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Chemotherapy treatment


You might have chemotherapy before or after surgery for oesophageal cancer.  Common chemotherapy drugs for oesophageal cancer are fluorouracil, capecitabine, cisplatin, epirubicin and docetaxel. You usually have a combination of 2 or 3 of these drugs.

This page is about chemotherapy for oesophageal cancer that hasn’t spread to another part of the body.

When you have it

You’re likely to have chemotherapy before surgery if you have stage 2 or stage 3 cancer. You don’t usually need chemotherapy for stage 1 oesophageal cancer.

Your treatment plan depends on whether you have squamous cell cancer or adenocarcinoma.

For squamous cell cancer you usually have chemotherapy combined with radiotherapy (chemoradiotherapy). You either have it before surgery, or you can have chemoradiotherapy as your only treatment.

For adenocarcinoma, you either have chemotherapy or chemoradiotherapy before surgery. Or you might have chemotherapy before and after surgery.

Chemotherapy before surgery is called neoadjuvant chemotherapy. Chemotherapy before and after surgery is called peri operative chemotherapy.

These treatments aim to:

  • reduce the size of the cancer so it’s easier for the surgeon to remove
  • lower the risk of the cancer coming back

You might also have chemotherapy if your cancer has spread to another part of your body (advanced oesophageal cancer).

How often do you have it?

You usually have chemotherapy every 2 or 3 weeks depending on what drugs you have. Each 2 or 3 week period is called a cycle. You might have between 2 and 8 cycles of chemotherapy.  This depends on what chemotherapy you have, and what other treatment you're having. 

Types of Chemotherapy

Usually you have a combination of 2 or 3 drugs. The most common drugs are:

  • fluorouracil (5FU) or capecitabine (Xeloda)
  • cisplatin, oxaliplatin or carboplatin
  • paclitaxel or docetaxel
  • epirubicin

Common combinations include:

  • cisplatin and capecitabine (CX)
  • cisplatin and fluorouracil (CF)
  • epirubicin, cisplatin and capecitabine (ECX)
  • epirubicin, cisplatin and fluorouracil (ECF)
  • epirubicin, oxaliplatin and capecitabine (EOX)
  • carboplatin and paclitaxel
  • fluorouracil, oxalipatin and docetaxel (FLOT)

How you have it

You have most of the chemotherapy drugs for oesophageal cancer into your bloodstream (intravenously). Capecitabine is a tablet.

Into your blood stream


Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

Diagram showing a central line




You should take the right dose, not more or less.


Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.



Before you start chemotherapy

COVID swab test

Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.

To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.

At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.

This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.

Check with your team about when you’ll have the test as there are some differences between hospitals.

Blood tests


Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.

Before your first chemotherapy, your doctor will explain what drugs you need, how you have them, and what the side effects are. You’ll sign a consent form. This is a good time to ask any questions you might have.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. You should have a test before you start this treatment to check if you have a DPD deficiency. 

Some people have severe side effects from capecitabine or fluorouracil even if they don't have low DPD levels. Contact your doctor or nurse if your side effects are severe.

When you're at home

Last reviewed: 
09 Oct 2019
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    Published January 2018

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    Ann Oncol. 2016 27 Suppl 6: v50-v57

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    The Lancet Vol 390, November 25th 2017

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    Nature Reviews Disease Primers Volume 3: 17048 (2018)