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Chemotherapy for Esophageal Cancer

Esophageal Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.

When might chemotherapy be used for esophageal cancer? 

Chemo is part of the treatment for many people with esophageal cancer if they’re healthy enough to tolerate it. It might be used in any of the following situations: 

  • Chemo (with radiation) may be used as the main treatment for some people with early stage esophageal cancer. This may be more likely if you aren’t healthy enough for surgery.

  • People with esophageal cancer that has not yet spread to distant parts of the body may get chemotherapy (often with radiation) before surgery to try to shrink the tumor. This could make the surgery easier. This is called neoadjuvant therapy. Or a person may get chemo after surgery (often with radiation) to help make sure all the cancer cells are killed. This is known as adjuvant chemotherapy.

  • For people with advanced esophageal cancer, chemo is often used to try to shrink the cancer or keep it under control for as long as possible. This can also often help ease symptoms, such as pain.

How is chemotherapy given for esophageal cancer?

Before treatment starts, you will meet with a medical oncologist. This is a doctor who specializes in treating cancer with drugs, such as chemo. The doctor will discuss your treatment options with you and explain what to expect. 

Depending on the specific chemo drugs you’re taking, you may get them in one of these ways: 

  • Intravenous (IV). The drug is given through a small needle that’s been put into a vein. The drug may drip in slowly over several hours, or it may be given more quickly over a few minutes.

  • Oral. You swallow these drugs as pills.

Chemo is often given in an outpatient setting. That means that you get it at a clinic, healthcare provider's office, or hospital, and you can go home after the treatment is given. Less often, you may need to stay in the hospital during treatment. Your healthcare provider will watch you for reactions during your treatments. Chemo treatments may last for a while. So, you may want to take something that is comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

To reduce the damage to healthy cells and to give them a chance to recover, chemo is given in cycles. Each cycle consists of one or more days of treatment, followed by some time to rest. Cycles normally last three or four weeks. Your healthcare provider will discuss your chemotherapy schedule with you.

What chemo drugs are used to treat esophageal cancer?

These are some of the chemo medicines used to treat esophageal cancer:

  • Capecitabine

  • Cisplatin

  • Carboplatin

  • Docetaxel

  • Epirubicin

  • Fluorouracil

  • Irinotecan

  • Oxaliplatin

  • Paclitaxel

  • Vinorelbine

Two or more of these medicines are often combined as the first treatment. Some people may only receive one medicine. These include people who aren’t healthy enough to get two drugs or people who have already gotten chemo for their esophageal cancer.

In some cases, chemo might be combined with a targeted therapy medicine, which works in a different way.

What are common side effects of chemotherapy?

Side effects of chemo are different for everyone. They vary based on the drugs you receive. Below is a list of the some of the most common side effects from chemotherapy. Ask your healthcare provider what side effects to watch for.

Hair loss

If you have hair loss, the hair will often grow back after the treatment stops.

Nausea and vomiting

This side effect can often be controlled with medicines. Ask your healthcare provider about it.

Mouth sores

Chemo can sometimes cause mouth sores. This might make it hard for you to eat or swallow. It's important to keep your mouth very clean and avoid foods and substances that could irritate your mouth.

Diarrhea

If you have diarrhea, take antidiarrheal medicines as prescribed by your healthcare provider. You may also need to make changes in your diet.

Loss of appetite or changes in the way things taste

Talk to your healthcare provider if you find you’re having trouble eating or are losing weight. There are often ways to help.

Increased risk of infection

During your chemo treatments, your white blood cell count may become low. This means your immune system won’t be working as well as it normally does. It’s a good idea for you to avoid people who have illnesses that you could catch. It’s also a good idea to take extra safety measures against cuts and scrapes that could become infected. Your healthcare provider will check your blood counts regularly during your treatment. Let your healthcare provider know if you have any signs of an infection. Symptoms include fever, sore throat, a new cough, or burning during urination.

Bleeding and bruising more easily

Chemo can also lower your blood platelet counts. Platelets are needed to help the blood clot well. 

Fatigue

You may feel tired while getting chemo. This normally goes away once treatment ends. 

Some other side effects can also be seen with certain chemo drugs. For example, cisplatin, carboplatin, and some other drugs can cause  nerve damage (neuropathy ). This can lead to pain, tingling, and numbness in your hands and feet. 

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For example, chemotherapy can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.

Esophageal Cancer: Treatment Choices

There are many treatment choices for esophageal cancer. Which may work best for you? It depends on a number of factors. These include the type, size, location, and stage of your cancer. Factors also include your age, overall health, and what side effects you can stand.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may require a second opinion. In addition, you may want to involve your family and friends in this process.

Understanding the goals of treatment for esophageal cancer

For some esophageal cancers, the goal of treatment is to cure the cancer. If a cure isn’t possible, you may receive treatment to shrink the cancer. Or treatment may keep it under control for as long as possible. Treatment can also improve your quality of life. It does this by helping to control the symptoms of your cancer. The goals of treatment can include the following:

  • Remove or destroy the cancer in the esophagus

  • Remove or destroy tumors in other parts of your body

  • Kill or stop the growth or spread of esophageal cancer cells

  • Prevent or delay the cancer's return

  • Ease symptoms from the cancer. These can include pain or pressure on organs.

Types of treatment for esophageal cancer

Several types of treatment can be used for esophageal cancer. You may receive combinations of treatments. These depend on a number of factors. These can include: 

  • The type and location of the cancer 

  • The stage (extent) of the cancer

  • Your age and overall health

  • Your concerns and preferences

Each treatment has its own goals.

Surgery

This is the most common treatment for early stage esophageal cancer, especially cancer in the lower part of the esophagus. It may cure the cancer if it’s caught in an early stage. Even when cancer can’t be cured, your healthcare provider may suggest surgery to ease your symptoms.

Radiation therapy 

This treatment is often used with chemotherapy, either before or after surgery. Radiation and chemotherapy before surgery can help shrink a tumor. This can make it easier to take out. After surgery, radiation and chemotherapy can try to kill cancer cells that are left. It may also be used as part of the main treatment in people who can't have surgery. Or it may be used to help relieve symptoms in people with advanced cancer.  

Chemotherapy and targeted therapy

For esophageal cancer, chemotherapy is often used with radiation. It may be used before or after surgery. Or it may be part of the treatment for people who can't have surgery. Targeted therapy medicines work differently from standard chemotherapy medicines. Targeted therapy may be useful for some people.

Photodynamic therapy (PDT) and other endoscopic treatments

PDT uses a special light-activated medicine and laser to kill cancer cells. It can be used to treat some very early stage cancers. But it’s most often used to help relieve symptoms, such as trouble swallowing, in people with advanced cancer. Other endoscopic treatments can also be used to help relieve symptoms in advanced cancer. These include using a laser or electric current to destroy cancer cells in your esophagus. 

Supportive care

Your healthcare provider may suggest treatments that help ease your symptoms, but don’t treat the cancer. These can sometimes be used with other treatments. Or your healthcare provider may suggest supportive care if he or she believes that treatments are more likely to cause more harm than good.

Clinical trials for new treatments

Researchers are always looking for new ways to treat esophageal cancer. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare provider

Thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Think about the benefits and side effects of each option. Talk about your concerns with your healthcare provider before making a decision.