Chemotherapy for cancer of the esophagus

Chemotherapy (chemo) uses drugs that are given through a vein or by mouth to treat cancer. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread. Depending on the type and stage of esophageal cancer, chemo may be given:

• As part of the main (primary) treatment, along with radiation therapy.
• Before surgery (usually along with radiation therapy) to try to shrink the cancer and make it easier to remove. This is called neoadjuvant treatment.
• After the cancer has been removed by surgery (usually along with radiation therapy) to try to kill any small areas of tumor cells that may have been left behind. This is known as adjuvant treatment.
• Alone or with radiation to help control symptoms like pain or trouble swallowing when the cancer can't be cured. This is called palliative treatment.

Chemo by itself rarely cures esophageal cancer. It is often given together with radiation therapy. This combination (called chemoradiation or chemoradiotherapy) can be useful for large tumors that couldn't be removed otherwise. It can shrink the tumor enough for surgery to be an option.

Chemoradiation is also often used before surgery for smaller tumors. Using chemoradiation before surgery can help people live longer than using surgery alone. Chemoradiation is also sometimes given after surgery, but it isn’t clear that it is as helpful as giving it before surgery.

In some cases, chemoradiation may be used as the only treatment. This may be a good choice for patients who cannot have surgery because they have other major health problems. This may also be an option for some patients who could have surgery.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each chemo cycle typically lasts for a few weeks.

Many different chemo drugs can be used to treat esophageal cancer. Common regimens are:

• Carboplatin and paclitaxel (Taxol^®) (which may be combined with radiation)
• Cisplatin and 5-fluorouracil (5-FU) (often combined with radiation)
• ECF: epirubicin (Ellence^®), cisplatin, and 5-FU (especially for gastroesophageal junction tumors)
• DCF: docetaxel (Taxotere^®), cisplatin, and 5-FU
• Cisplatin with capecitabine (Xeloda^®)

Other chemo drugs that have been used to treat cancer of the esophagus include oxaliplatin, doxorubicin (Adriamycin^®), bleomycin, mitomycin, methotrexate, vinorelbine (Navelbine^®), topotecan, and irinotecan (Camptosar^®).

For some esophagus cancers, chemo may be used along with the targeted drug trastuzumab (Herceptin^®). For more information on this drug, see "Targeted therapy for cancer of the esophagus."

Possible side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects. Side effects depend on the specific drugs used, their dose, and the length of treatment. Common side effects of chemo include:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Mouth sores
• Diarrhea
• Low blood counts

Chemo often affects the blood forming cells of the bone marrow, which can lead to low blood counts, and:

• An increased chance of infection (because of a shortage of white blood cells)
• Problems with bleeding or bruising (due to a shortage of blood platelets)
• Fatigue or shortness of breath (due to low red blood cell counts)

Along with the risks above, some chemo drugs can cause other, less common side effects. For example, cisplatin, docetaxel, and paclitaxel can cause nerve damage. This can lead to problems with numbness, tingling, or pain in the hands and feet. Cisplatin can also cause hearing loss and kidney damage. Doxorubicin and epirubicin both can cause heart damage if enough of the drug is given.

Most side effects improve once treatment is stopped, but some can last a long time or even be permanent. If your doctor plans treatment with chemo you should be sure to discuss the drugs that will be used and the possible side effects. Let your health care team know if you have side effects, so they can be treated. There are ways to prevent and treat many of the side effects of chemo. For example, many good drugs are available to help prevent or treat nausea and vomiting.

People with esophageal cancer have often already lost weight before the cancer was found. Treatment such as chemo, radiation, and chemoradiation can cause painful sores in the mouth and throat. These can make it hard to eat well enough to get good nutrition, making weight loss worse. Some people with esophageal cancer may need to have a feeding tube, usually called a jejunostomy tube (or J-tube), put in place before treatment. This is done through a small hole in the skin over the abdomen during a minor operation. A J-tube allows liquid nutrition to be put directly into the small intestine to prevent further weight loss and improve nutrition. This can make treatment easier to tolerate. Feeding tubes can easily be removed when they are no longer needed.