Chemotherapy is a treatment using drugs that are taken to destroy cancer cells (cytotoxic) within the body.  They can be used at various stages of treatment.  The treatment is aimed to reduce the size of the cancer to either shrink the tumour prior to surgery or to improve the chances of survival.

If chemotherapy is considered for the treatment of advanced and incurable cancer then a combination of three drugs: Epirubicin, Oxaliplatin and Capecitabine (EOX) is the current standard for incurable disease. In a small number of cases the cancer will be suitable for treatment with Trastuzumab (Herceptin), best known for its role in breast cancer treatment.  Oesophageal tumours are now routinely tested to see whether Herceptin is likely to work.

Squamous cell cancer of the oesophagus often responds well to a combination of chemotherapy and radiotherapy (chemoradiotherapy).

Patients whose tumours have advanced beyond the oesophageal lining (mucosa) and/or have evidence of cancer in local lymph glands and are fit enough to undergo aggressive treatment are considered for pre-operation (neo-adjuvant) therapies following by surgery.  Several large clinical trials conducted in the UK, Europe and the USA have proven that this strategy of giving anti-cancer treatment before surgery offers the best chance of long-term survival and cure.  Uncertainty remains regarding whether this pre-operative treatment should be chemotherapy alone or chemotherapy and radiotherapy together. 

Unfortunately, the survival benefit of neoadjuvant therapy in oesophageal cancer is limited to only about 20% of patients, at the expense of the many who derive no benefit at all, and who may be harmed by over-treatment. Several international research groups including Professor Underwoods from Southampton, are primarily focused on identifying which patients and which tumours will respond best to specific treatment, with the ultimate goal of providing personalised cancer care.