Chemotherapy for oesophageal cancer

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1 Chemotherapy for oesophageal cancer This information is an extract from the booklet Understanding oesophageal cancer (cancer of the gullet). You may find the full booklet helpful. We can send you a free copy see page 9. Contents Chemotherapy overview When chemotherapy is given How chemotherapy is given Side effects of chemotherapy Chemotherapy overview Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Cytotoxic means toxic to cells. These drugs disrupt the way cancer cells grow and divide, but they also affect normal cells. When chemotherapy is given Chemotherapy is often given before an operation to remove an oesophageal cancer. This is sometimes called neoadjuvant chemotherapy. It can shrink the tumour, making it easier to remove. If there s a possibility that the cancer has spread somewhere else in the body, giving chemotherapy earlier may increase the chance of controlling it. Chemotherapy can sometimes be given after surgery to reduce the chances of the disease coming back. It works by destroying any cancer cells that might be left behind after the operation. This is called adjuvant chemotherapy. Chemotherapy may also be used if the cancer has spread to other parts of the body. This aims to shrink the tumour to improve symptoms and maintain a good quality of life. Questions about cancer? Ask Macmillan Page 1 of 9

2 This is called palliative chemotherapy. In some people, the chemotherapy will help. For others, the chemotherapy will not shrink the cancer and they will have the side effects of treatment with little benefit. It s important to discuss the benefits and side effects of chemotherapy with your cancer specialist. If you have a cancer that has spread, and you decide that you don t want to have chemotherapy, your doctor can still prescribe medicines to help control symptoms. The drugs used The chemotherapy drugs most commonly used are: fluorouracil (5FU) cisplatin (or sometimes carboplatin is used) epirubicin capecitabine (Xeloda ) paclitaxel (Taxol) oxaliplatin (Eloxatin ). Other chemotherapy drugs may also be used. Usually a combination of two or more drugs is given. A common combination used to treat adenocarcinoma of the oesophagus is the ECF regimen. This contains the drugs epirubicin, cisplatin and 5FU. Capecitabine is a tablet form of 5FU. If this is used instead of 5FU, the combination is known as the ECX regimen. Another combination is called the EOX regimen and uses the drugs epirubicin, oxaliplatin and capecitabine. EOX is sometimes called the EEX regimen. Squamous cell carcinoma of the oesophagus is commonly treated with a combination of cisplatin and 5FU. Page 2 of 9 Questions about cancer? Ask Macmillan

3 How chemotherapy is given You usually have chemotherapy in a chemotherapy day unit. It is given by injection into a vein (intravenously). Chemotherapy can be given through: a cannula a short, thin tube put into a vein in the back of your hand a PICC line a thin tube put into a vein in the crook of your arm a central line a plastic tube put into a vein in your chest. Sometimes chemotherapy is given as tablets. The line is threaded through the vein until the end is near your heart Line comes out here The heart A PICC line Questions about cancer? Ask Macmillan Page 3 of 9

4 1 Central line inserted into chest here 2 Line tunnelled under skin 3 Line comes out here The heart A central line Chemotherapy is usually given during a session of treatment. After each session you ll usually have a rest period of a few weeks. This allows your body to recover from the side effects. The treatment and the rest period make up a cycle of treatment. Your specialist will discuss this with you. The number of cycles you have will depend on how well the cancer responds to the drugs. Sometimes chemotherapy can be given to you continuously through a small portable pump that is attached to your central or PICC line. A controlled amount of the drug can be given into the bloodstream over a period of time. This means that you can go home with the pump and spend less time in hospital. We have more information about chemotherapy drugs and how treatment is given. You can order information from be.macmillan.org.uk or call our support line on Page 4 of 9 Questions about cancer? Ask Macmillan

5 Side effects of chemotherapy Chemotherapy drugs may cause unpleasant side effects, but these can usually be well controlled with medicines and will usually go away once treatment has finished. Not all drugs cause the same side effects and some people may have very few. You can talk to your doctor or nurse about what to expect from the treatment that s planned for you. The main side effects are described here, as well as some ways to reduce or control them. Risk of infection Chemotherapy can reduce the number of white blood cells, which help fight infection. If the number of your white blood cells is low you ll be more prone to infections. A low white blood cell count is called neutropenia. Always contact the hospital immediately on the 24-hour contact number you ve been given and speak to a nurse or doctor if: you develop a high temperature this may be over 37.5 C (99.5 F) or over 38 C (100.4 F) depending on the hospital s policy. Follow the advice that you have been given by your chemotherapy team you suddenly feel unwell, even with a normal temperature you feel shivery and shaky you have any symptoms of an infection such as a cold, sore throat, cough, passing urine frequently (urine infection), or diarrhoea. If necessary, you ll be given antibiotics to treat any infection. You ll have a blood test before each cycle of chemotherapy to make sure your white blood cells have recovered. Occasionally, your treatment may need to be delayed if the number of your white blood cells is still low. Anaemia (reduced number of red blood cells) Chemotherapy may reduce the number of red bloods cells (haemoglobin) in your blood. A low level of red blood cells is known as anaemia, which can make you feel very tired and lethargic. You may also become breathless. Anaemia can be treated with blood tranfusions. This should help you to feel more energetic and ease the breathlessness. Questions about cancer? Ask Macmillan Page 5 of 9

6 Bruising and bleeding Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. If you develop any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin, contact your doctor or the hospital straightaway. Tiredness (fatigue) You re likely to become tired and have to take things slowly. Try to pace yourself and save your energy for things that you want to do or that need doing. Balance rest with some physical activity even going for short walks will help increase your energy levels. Feeling sick Some chemotherapy drugs can make you feel sick (nauseated) or possibly be sick (vomit). Your cancer specialist will prescribe anti-sickness (anti-emetic) drugs to prevent this. Let your doctor or nurse know if your anti-sickness drugs are not helping, as there are several different types you can take. I had a few side effects, nausea and sickness mainly, which didn t help with eating and drinking to keep your strength up. But on good days, I did manage a skydive, and a trip to Greece. Elizabeth Loss of appetite Some people lose their appetite while they re having chemotherapy. This can be mild and may only last a few days. If you don t feel like eating during treatment, talk to your dietitian. They can give you advice to help you boost your intake and maintain your weight. Page 6 of 9 Questions about cancer? Ask Macmillan

7 Sore mouth Your mouth may become sore or dry, or you may notice small ulcers during treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. Taste changes You may find that your sense of taste changes, or that the texture of food seems different. This may be due to the cancer, or it can be a temporary change following cancer treatment. You may no longer enjoy certain foods, or find that all foods taste the same. Some people having chemotherapy notice a metallic taste in their mouth. Others find that food has no taste at all. Hair loss Some chemotherapy drugs may cause hair loss. Some people may have complete hair loss including eyelashes and eyebrows. Others may only experience partial hair loss or thinning. It depends on what chemotherapy drugs you are having (your doctor or nurse can tell you more about what to expect). If you do experience hair loss your hair should start to grow back within about 3 6 months of the end of treatment. It may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss and how to look after your scalp. Effects on the nerves Some chemotherapy drugs can affect the nerves in your hands or feet. This can cause tingling or numbness, a sensation of pins and needles or muscle weakness (called peripheral neuropathy). It s important to let your doctor know if this happens. They may need to change the chemotherapy drug if it gets worse. Usually, peripheral neuropathy gradually gets better when chemotherapy is over but sometimes it s permanent. Questions about cancer? Ask Macmillan Page 7 of 9

8 Diarrhoea Some chemotherapy drugs can cause diarrhoea. This often starts several days after treatment. If you re taking chemotherapy tablets or capsules at home, it s important to let your doctor or nurse know if you have diarrhoea as your treatment may need to be interrupted. Medicine can be prescribed to help. It s important to drink plenty of fluids if you have diarrhoea. Sore hands and feet This is sometimes known as palmar-plantar, or hand-foot, syndrome. It s usually temporary and improves when the treatment is finished. Your doctor may prescribe creams or a vitamin called pyridoxine (vitamin B6), which some people find helpful. It can also help to keep your hands and feet cool, and to avoid tight-fitting clothing, such as socks, shoes and gloves. Increased risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it s important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information about blood clots. Changes in the way the heart works Some chemotherapy drugs can affect the way the heart works. You may have tests to see how well your heart is working before, during and sometimes after treatment. If you have pain or tightness in your chest, feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions but it s important to get them checked by a doctor. Page 8 of 9 Questions about cancer? Ask Macmillan

9 We have more information about the side effects above and how to cope with them. Call us to order more booklets. There are also videos about many side effects at macmillan.org.uk/cancerinformationvideos More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding oesophageal cancer (cancer of the gullet) or any other cancer information, visit be.macmillan.org.uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN FEBRUARY 2015 Planned review in 2017 Questions about cancer? Ask Macmillan Page 9 of 9

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