Esophageal Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses strong medicines to kill cancer cells. These medicines attack and kill cells that grow quickly, like cancer cells. But 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? 

Chemotherapy (chemo) is part of the treatment for many people with esophageal cancer if they’re healthy enough to get it. It's often given at the same time as radiation therapy. This is called chemoradiation. It might be used in these cases: 

• To try to shrink cancer before surgery. Chemo (with radiation) may help shrink a tumor and make it easier to remove. It might also help lower the chance that the cancer will come back later. This is called neoadjuvant therapy.

• To try to kill any cancer cells left after surgery. Chemo can be used after surgery to kill any cancer cells that may be left in the body. This is called adjuvant therapy.

• To ease symptoms. Chemo is often used to try to shrink the tumors that have spread to other organs and ease problems they're causing, like pain or bleeding. Even when chemo can't cure esophageal cancer, it can help keep it under control so that the person can live longer.

How is chemotherapy given for esophageal cancer?

Before treatment starts, you will meet with a medical oncologist. This healthcare provider specializes in treating cancer with medicines, such as chemo. The provider will discuss your treatment choices with you and explain what to expect. 

Depending on which chemo medicines you’re taking, you may get them in one of these ways: 

• IV (intravenous). The medicine is put right into your blood through a small tube (called a catheter) that’s put into a vein. The medicine goes in slowly, over several hours. This is the most common way to get chemo for esophageal cancer.

• Oral. You swallow these medicines as pills.

IV chemo is often given in an outpatient setting. That means that you get it at a clinic, healthcare provider's office, or hospital infusion center, and you can go home after treatment. In rare cases, 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 bring something that's comforting to you, like 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 3 or 4 weeks. Your healthcare provider will discuss your chemo schedule with you so you know what to expect.

What chemo medicines are used to treat esophageal cancer?

These are some of the chemo medicines used to treat esophageal cancer:

• Capecitabine

• Cisplatin

• Carboplatin

• Docetaxel

• Epirubicin

• Fluorouracil

• Irinotecan

• Oxaliplatin

• Paclitaxel

Two or more of these medicines are often combined as the first treatment. Some people may only get one medicine. These include people who aren’t healthy enough to get two medicines. Or people who have already gotten chemo for esophageal cancer.

Sometimes chemo is combined with a targeted therapy medicine, such as trastuzumab or ramucirumab, which work in a different way.

What are common side effects of chemotherapy?

Side effects of chemo are different for everyone. They vary based on the medicines you get and the dose. They tend to be worse if chemo is given along with radiation. Below is a list of the most common side effects from chemo. Ask your healthcare provider what side effects to watch for and when to report them. Ask your healthcare team what steps you can take to manage or prevent side effects.

Hair loss

Hair grows back after treatment stops.

Nausea and vomiting

This side effect can often be controlled with medicines. Ask your healthcare provider about it.

Mouth sores

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 not have any foods and substances that could irritate your mouth.

Bowel problems

If you have diarrhea, take antidiarrheal medicines as prescribed by your healthcare provider. You may also need to make changes in your diet.

Constipation can be caused by being less active, not eating or drinking fluids, and by some kinds of chemo or pain medicines. Talk with your provider about what you can do to keep constipation from happening.

Loss of appetite or changes in the way things taste

Talk with your healthcare provider if you find you’re having trouble eating or are losing weight. You can also ask to see a dietitian. There are often ways to help.

Increased risk for 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. Try to not be around 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 treatment. Let your healthcare provider know if you have any signs of an infection. Symptoms include fever, chills, sore throat, a new cough, or burning during urination.

Bleeding and bruising more easily

Chemo can lower your blood platelet counts. Platelets are needed to help the blood clot well. 

Tiredness (fatigue)

You may feel very tired while getting chemo. This gets better over time after treatment ends. 

Medicine-specific side effects

Some side effects are linked with certain chemo medicines. For instance, cisplatin, oxaliplatin, paclitaxel and some other medicines can cause nerve damage (peripheral neuropathy). This can lead to pain, tingling, and numbness in your hands and feet. Irinotecan can cause severe diarrhea. Capecitabine or fluorouracil can cause hand-foot syndrome. This is redness, pain and sensitivity on your hands and feet that can progress to blistering or sores. Be sure you know what to expect from the chemo medicines you're taking.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work, how to take them, and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For instance, chemotherapy can make you more likely to get infections, which may need to be treated to keep them from getting worse. 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.