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Stomach and oesophageal cancers


Treatment for oesophageal cancer

Page last updated: March 2024

The information on this webpage was adapted from Understanding Stomach and Oesophageal Cancers - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in March 2024.

Expert content reviewers:

This information was developed based on international clinical practice guidelines, and with the help of a range of health professionals and people affected by these cancers:

  • Prof David I Watson, Matthew Flinders Distinguished Professor of Surgery, Flinders University, and Senior Consultant Surgeon, Oesophago-Gastric Surgery Unit, Flinders Medical Centre, SA
  • Prof Bryan Burmeister, Senior Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD
  • Kieran Cahill, Consumer;
  • Jessica Jong, Clinical Dietitian, Upper GI and Hepatobiliary Services, Peter MacCallum Cancer Centre, VIC
  • John Leung, Consumer
  • Prof Rajvinder Singh, Professor of Medicine, University of Adelaide, and Director, Gastroenterology Department and Head of Endoscopy, Lyell McEwin Hospital, SA
  • Dr Sarah Sutherland, Medical Oncologist, Chris O’Brien Lifehouse, NSW
  • Paula Swannock, Upper GI Cancer Nurse Consultant, St Vincent’s Hospital Melbourne, VIC
  • Rebecca Yeoh, 13 11 20 Consultant, Cancer Council Queensland


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. We cannot give advice about the best treatment for you, this needs to be discussed with your doctors,

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.

How the surgery is done

To remove the cancer, the surgery can be done in two ways:

  • Open surgery – The surgeon makes a large cut in the chest and the abdomen, and, sometimes, a small cut in the neck.
  • Keyhole surgery – The surgeon makes some small cuts in the abdomen, then inserts a thin instrument with a light and camera (laparoscope) into one of the cuts to see inside the body. Sometimes a small cut is made at the base of the neck on the left side. This may be used to join the oesophagus and stomach back together.

Your surgeon will talk to you about the best type of surgery for you. 

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.

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.

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 nasogastric tube will be removed before you leave hospital, but a feeding tube is likely to stay in and be removed after you have gone home.
  • Once you begin eating, it is common to start with fluids such as soup, then move onto puréed and soft foods, and eventually normal, solid foods. 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). 

 

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 uses a controlled dose of radiation, such as focused x-ray beams, to kill or damage cancer cells. The radiation is targeted at the cancer, and treatment is carefully planned to do as little harm as possible to healthy body tissue.

Radiation therapy is the main treatment for oesophageal cancer that has not spread to other parts of the body and cannot be removed with surgery. It may be given alone or combined with chemotherapy (chemoradiation).

Chemoradiation is often used 1–3 months before surgery to shrink large tumours and destroy any cancer cells that may have spread.

Before starting treatment, you will have a planning session that will include a CT scan. Some small permanent or temporary tattoos may be made on your skin so that the same area is targeted during each treatment session

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.

“My diagnosis of oesophageal cancer came as a complete shock. I had chemotherapy and radiation therapy to shrink the tumour, and then went home to recover for six weeks before surgery.” John

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells. The aim is to destroy cancer cells, while causing the least possible damage to healthy cells.

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 drugs are usually given as a liquid through a drip inserted into a vein (intravenous infusion). It may also be given through a central venous access device (CVAD) 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. There may be a rest period of a few weeks between each treatment session.

Side effects of chemotherapy

Your treatment team can help you prevent or manage any side effects.

Common side effects may include nausea and/or vomiting, appetite changes and difficulty swallowing, sore mouth or mouth ulcers, skin and nail changes, numbness or tingling in the hands or feet, ringing in the ears or hearing loss, changed bowel habits (e.g. constipation, diarrhoea), and hair loss or thinning.

Chemotherapy affects your immune system, so you may also be more likely to catch infections. If you feel unwell or have a temperature of 38°C or higher, seek urgent medical attention

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 safely removed with surgery, or if the doctor thinks the risk with surgery is too high.

If you have chemoradiation, you will usually have chemotherapy a few hours before some radiation therapy appointments. Your doctor will talk to you about the treatment schedule and managing side effects.

You will usually have treatment as an outpatient once a day, Monday to Friday, for 4–6 weeks. If radiation therapy is used palliatively, you may have a short course of 1–15 sessions.

Each treatment takes about 10 minutes and is not painful. You will lie on a table under a machine that delivers radiation to the affected parts of your body. 

Immunotherapy

Immunotherapy uses the body’s own immune system to fight cancer. Nivolumab is a type of immunotherapy drug called a checkpoint inhibitor. It may be given to people after surgery or to some people with advanced oesophageal cancer.

This area of cancer treatment is changing rapidly. Talk to your doctor about whether immunotherapy is an option for you

Side effects of immunotherapy

The side effects of immunotherapy can vary from person to person.

Immunotherapy can cause redness, swelling or pain (inflammation) in any of the organs of the body, leading to common side effects such as fatigue, skin rash, diarrhoea and cough.

The inflammation can lead to more serious side effects in some people, but this will be monitored closely and any issues will be managed quickly. Let your treatment team know immediately if you develop any side effects or have concerns.

Palliative treatment

Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease. It can also slow the spread of the cancer.

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 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.

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. 

Learn more

Understanding Stomach and Oesophageal Cancers

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

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