant chemotherapy) – to reduce the chance of the disease coming back
  • on its own (palliative treatment) – for people unable to have surgery or where cancer has spread to different parts of the body.

Chemotherapy is usually given by injecting the drugs into a vein in the arm. It may also be given through a tube that is implanted and stays in your vein throughout treatment (called a port-a-cath or PICC line), or as tablets you swallow. You will usually receive treatment as an outpatient. Most people have a combination of chemotherapy drugs over several treatment sessions.

How you react to chemotherapy will vary, depending on the drugs you receive, how often you have treatment, and your general fitness and health.

Immunotherapy

There have been some advances in treating advanced oesophageal cancer with immunotherapy drugs known as checkpoint inhibitors. These use the body’s own immune system to fight cancer.

Clinical trials are testing checkpoint inhibitors for oesophageal cancer after surgery (adjuvant treatment). Checkpoint inhibitors are also given to some people with advanced oesophageal cancer as a first-line treatment together with chemotherapy.

New immunotherapy drugs are changing rapidly. Talk to your doctor about whether immunotherapy is an option for you.

Palliative treatment

Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease. Many people think that palliative care is for people at the end of life, but it can help at any stage of advanced oesophageal cancer.

Treatments will be tailored to your individual needs. For example, radiation therapy can help to relieve pain and make swallowing easier by helping to shrink a tumour that is blocking the oesophagus. Palliative treatments can also slow the spread of the cancer.

Palliative treatment is one aspect of palliative care, in which a team of health professionals help meet your physical, emotional, cultural, spiritual and social needs. The team also supports families and carers.

Learn more about palliative care

Learn more about advanced cancer

Having a stent

People with advanced oesophageal cancer who are having trouble swallowing and do not have any other treatment options may have a flexible tube (stent) inserted into the oesophagus. The stent expands the oesophagus to allow fluid and soft food to pass into the stomach more easily. This stent also prevents food and saliva going into the lungs and causing infection.

The stent does not treat the cancer but will allow you to eat and drink more normally. Stents can cause indigestion (heartburn) and discomfort. Occasionally, the stents will move down the oesophagus into the stomach and may need to be removed. 

Understanding Stomach and Oesophageal Cancers

Download our Understanding Stomach and Oesophageal Cancers booklet to learn more.

Download now  

 

Expert content reviewers:

Dr Spiro Raftopoulos, Gastroenterologist, Sir Charles Gairdner Hospital, WA; Peter Blyth, Consumer; Jeff Bull, Upper Gastrointestinal Cancer Nurse Consultant, Cancer Services, Southern Adelaide Local Health Network, SA; Mick Daws, Consumer; Dr Steven Leibman, Upper Gastrointestinal Surgeon, Royal North Shore Hospital, NSW; Prof Michael Michael, Medical Oncologist, Lower and Upper Gastrointestinal Oncology Service, and Co-Chair Neuroendocrine Unit, Peter MacCallum Cancer Centre, VIC; Dr Andrew Oar, Radiation Oncologist, Icon Cancer Centre, Royal Brisbane Hospital, QLD; Rose Rocca, Senior Clinical Dietitian: Upper Gastrointestinal, Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, VIC; Letchemi Valautha, Consumer; Lesley Woods, 13 11 20 Consultant, Cancer Council WA.

Page last updated:

The information on this webpage was adapted from Understanding Stomach and Oesophageal Cancers - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in April 2022. 

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