Chemotherapy for Esophageal Cancer

Chemotherapy (chemo) is treatment with anti-cancer drugs.

How is chemotherapy given?

The main way chemo is given for esophageal cancer is called systemic chemotherapy. The drugs are injected into your vein or you take them by mouth. These drugs enter your bloodstream and reach most areas of your body.

Doctors give chemo in cycles, with each period of treatment followed by a period of rest to give the body time to recover. Chemotherapy cycles generally last about 2 to 4 weeks, and people usually get at least several cycles of treatment.

When is chemotherapy used for esophageal cancer?

Chemo may be used at different times during treatment for esophageal cancer.

  • Adjuvant chemo: Chemo can be given after surgery. The goal is to kill any cancer cells that may have been left behind during surgery because they were too small to see, as well as cancer cells that might have escaped from the main tumor and settled in other parts of the body (but are too small to see on imaging tests).
  • Neoadjuvant chemo: For some cancers, chemo is given (often with radiation) before surgery to try to shrink the cancer and make surgery easier.
  • Chemo for advanced cancers: For cancers that have spread to other organs, such as the liver, chemo can also be used to help shrink tumors and relieve symptoms. Although it is not likely to cure the cancer, it often helps people live longer.

Chemo by itself rarely cures esophageal cancer. It is often given together with radiation therapy (called chemoradiation or chemoradiotherapy). Chemoradiation is often used before surgery. This can lower the chance of the cancer coming back and 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.

Drugs used to treat esophageal cancer

Some common drugs and drug combinations used to treat esophageal cancer include:

  • 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)
  • Oxaliplatin and either 5-FU or capecitabine
  • Irinotecan (Camptosar)
  • Trifluridine and tipiracil (Lonsurf), a combination drug in pill form

For some esophagus cancers, chemo may be used along with the targeted drug trastuzumab (Herceptin) or ramucirumab (Cyramza). For more information on these drugs, see Targeted Therapy for Esophageal Cancer.

Possible side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells, 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 or constipation
  • Low blood counts
  • Increased chance of infection (from having too few white blood cells)
  • Easy bleeding or bruising (from having too few blood platelets)
  • Fatigue (from having too few red blood cells)

Along with these, some side effects are specific to certain drugs. For example:

  • Hand-foot syndrome. During treatment with capecitabine or 5-FU (when given as an infusion), this can start out as redness in the hands and feet, and then progress to pain and sensitivity in the palms and soles. If it worsens, blistering or skin peeling can occur, sometimes leading to painful sores. It’s important to tell your doctor right away about any early symptoms, such as redness or sensitivity, so that steps can be taken to keep things from getting worse.
  • Neuropathy (nerve damage). This is a common side effect of oxaliplatin, cisplatin, docetaxel, and paclitaxel. Symptoms include numbness, tingling, and even pain in the hands and feet. Oxaliplatin can also cause intense sensitivity to cold in the throat and esophagus (the tube connecting the throat to the stomach) and the palms of the hands. This can cause problems swallowing liquids or holding a cold glass. If you will be getting oxaliplatin, talk with your doctor about side effects beforehand, and let him or her know right away if you develop numbness and tingling or other side effects.
  • Allergic or sensitivity reactions. Some people can have reactions while getting the drug oxaliplatin. Symptoms can include skin rash, chest tightness and trouble breathing, back pain, or feeling dizzy, lightheaded, or weak. Be sure to tell your nurse right away if you notice any of these symptoms while you are getting chemo.
  • Diarrhea. This is a common side effect with many of these drugs, but can be particularly bad with irinotecan. It needs to be treated right away — at the first loose stool — to prevent severe dehydration. This often means taking drugs like loperamide (Imodium). If you are on a chemo drug that is likely to cause diarrhea, your doctor will give you instructions on what drugs to take and how often to take them to control this symptom.

Most of these side effects tend to go away after treatment is finished. Some, such as hand and foot numbness, may last for a long time. There are often ways to lessen these side effects. For example, you can be given drugs to help prevent or reduce nausea and vomiting.

Be sure to discuss any questions about side effects with your cancer care team, and report any side effects or changes you notice while getting chemo so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.

People with esophageal cancer have often already lost weight before the cancer was found. Treatments 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 lets liquid nutrition 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. Less often, the tube is placed into the stomach instead. This is known as a gastrostomy tube or G-tube.

For more information about chemo, see Chemotherapy.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: June 14, 2017 Last Revised: February 27, 2019

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