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Oesophageal Cancer

Understanding treatment for oesophageal cancer and how it is delivered

Last modified: February 28, 2022

What are the treatment options for oesophageal cancer? Treatment options

The treatment options for oesophageal cancer may include surgery, radiation therapy, chemotherapy, immunotherapy and targeted therapies. The type of treatment you receive will depend on several different considerations, such as the type of oesophageal cancer you have and its stage, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how oesophageal cancer treatment works in the private health system.

Types of oesophageal cancer treatmentTypes of treatment

Surgery

Radiation therapy

Chemotherapy

Targeted therapy

Immunotherapy

Clinical trials

Surgery for oesophageal cancerSurgery

Surgery is commonly performed for people with oesophageal cancer to remove cancerous tissue and reduce the risk of the cancer returning. Surgery is typically a treatment option for early-stage oesophageal cancer that has not spread beyond the oesophagus and may be combined with other treatments for more advanced cancer. Typically at least 15 lymph nodes will be removed during surgery and looked at under the microscope. This helps to inform whether further treatment such as chemotherapy or radiation therapy will be required.

There are a number of different surgeries you may receive depending on the size and stage of your cancer and its location within the oesophagus.

Endoscopic resection

An endoscopic resection is a procedure which involves an endoscope. This is passed down the throat to remove small cancerous tumours in the lining of the oesophageal wall called the mucosa. It is a treatment option for very early-stage oesophageal cancer which has not grown deeply into the oesophageal wall.

Oesophagectomy

An oesophagectomy is a surgical procedure which involves removing the cancerous tissue and part or all of the oesophagus. The type of surgery performed will depend on the size and stage of the cancer and where it is located within the oesophagus.

The two approaches for oesophagectomy, performed under general anaesthesia, include:

Open oesophagectomy – Where a long incision is made in the neck, chest and/or abdomen
Laparoscopic oesophagectomy – Where several small incisions are made to access the oesophagus

Oesophagogastrectomy

An oesophagogastrectomy is a surgical procedure which involves removing part or of all of your oesophagus, nearby lymph nodes and often a small part of the upper stomach. The remaining stomach is then connected to the upper oesophagus and partly pulled into the chest or neck, helping you to swallow.

Radiation therapy for oesophageal cancer Radiation therapy

Radiation therapy uses highly targeted radiation to destroy oesophageal cancer cells and can be delivered internally or externally, before or after surgery. Radiation therapy for oesophageal cancer can be used in a number of ways:

Before surgery – With chemotherapy to help shrink the size of the oesophageal cancer cells before surgery or for people unable to have surgery
Radiation alone – To help relieve symptoms such as trouble swallowing or pain. Occasionally radiation will be used on its own if chemotherapy is not considered safe or feasible
After surgery – To help destroy any remaining oesophageal cancer cells and prevent them from spreading and growing elsewhere

External beam radiation therapy (EBRT)

Oesophageal cancer patients who have radiation therapy will usually receive external beam radiation therapy (EBRT). External beam radiation therapy is used to treat oesophageal cancer by delivering highly targeted radiation therapy beams to the oesophagus and other areas where cancerous cells have been detected

Intensity modulated radiation therapy (IMRT) – The most common type of EBRT treatment for oesophageal cancer is intensity modulated radiation therapy. This is a radiation therapy technique that uses 3D mapped images of your oesophageal cancer to deliver high dose radiation while limiting the impact on healthy surrounding tissue

Internal radiation therapy

Advanced oesophageal cancer patients may receive a special form of internal radiation therapy known as brachytherapy, where a radioactive source is placed beside or inside a tumour in the oesophagus to deliver radiation to small areas over a period of time

Chemotherapy for oesophageal cancerChemotherapy

Chemotherapy uses a range of drugs to kill and slow the growth of oesophageal cancer cells. These drugs may be delivered at any stage of your oesophageal cancer treatment, from shrinking large tumours before surgery to destroying potential remaining cancer cells after surgery. Chemotherapy plays an important part in reducing the risk of your oesophageal cancer returning in both the oesophagus and the rest of the body.

Chemotherapy may be delivered:

Before surgery (neoadjuvant chemotherapy) – To help reduce the size of a large tumour and kill and slow the growth of oesophageal cancer cells that may have spread
After surgery (adjuvant chemotherapy) – To help reduce the risk of oesophageal cancer returning
On its own (palliative chemotherapy) – When the cancer cannot be cured and treatment is intended to shrink the tumour or slow its growth

Learn more about chemotherapy and how it is delivered.

Chemotherapy treatment for oesophageal cancer takes place over several sessions, given every one to three weeks depending on the type of chemotherapy drugs used. This is known as a cycle. Your care team will walk you through how many cycles you may need for your course of treatment, with most people completing chemotherapy in a period of three to six months.

Common chemotherapy medicines

There are a number of different chemotherapy drugs that are used to treat oesophageal cancer. These drugs are typically combined based on factors such as the type of cancer you have, your cancer’s size and how much it has spread. Some chemotherapy drugs include:

Capecitabine and oxaliplatin

These chemotherapy drugs may be given in combination every 21 days over eight cycles and are typically used after surgery as adjuvant therapy to help destroy any remaining cancer cells. Oxaliplatin is given by intravenous infusion over a period of two hours and capecitabine given orally as a tablet twice daily for 14 days.

5-fluorouracil and cisplatin

These drugs can be given in combination as a cycle every 28 days as chemoradiation. The cisplatin is given by intravenous infusion, while 5-flourouracil is usually given intravenously over four days via an infusion pump at home. This combination can also be used for the treatment of advanced (metastatic) oesophageal cancer.

Carboplatin and paclitaxel

This combination may be given as chemoradiation by intravenous infusion every seven days as a weekly cycle for five weeks.

Cisplatin and capecitabine

These chemotherapy drugs are given in combination as chemoradiation every 28 days for four cycles, with the first two cycles given on the same day as radiation therapy. The cisplatin is usually given as an intravenous infusion into the vein over 30 minutes, and the carboplatin is given orally as a tablet twice daily.

Fluorouracil, leucovorin and oxaliplatin (FOLFOX6)

This combination is typically given in combination as a cycle every 14 days for six weeks, with the first three cycles given together with radiation therapy. They are given by intravenous infusion with the fluorouracil delivered through an intravenous infusion pump at home over 46 hours.

Fluorouracil, leucovorin and irinotecan (FOLFIRI)

This combination is used to treat advanced (metastatic) oesophageal cancer every 14 days. It is given by intravenous infusion, with the fluorouracil infusion continued as an infusion pump at home over 46 hours.

Targeted therapies for oesophageal cancerTargeted therapies

Targeted therapies use specialised drugs to destroy specific proteins in oesophageal cancer cells. Targeted therapies are often combined with chemotherapy for advanced oesophageal cancers or those that don’t respond to treatment.

Common targeted therapy medicines

Common types of targeted therapy drugs used to treat oesophageal cancer include:

Trastuzumab

This is a type of monoclonal antibody that works by blocking a protein known as HER2 (human epidermal growth factor receptor 2) which stimulates the growth of cancer cells. Blocking the HER2 protein helps to prevent cancer cells from growing and spreading. This is used to treat advanced (metastatic) oesophageal cancers which are HER2 positive. It is typically given by intravenous infusion over 30 to 90 minutes, usually in combination with other chemotherapy drugs.

Ramucirumab

This is used to treat advanced (metastatic) oesophageal cancer which has not responded to other chemotherapy drugs. It targets a protein receptor called VEGF and works by preventing the supply of blood vessels that provide nutrients to cancer cells. It is usually given as an intravenous infusion every 14 days, with each infusion given over 60 minutes.

Immunotherapy for oesophageal cancerImmunotherapy

Immunotherapy uses your immune system to slow the growth of oesophageal cancer cells and destroy existing cancer cells. You may receive immunotherapy if your oesophageal cancer is advanced, has come back or has spread to other areas of the body. Some patients may receive immunotherapy after surgery to eradicate any cancer cells that may be left behind.

A common type of immunotherapy treatment for advanced oesophageal cancer are checkpoint inhibitors. These drugs help the immune system to respond more strongly to a tumour by releasing ‘brakes’ that keep T cells (a type of white blood cell and part of the immune system) from destroying oesophageal cancer cells.

Common checkpoint inhibitor medicines

Checkpoint inhibitor immunotherapy drugs that are commonly used to treat oesophageal cancer include:

Nivolumab

This is a monoclonal antibody which binds to a protein receptor called PD-1 (which is present on the surface of immune system T cells). Blocking the PD-1 receptor activates your immune system, supporting it to target and destroy cancer cells. It may be used as alone to treat advanced (metastatic) or recurrent oesophageal cancer when surgery is not possible or after initial treatment with other chemotherapy drugs. It is given by intravenous infusion every 28 days, with each infusion typically given over 30 minutes.

Clinical trials for oesophageal cancer

Icon offers a wide range of clinical trials providing patients with access to new and evolving treatments. Clinical trials offer hope and opportunity and contribute to breakthroughs in treatment for future cancer patients.

See current oesophageal cancer clinical trials delivered by Icon Cancer Centre.

Treatment by stage of oesophageal cancerTreatment by stage

When you are diagnosed with oesophageal cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer.

Common treatment options for each stage of oesophageal cancer include:

Early oesophageal cancer (Stage 0 and Stage I)

In Stage 0 oesophageal cancer, the cancer is only located in the top layer of the oesophageal lining (epithelium) and has not spread to deeper layers of the oesophagus. Surgery by endoscopic resection will usually be recommended to remove these cancerous cells. For Stage I oesophageal cancer, you may receive chemotherapy and radiation therapy before surgery to help shrink the cancer cells or after surgery to destroy any remaining cancer. Surgery by endoscopic resection or an oesophagectomy may be recommended to remove the cancerous tissue and part or all of the oesophagus. The amount of oesophagus that is removed will depend on the size of your cancer and where it is located within the oesophagus.Following surgery, some people will receive chemoradiation if the cancer could not be fully removed, if the cancer is located in the upper part of the oesophagus or to reduce the risk of their cancer returning.
Locally advanced oesophageal cancer (Stage II and Stage III)

Locally advanced oesophageal cancer requires a combination of treatments, which usually begins with surgery and chemotherapy. The chemotherapy may be given before surgery to help shrink the cancer, while you may receive immunotherapy after surgery to destroy any remaining cancer.
Metastatic or advanced oesophageal cancer (Stage IV)

In Stage IV oesophageal cancer, common treatments include chemotherapy, targeted therapy or immunotherapy. Radiation therapy may also be used for metastatic oesophageal cancer to help reduce symptoms caused by oesophageal tumours (such as pain or obstruction).

ReferencesReferences

For a full list of references, click here.

Cancer Council. (2021). Understanding Stomach and Oesophageal cancers. Retrieved on 20 December 2021 from https://www.cancercouncil.com.au/wp-content/uploads/2021/11/Understanding-Stomach-and-Oesophageal-Cancers-2021.pdf
Cancer Council (2021). Surgery for oesophageal cancer. Retrieved on 20 December 2021 from https://www.cancercouncil.com.au/oesophageal-cancer/treatment/surgery/
American Cancer Society (2020). Surgery for esophageal cancer. Retrieved on 20 December 2021 from https://www.cancer.org/cancer/esophagus-cancer/treating/surgery.html
Mayo Clinic (2020). Esophageal cancer – diagnosis & treatment. Retrieved on 20 December 2021 from https://www.mayoclinic.org/diseases-conditions/esophageal-cancer/diagnosis-treatment/drc-20356090
American Cancer Society (2020). Chemotherapy for esophageal cancer. Retrieved on 20 December 2021 from https://www.cancer.org/cancer/esophagus-cancer/treating/chemotherapy.html
American Cancer Society (2020). Radiation therapy for esophageal cancer. Retrieved on 20 December 2021 from https://www.cancer.org/cancer/esophagus-cancer/treating/radiation.html
American Cancer Society (2020). Targeted drug therapy for esophageal cancer. Retrieved on 20 December 2021 from https://www.cancer.org/cancer/esophagus-cancer/treating/targeted-therapy.html
Cancer Council NSW (2021). Immunotherapy for oesophageal cancer. Retrieved on 20 December 2021 from https://www.cancercouncil.com.au/oesophageal-cancer/treatment/immunotherapy/
American Cancer Society (2020). Treating esophageal cancer by stage. Retrieved on 21 December 2021 from https://www.cancer.org/cancer/esophagus-cancer/treating/by-stage.html
Cancer Institute NSW. EviQ. Medical Oncology. Gastric and Oesophageal Cancer. Retrieved on 1 February, 2022 from https://www.eviq.org.au/medical-oncology/upper-gastrointestinal/gastric-and-oesophageal
ESMO European Society of Medical Oncology Patient Guides. Oesophageal Cancer: A Guide for Patients. Retrieved on 2 February 2022 from https://www.esmo.org/for-patients/patient-guides/oesophageal-cancer
For Esophageal Cancer, Immunotherapy Likely to Play Larger Role (2020). National Cancer Institute. Retrieved on 2 February 2022 from https://www.cancer.gov/news-events/cancer-currents-blog/2020/esophageal-cancer-immunotherapy-pembrolizumab-nivolumab
American Cancer Society (2021). Targeted Drug Therapy for Stomach Cancer. Retrieved on 2 February 2022 from https://www.cancer.org/cancer/stomach-cancer/treating/targeted-therapies.html

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