Chemotherapy (chemo) involves the use of drugs that are given through a vein or by mouth. 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, chemotherapy may be given as a main (primary) treatment. It can also be given before surgery to shrink the cancer and make it easier to remove. This is called neoadjuvant treatment. Chemo is also sometimes given after the cancer has been removed completely at surgery. This is called adjuvant chemo, and is meant to kill any tiny deposits of tumor cells too small to see that may have been left behind.

Chemotherapy by itself rarely cures esophageal cancer. Often it is combined with radiation therapy and/or surgery.

Chemotherapy may be given by itself before surgery as a way to reduce the tumor size. This may make it easier to remove the tumor completely.

Chemo 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 and surgery may help people live longer than using surgery alone. In some cases, chemoradiation may be used as the only treatment - without surgery. This may be a good choice for patients who cannot have surgery due to other major health problems. This may also be an option for patients who could have surgery. Some studies have shown that chemoradiation may be as effective as surgery as the main treatment. Chemoradiation can also be given after surgery. This approach also seems to help people live longer than surgery alone.

Chemo may also be used alone or with radiation to help control symptoms, such as pain or trouble swallowing. This is called palliative treatment.

The chemotherapy drugs often used to treat esophageal cancer include 5-fluorouracil (5-FU), capecitibine (Xeloda), cisplatin, carboplatin, oxaloplatin, doxorubicin (Adriamycin), epirubicin. Bleomycin, mitomycin, methotrexate, paclitaxel (Taxol), vinorelbine (Navelbine), topotecan, and irinotecan (Camptosar, CPT-11) have also been used. 5-FU, either alone or with cisplatin, is the drug most often used with radiation.

Chemotherapy drugs kill cancer cells but can also damage some normal cells, leading to some 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
• loss of hair
• mouth sores.
• low blood counts

Low blood counts result from the effect of chemo on the blood-producing cells of the bone marrow. This can result in:

• 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)

Certain drugs have their own specific side effects. For example, 5-FU often causes diarrhea. Cisplatin can cause nerve and kidney damage. Doxorubicin and epirubicin both can cause heart damage, if enough of the drug is given. Although most side effects improve once treatment is stopped, 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. If you have side effects, let you health care team know so they can be treated. There are ways to prevent and treat many of the side effects of chemotherapy. For example, many good drugs are available to prevent and treat nausea and vomiting.

People with esophageal cancer often had problems with weight loss 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. Some people with esophageal cancer need to have a feeding tube placed before treatment. This allows liquid nutrition to be put directly into the intestine. A feeding tube can help prevent further weight loss and improve nutrition. It may help make treatment easier to tolerate.

Last Medical Review: 05/04/2009
Last Revised: 05/13/2009