Chemotherapy for oesophageal or gastric cancer

What is chemotherapy?

Chemotherapy works by preventing cancer cells from replicating.

The drugs which are commonly used in oesophageal and gastric cancer are:

In oesophageal and gastric cancer, chemotherapy drugs in combination are often given before surgery (neoadjuvant treatment). The most common combination is FLOT (Flourouracil, Leucovorin, Oxaliplatin and Docetaxel)
The aim of giving chemotherapy before surgery is to reduce the size of the tumour and to eliminate any cancer cells which may have escaped from the main tumour site.

Depending on the results from the surgery and patient recovery, further chemotherapy is often given after the surgery as well (adjuvant chemotherapy).

How long does it take?

Chemotherapy before surgery usually involves 3-4 “cycles” of treatment. Each cycle takes about 2-3 weeks. Depending on your blood tests there may be a break between cycles. After completion of chemotherapy there is a period of 6-8 weeks before the surgery to allow the immune system to recover, during which time more scans are performed.

Where is treatment given?

The chemotherapy will be overseen by a consultant oncologist. We will try to ensure your treatment is in a convenient location and will help you find a consultant.

How will I know if it is working?

Patients often report an improvement in their symptoms after the first cycle of treatment. For example, in oesophageal cancer, a patient’s ability to swallow may get better with treatment. This is a good sign and suggests a response to the chemotherapy.

After completion of treatment, a CT scan will be performed to assess the response. This will determine whether surgery of further chemotherapy is required.

Can I work during treatment?

The effects of chemotherapy are extremely variable. Many patients do continue to work during treatment. It is important to stay physically active during chemotherapy. Exercise has been shown to have numerous benefits in patients having cancer treatment and also reduces the risks of surgery.

What are the side effects?

Unfortunately, healthy cells also take up chemotherapy drugs. These healthy cells can usually repair themselves and the effects stop once the treatment has finished.

The side-effects of treatment include:

What happens if I stop treatment?

Some patients tolerate chemotherapy poorly. If this happens then an early reassessment will be performed and a decision will be made on the next appropriate course of treatment.