Understanding Esophageal Cancer: Chemotherapy
Chemotherapy treatment (usually called “chemo”) is the use of drugs that prevent cancer cells from growing and spreading. Chemotherapy medicines either destroy cancer cells altogether or stop them from dividing. Chemo affects your whole body because it goes through your bloodstream. Chemo doesn’t refer to one treatment but many, because there are lots of different chemotherapy medicines.
When is chemotherapy used?
Chemo can be used in several ways:
- As the main treatment
- Before surgery to shrink the cancer and make it easier to remove. (This called neoadjuvant treatment.)
- After the cancer has been removed by surgery. (This is called adjuvant treatment.) This treatment is used to try to kill any tumor cells that were too small to be seen and may have been left behind.
- Alone or with radiation to help control symptoms like pain or trouble swallowing when the cancer can't be cured. (This is called palliative treatment.)
Chemo by itself rarely cures esophageal cancer. Often it is combined with radiation or surgery.
When given alone, chemo is given in a higher dose designed to kill off cancer cells. When given along with radiation therapy, it is delivered at a lower dose. This is designed to make the cancer more sensitive to the radiation.
Chemotherapy is usually given by vein, but some forms can be given by mouth. Your medical oncologist will tell you how many cycles or courses of chemotherapy are best for you.
The number of cycles of chemotherapy needed vary. It is relatively common for chemo treatment to begin 4 to 6 weeks after surgery and recovery.
Different oncologists used different schedules. The type of chemo drug being used is another factor. You may also want to ask your doctor if you are a good candidate for chemotherapy research trials.
What can I expect from chemotherapy?
Chemotherapy not only weakens and destroys cancer cells at the site of the tumor, but throughout the body as well. Unfortunately, this means that chemo can unintentionally harm the development of normal cells like your hair, nails, mouth, and digestive tract.
The side effects chemo causes depend on the type of chemotherapy you receive and how many cycles you receive. The most common side effects of chemo are:
- Nausea and vomiting
- Fatigue or tiredness
- Confusion, forgetfulness (“chemo brain”)
- Decreased blood counts, sometimes with bruising, bleeding, or infection
- Sores inside your mouth
- Numbness in your hands and feet
- Diarrhea, loose stool
- Increased urgency to have a bowel movement or urinate
When chemotherapy is given at a lower dose, these side effects are less common. This sometimes happens when radiation is necessary too. If you experience side effects, call your physician right away. It is better to address side effects right away, and there are numerous drugs available to help manage side effects.
Most side effects go away once treatment is over. Anyone who has problems with side effects should talk with their doctor or nurse as there are often ways to help.
People with esophageal cancer often have trouble eating and problems with weight loss before the cancer is even found. Chemo and can cause painful sores in the mouth and throat, which can make it even harder to eat and get good nutrition. Some people with esophagus cancer need to have a feeding tube put in during a minor operation before treatment. This allows liquid "food" to be put right into the intestine. A feeding tube can help prevent further weight loss. It may help make it easier to get through treatment.
How is chemotherapy given?
Chemo medicines come in different forms and can be given in different ways:
- Intravenously (IV): As an infusion, the medicine comes through a thin needle (IV) in a vein in your hand or lower arm. An oncology nurse will insert the needle before each infusion and take it out afterwards.
- Injection: As a single shot into a muscle in your leg, arm, hip, or under the skin in the fatty part of your stomach, leg or arm.
- By mouth: As a pill or capsule. You may take this yourself at home.
- Through a port: This is inserted in your chest during a short outpatient surgery. It is about the size of a quarter and sit right under your skin. A port is a small disc made of plastic or metal. A catheter (soft thin tube) connects the port to a large vein. The chemo medicines are delivered through a thin needle right into the port. You can also get your blood drawn through the port. Once you have finished chemo, the port is removed in a brief outpatient procedure.
- Through a catheter in your chest or arm. This is a soft thin tube that is inserted into a large vein. This is done in a short outpatient surgery. The other end of the catheter stays outside your body. This is similar to having a port.
If you have a catheter or port, your medical team will tell you signs of infection to look for.
What’s the advantage to a port or catheter?
Many doctors recommend getting a catheter or port. It makes chemotherapy easier and more comfortable each time, as you don’t have to be restuck each time, like with an IV or injection. Some esophageal cancer patients have a portable pump attached to the port or catheter. This controls how much and how fast the chemotherapy medicine goes in. The pump can either be internal (implanted under the skin during a short outpatient procedure) or external (carried with you). Once your rounds of chemo are done, the pump is taken out.
How often will I receive chemotherapy?
Your oncologist will set your treatment regimen. Every chemo regimen is made up of cycles. This means a period of treatment followed by a period of recovery. For example, you may get chemo one day and then have a few weeks of recovery with no treatment. That would be one cycle. Or you may get chemo for several days in a row and then have a recovery period. Several cycles make up a complete chemotherapy regimen.
The number of cycles in a regimen and the length of each regimen vary from patient to patient. A lot depends on the medicines used. However, most regimens take 3 to 6 months to complete. A typical routine is treatment every 3 weeks.
You can get chemotherapy in a variety of settings: at a hospital, in a doctor’s office, or in a clinic. You may even get chemo at home if you are taking chemo in a pill form or you have a portable pump.
If you take chemo in a clinic, hospital or doctor’s office, you usually go home between treatments. In some cases, you may stay in the hospital to be monitored. This is especially true if your immune system isn’t working as well as it should be. Your doctor will explain where you’ll be getting your treatment.
What should I bring to my chemotherapy appointment?
A chemotherapy treatment at a hospital or clinic can take anywhere from one to several hours. Although many chemo treatment areas have televisions and magazines, you may want to bring something to help pass the time. Ideas include:
- A laptop
- Knitting, needlepoint or crochet
- A thick novel
- Crossword or other puzzle book
- Coloring book
- Sketchbook and pencils
- Cards or board games (if you have someone to play with)
- Music and headphones
- Paper and pens to keep a journal or write letters
Is there anything I should do before I start chemotherapy?
Chemotherapy treatment can drain most of your energy. This is a major process your body is going through. There are some things you should take care of before you start chemo:
- Get your teeth cleaned and get a dental check-up. Chemo weakens your immune system, so you may be more vulnerable to infections caused by bacteria that are dislodged during teeth cleaning.
- Get any heart tests (like an EKG) that your doctor recommends.
- If you’re a woman, get a Pap smear, if you’re overdue. Chemo can alter the results of your Pap smear, so get one beforehand.
- Find someone to help around the house. Chemo causes extreme fatigue. Line up someone to help with your daily chores: cleaning, grocery shopping, carpooling, and cooking to name a few. Don’t be too proud or stoic to ask for help. Friends and family members will be happy to do something that helps you during this treatment phase. Ask yourself: wouldn’t you be willing to do it for someone else?
- Join a support group if that sounds helpful.
- Find out ahead of time what you should and shouldn’t eat or drink on treatment days.
- Tell your doctor all the vitamins, supplements, over-the-counter and prescription medicines you take.
- Talk to your doctor about hair loss. Most chemo medicines cause some amount of hair loss. If you plan on wearing a wig, you might want to go ahead and get it so you can match it to your hair color and style.