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:
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.
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.
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.
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.
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.
March 21, 2017
Systemic Therapy for Locally Advanced Unresectable and Metastatic Esophageal and Gastric Cancer. UpToDate.
Alteri, Rick, MD,Gersten, Todd, MD