Oesophageal Cancer
Oesophageal cancer is a disease of the oesophagus or “gullet” starting just below the voice box to the junction of the stomach and oesophagus.
Due to the large length of the oesophagus, cancers are usually designated as cervical (low part of neck), upper thoracic or lower thoracic oesophageal cancers.
There are 2 main types of Oesophageal Cancer:
- Squamous cell carcinomas typically occur in the middle or upper thirds of the oesophagus.
- Adenocarcinomas commonly occur in the lower oesophagus or where the oesophagus meets the stomach.
Overall oesophageal cancer is relatively rare with about 1300 new cases being diagnosed in Australia each year. The rate is gradually increasing, particularly for adenocarcinomas.
Radiation Therapy and Oesophageal cancer
The best person to talk to about radiation therapy for skin cancer is a radiation oncologist. You can ask your doctor for a referral to a radiation oncologist to learn if radiation therapy is an option for you.
The Treatment Team
Radiation oncologists (specialist doctors) make a treatment plan for each person based on the:
- type of oesophageal cancer
- where the cancer is
- what other treatments have been tried
- the person’s health.
Treatment can include surgery, radiation therapy and drug therapy (immunotherapy or chemotherapy).
The type of treatment a person gets is worked out by a team of doctors and health professionals often called a Multidisciplinary Team.
A highly trained radiation oncology team takes care of people having radiation therapy. This includes radiation oncologists, radiation therapists, medical physicists and radiation oncology nurses.
Role of Radiation Therapy in Oesophageal Cancer
Treatments for oesophageal cancer are different depending on where the cancer is situated and whether it is early stage or advanced stage (has spread to somewhere else).
Early stage oesophageal cancers are usually managed with surgery often when very shallow.
For advanced (later) stages of oesophageal cancer, radiation therapy and chemotherapy are often used before surgery which is done afterwards. Combination therapy can make side effects of the treatment worse. If surgery is not able to be done (for example patient is not well enough), radiation therapy with or without chemotherapy is used to cure the cancer.
Cervical oesophagus (lower part of neck): Radiation therapy and chemotherapy given together is the main treatment used to cure the cancer due to the risks and complications of operations performed in this area. The use of radiation therapy and chemotherapy is more common because surgery in this area is often not possible.
Thoracic oesophagus: Treatment depends on whether surgery is possible. Removal of part of the oesophagus and lymph nodes can be considered. Chemotherapy and radiation therapy are often given to make the size of the cancer smaller before surgery.
A feeding tube may be needed for a short time before chemotherapy and radiation therapy are started, depending on the patient’s nutritional condition.
Types of Radiation Therapy used in Oesophageal Cancer
External Beam Radiation Therapy (EBRT) is the most common type of radiation therapy used in oesophageal cancer. A machine called a linear accelerator (or LINAC) is used to deliver external beam radiation therapy.
Radiation oncologists often use Volumetric Arc Therapy (VMAT) or Stereotactic Radiosurgery (SRS) which are advanced types of external beam radiation therapy, to carefully deliver radiation to the areas that need to be treated.
While having radiation treatment, the patient lies flat & still on the treatment couch. The machine moves around the patient, usually at a distance. A mask may be needed if treating the neck region, to help the patient stay still.
Radiation treatment is given once a day, 5 days a week from Monday to Friday. The length of treatment can vary, and may be up to 5 weeks. Your radiation oncologist will help decide this.
General Information About Side Effects of Radiation Treatment
Radiation therapy is more effective with fewer side effects than ever before.
Recent advances mean radiation oncologists can effectively treat the cancer while getting less radiation on healthy body parts. This means much fewer side effects.
Side effects from radiation therapy vary between people, even for those having the same treatment.
While some people feel no side effects, some feel mild side effects, such as tiredness or skin redness during and/or just after treatment. These usually get better within a few weeks.
The treatment team will offer advice and medicine to help with side effects.
Serious side effects that start later (months to years after the radiation therapy) are rare.
Before starting treatment, your radiation oncologist will talk to you about side effects and answer your questions.
The side effects of radiation treatment can be split into 2 groups:
- Early side effects which occur during and shortly after radiation treatment.
- Late side effects which can occur months to years after radiation treatment.
For more information, go to the Potential Side Effects page.
Early Side Effects of Radiation Therapy for Oesophageal Cancer
General – Fatigue is common in the second half of treatment and is very variable between patients. Fatigue may persist for several weeks after treatment.
Local – All other sided effects of radiation therapy come from the structures/organs in and just next to where the radiation is being targeted.
Nausea – occurs in some patients and depends on the type of chemotherapy being used with the radiation therapy.
Discomfort & difficulty swallowing – many patients develop discomfort while swallowing foods and occasionally a feeding tube may be required to help improve nutrition during treatment.
Skin reddening and irritation – may occur, particularly on the back
Inflammation of the lung (pneumonitis) – some patients may develop this, which can present with shortness of breath or coughing several weeks after the end of radiation therapy but this depends on the amount of lung in the radiation field.
If a patient is having an operation after radiation therapy there is a slight increased risk of breakdown of the join between the oesophagus and stomach.
What can help reduce acute side effects?
Resting as needed can help with fatigue. During treatment your Radiation Oncology team will provide advice on creams based on the degree of your skin reaction, dietitian advice to help with swallowing, and if pain or discomfort occurs, pain medications can be prescribed.
Late Side Effects of Radiation Therapy for Oesophageal Cancer
Late side effects vary between people and can happen a few months to a few years after treatment.
These side effects may never occur, occur once, continue over time, or come and go.
Narrowing of the oesophagus – the risk of this is variable, and may need to be managed with a endoscopic procedure (camera down the osephagus, under sedation) to help stretch the oesophagus.
Radiation induced cancers – Any exposure to radiation increases the risk of a second cancer developing in that area, usually decades later. This risk is not entirely attributable to radiation received as part of your treatment. All X-rays and scans received over your lifetime contribute to this risk, as does unavoidable exposure to environmental radiation. The risk of a cancer being caused by radiation therapy is in the order of 0.5 – 1% at 10 years.
Your Radiation Oncologist will explain if any extra late side effects are relevant to you based on what area of the body is being treated.
Other Useful Resources Oesophageal Cancer
Find additional information about cancer types, research groups, and support groups.
Radiation Oncologist
The best person to talk to is a radiation oncologist. You can ask your doctor for a referral to find out if radiation treatment is right for you.
GPs and Health Professionals
Information for any health professional involved in a patient's cancer care with a particular focus on primary care providers.
Talking to Your Doctor
Your GP or other doctors in the cancer team can organise a referral to a radiation oncologist.
Treatment Centres
Search and find your closest Radiation Oncology Treatment Centre.
