Chemotherapy uses cytotoxic drugs to destroy cancer. "Cytotoxic" means toxic for the cells. These drugs do not only alter the way in which cancer cells grow and divide, but they may also affect normal cells.

When is chemotherapy administered?

Chemotherapy is often given before surgery to eliminate esophageal cancer (neoadjuvant chemotherapy). The size of the tumor can be reduced so that it can be removed more easily. If there is any chance that the cancer has spread to another place in the body, administering chemotherapy increases the likelihood of it being controlled.

In other situations, it is given after surgery to reduce the chance of the disease coming back; this is because chemotherapy destroys any cancer cells that may have remained after the operation (adjuvant chemotherapy).

Chemotherapy can also be used if the cancer has spread to other parts of the body. The aim of this is to reduce the size of the tumor so as to improve the symptoms and maintain a good quality of life (palliative chemotherapy).

If you have cancer that has spread and decide not to have chemotherapy, your doctor can prescribe other drugs to help you control the symptoms.

It is important to talk about the benefits and side effects of chemotherapy with your cancer specialist.

The drugs used

The most commonly used chemotherapy drugs for this type of cancer are:

  • fluorouracil (5FU)
  • cisplatin (carboplatin is sometimes used)
  • epirubicin
  • capecitabine
  • paclitaxel
  • oxaliplatin

Other chemotherapy drugs can also be used.

Normally, a combination of two or more drugs is given. A commonly used combination to treat adenocarcinoma of the esophagus of the ECF regimen, which contains epirubicin, cisplatin, and 5FU.

Capecitabine is an oral for of 5FU. If used in place of 5FU, the combination is knows as the ECX regimen.

Another combination is the EOX regimen, which uses epirubicin, oxaliplatin, and capecitabine.

Squamous cell carcinoma of the esophagus is commonly treated with a combination of cisplatin and 5FU.

How is the chemotherapy administered?

Chemotherapy is usually given in the day hospital through an injection in a vein (intravenous) through:

  • A fine, thin tube inserted into one of the veins in your hand or arm.
  • A PICC line: a thin plastic tube placed in a vein on the interior part of your arm.
  • A central line: a plastic tube placed in a vein in your chest.

Sometimes, chemotherapy is given in tablet form.

Chemotherapy is usually given during as part of a treatment session. After each session, you will normally have a period of rest lasting for a few weeks. This lets your body recover from the side effects.

The treatment and rest period make up one treatment cycle. Your specialist will talk to you about how many cycles you are going to have.

Sometimes, chemotherapy can be given continuously through a small portable pump connected to your line or PICC line. A controlled amount of medication is delivered to the blood stream over a period of time. This means you can take the pump home and spend less time in the hospital.