Future treatments

Major national and international trials are studying the effect of chemotherapy (or combined chemotherapy and radiotherapy), given either before or with surgery, compared to surgical treatment alone. The patient’s specialist will determine exactly which variety of treatment is needed and it will be some time before it is known which patients benefit most from these various treatment methods. A new approach to treatment is the use of photodynamic therapy (PDT), which involves giving the patient a special chemical which enters the cancer cells and is sensitive to certain light wavelengths. When light is passed into the oesophagus using a probe, it activates the chemical which then destroys the cancer. This remains an experimental treatment, currently being investigated in trials.

Prevention of oesophageal cancer

Patients with Barrett’s Oesophagus (as explained earlier in the leaflet), are at increased risk of developing adenocarcinoma of the oesophagus. To try to prevent cancer developing, these patients are required to undergo endoscopic surveillance (inspection of the oesophagus through an endoscope) every one to two years in an attempt to pick up pre-cancerous changes, known as dysplasia, and prevent progression to cancer. A number of trials of endoscopic surveillance in Barrett’s Oesophagus are still underway, and it is not known for certain how effective different patterns of surveillance are likely to be.

Chemoprevention (preventing cancer by using drugs) is an exciting new idea in the prevention of oesophageal cancer, and trials are currently underway to determine whether drugs, such as aspirin giving in conjunction with an acid suppressing agent, are capable of preventing the development of cancer of the oesophagus.

Summary points

The earliest symptom of cancer of the oesophagus is likely to be difficulty in swallowing food, and prompt consultation with a GP and early investigation are important if a cure is to be achieved.

Treatment of cancer of the oesophagus generally involves a surgical operation to remove the affected part of the oesophagus, and this may be combined with radiotherapy or chemotherapy.

When a cure is not possible, a number of treatments are available to relieve symptoms.

Research is in progress into ways of preventing cancer of the oesophagus, by picking up early pre-cancerous changes or by giving medications which prevent the development of cancer.