Oesophageal cancer affects the gullet, the tube that connects the throat to the stomach. There are 2 main types of oesophageal cancer - squamous cell carcinoma (SCC) and adenocarcinoma (AC). The diagnosis is determined by taking a sample, usually through an endoscope (a thin flexible tube with a camera, inserted in to the oesophagus). The extent of disease will also be assessed by either CT or PET-CT scan.
When oesophageal cancer is diagnosed at a very early stage, it may be treated with surgery alone. More frequently, the primary tumour extends deeper into the oesophageal wall, or cancer cells have spread to the local lymph nodes. In these situations, additional treatment may be needed.
SCC localized to the oesophagus and local lymph nodes is very sensitive to radiotherapy and therefore the curative treatment approach would be radiotherapy and chemotherapy given at approximately the same time. Treatment is given over 5 to 5.5 weeks. Chemotherapy is commonly given as a combination of 2 infusions and continuous tablets for the duration of the radiotherapy.
If an oesophageal cancer planned for radiotherapy is in the lower oesophagus, near the diaphragm, movement of the tumour with breathing can be significant. At Precision Oncology UK, we therefore use 4-dimensional CT (4D-CT) radiotherapy treatment planning to compensate for any movement during breathing. A 4D-CT scan provides additional information on the range of tumour movement throughout the breathing cycle. With this information we shape an individualised radiotherapy field to the motion of the tumour. This will minimize radiation dose to nearby organs and thereby side-effects to lung, heart, liver, bowel and stomach. All radiotherapy treatments are delivered using Volumetric Arc Radiotherapy (VMAT - see information on this website
Treatment for AC is often with surgery. However, in many cases we would recommend chemotherapy before and after surgery, or an alternative approach, combining radiotherapy with chemotherapy over 4.5 weeks before surgery. These additional treatments have been proven to increase the chance of cure and a successful operation compared to surgery alone. We may also recommend radiotherapy with chemotherapy as the primary treatment for AC for patients who are not fit or are otherwise unsuitable to undergo an operation.
When you meet us at Precision Oncology UK, we will discuss your individualized oncology treatment plan and will provide additional information on possible side effects. We will also direct you to websites providing useful information.
In clinic, the Precision Oncology Consultant will provide a thorough consultation and fully explain the treatment procedure, the benefits and any potential side effects or risks. All cases are discussed with the Multi-disciplinary Team, with whom we work closely to ensure you have easily accessible support during and after your treatment.