Chemotherapy for oesophageal cancer

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of the cells. Chemotherapy drugs that are commonly used to treat oesophageal cancer are fluorouracil (also known as 5FU), cisplatin and epirubicin. These drugs may be given together and are known as the ECF regimen.

A tablet form of 5FU called capecitabine (Xeloda®) is sometimes used in place of the intravenous (drip) 5FU. The combination is then known as the ECX regimen.

When it is given

If you are able to have surgery to remove your oesophageal cancer, chemotherapy is often given before the operation to help to reduce the chance of the cancer coming back. It may also be given if your doctors think that the tumour is too large to be removed by surgery, as the chemotherapy can sometimes shrink the cancer and make it easier to remove. Chemotherapy given before an operation is known as neo-adjuvant chemotherapy.

Chemotherapy may also be given after surgery if it was not possible to remove all of the tumour during the operation, or if there is a high risk that it may come back. Chemotherapy given after surgery is known as adjuvant therapy.

Chemotherapy is sometimes given alongside radiotherapy (known as chemoradiation). It is mainly used for squamous cell cancer (but can be used for adenocarcinoma too). Giving chemotherapy at the same time as radiotherapy may improve the effectiveness of radiotherapy. However, giving the two treatments at the same time also increases the side effects.

If the cancer has spread to other parts of the body, chemotherapy may be used as the main treatment. This aims to shrink the tumour, improving symptoms and extending good-quality life. In some people the chemotherapy will achieve this. Unfortunately, for other people the chemotherapy will not shrink the cancer and they will have the side effects of the treatment with little benefit.

It is helpful to discuss with your cancer specialist the benefits and side effects of chemotherapy in your particular situation. If you have a cancer that has spread, and you decide that you do not want to have chemotherapy, your doctor can still prescribe medicines that may help to control symptoms caused by the cancer.

How it is given

Before any chemotherapy is prescribed, you may need to have a test to check how well your kidneys are working (kidney function). This is because the dose of one of the chemotherapy drugs is decided according to your kidney function. This may involve just a blood test or you may be asked to collect all of your urine for 24 hours and to give a blood sample.

You may be asked to attend the hospital for an EDTA test, which is a specialised test that measures kidney function. An EDTA (ethylene diamine tetraacetic acid) test involves giving you an injection of a mildly radioactive liquid and taking two blood samples.

It is usual for chemotherapy treatment to consist of a combination of two or more drugs. These are often given by injection into a vein in your arm (intravenously). It may mean staying in hospital for a few days, or you may be able to be treated as a day patient. The treatment is generally repeated every three weeks, but in the three week interval while you are at home, one of the drugs – fluorouracil or 5FU – may be given continuously through a fine plastic tube (called a central line) put into a vein in your chest.

The central line is either stitched or taped firmly to your chest, and can be kept in the vein for many months. Sometimes, a tube may be put into a vein in the crook of your elbow instead of into the chest. This is known as a PICC line (peripherally inserted central catheter).

A small pump can be attached to the central line or PICC line to allow a continuous dose of one of the chemotherapy drugs to be given day and night, while you are at home. The pump can be carried round in a small bag, that is worn around the waist or over the shoulder.

Most of the chemotherapy drugs for oesophageal cancer are given by injection into a vein in your arm (intravenously) or through a central line or PICC line. Research is now in progress using a tablet called capecitabine (also known as Xeloda®), instead of giving fluorouracil through the central line.

Side effects

Chemotherapy drugs may cause unpleasant side effects, but these can usually be well controlled with medicines. Not all drugs cause the same side effects and some people may have very few side effects. Your doctor will tell you about any problems that your treatment may cause.

Lowered resistance to infection

While the drugs are acting on the cancer cells in your body, they also temporarily reduce the number of normal white cells in your blood. When these cells are reduced, you are more likely to get an infection and you may tire easily. Your blood will be tested regularly during chemotherapy and, if necessary, you may be given antibiotics to treat any infection.

If your temperature goes above 38°C (100.5°F), or you suddenly feel unwell, even with a normal temperature, you may have an infection. Contact your chemotherapy nurse or doctor at the hospital straight away.

Anaemia

If the level of red blood cells (haemoglobin) in your blood is low you will probably feel very tiredbreathless. These are all symptoms of anaemia – a lack of haemoglobin in the blood. and lethargic. You may also become

Anaemia can be very successfully treated by blood transfusions. These should help you to feel more energetic and ease the breathlessness.

Bruising and bleeding

Platelets are a type of blood cell which help to clot the blood. If the number of platelets in your blood is low you will bruise very easily and may bleed heavily from even minor cuts or grazes. If you develop any unexplained bruising or bleeding, contact your doctor or the hospital immediately.

Our information on platelet transfusions explains this in more detail.

Feeling sick

Some of the drugs used to treat oesophageal cancer can make you feel, or be, sick (nausea and vomiting) , but there are very effective anti-sickness drugs (anti-emetics) to prevent this. It is helpful to avoid eating immediately before and after your chemotherapy. If the sickness is not controlled or continues, even with anti-sickness treatment, let your doctor know. They can prescribe other medicines that may be more effective.

Tiredness

Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during treatment, but many find they have to take things much more slowly. Tiredness can build up over a course of treatment, and if you have a lot of chemotherapy, it can last for several months or more after your treatment has finished. It is best to cope with tiredness by planning ahead. Try to fit in rest periods and don’t do things that you don’t need to do. Accept help from others when you need to. There may be times when you feel less tired. A little activity can sometimes help with the symptoms of fatigue.

Sore mouth and loss of appetite

Some chemotherapy drugs can make your mouth sore and cause small ulcers. It is important to rinse your mouth regularly to keep it clean. Using a child’s soft toothbrush can be helpful. If you don't feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet.

Our section on eating well provides useful tips on coping with eating problems. Our information on mouth care during chemotherapy and diet in this section may be helpful.

Hair loss

Unfortunately, some chemotherapy drugs will make your hair fall out. If you lose your hair it will start to grow back within three to six months of finishing your treatment. People who lose their hair often cover up by wearing wigs, bandanas, hats or scarves. If you are being treated as an inpatient, or you are on income support, you can get a free wig from the NHS. If not, you can still get a subsidised wig from the hospital. Ask the team looking after you if a wig specialist is available to visit you. If your hair falls out it is important to protect your scalp from the sun.

Numbness or tingling in hands or feet

This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms. This problem usually improves slowly over a few months after the treatment is over

Diarrhoea

Some of the chemotherapy drugs used to treat oesophageal cancer can cause diarrhoea. This often starts several days after the chemotherapy. If you are taking chemotherapy tablets at home it is important to tell your doctor if you have diarrhoea more than 4–6 times a day, as your treatment may need to be stopped.

Your doctor can give you medicine to help slow down and stop the diarrhoea. It may help to follow a low-fibre diet if you can. It is important to drink plenty of fluids if you have diarrhoea.

Sore hands and feet

Soreness of the palms of the hands or soles of the feet can occur when 5FU or capecitabine are given over a long period of time, or when they are given continuously through a pump. It is known as palmar-plantar syndrome. A vitamin can be prescribed to help control this side effect and simple moisturising creams can often help to relieve symptoms.

Chemotherapy affects people in different ways. Some find they are able to lead a fairly normal life during their treatment, but many find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.

Our section on chemotherapy discusses this treatment and its side effects in more detail.

Via: http://www.cancerbackup.org.uk