Your doctors will tell you about the risks, benefits and unwanted side-effects of the treatments being offered, and how they may affect your life afterwards.

When you understand what the options are, you will need to agree to the treatment. This is called giving your consent. Don't be afraid to ask questions if there is anything you don't understand.

The choice of treatment depends on the results of the tests you have undergone. The team that treats patients who have just had a diagnosis of cancer discuss your case in detail. All of the specialists who are involved in your diagnosis and treatment should be present. They decide on the best treatment for you. This depends on:

• the position of the cancer
  
   
• its size and how far the cancer may have spread (stage)
  
   
• whether the lymph nodes are involved
  
   
• your general health
  
   
• your age
  
   
• your wishes.

Your consultant and the specialist nurse will discuss the options with you. You will be able to ask any questions you have. The options include:

Surgery

The most common operation is to remove the affected part (sometimes all) of the oesophagus. The surgery involves bringing the stomach into the chest and attaching it to the oesophagus that remains. Chemotherapy may be advised before surgery to reduce the size of the tumour (see neo adjuvant chemotherapy described below).

Removing the oesophagus is a major operation. The anaesthetist may review your fitness for major surgery before a final decision is made to recommend an operation.

After this surgery, smaller amounts of food can be managed, as the stomach is smaller than before. This makes it necessary to eat more often than before

Radiotherapy

Radiotherapy uses radiation to kill cancer cells. Radiation can be given from inside or outside the body. You may have either type of treatment, or both.

When given from outside the body it is called external beam radiotherapy. A machine directs high energy X-rays at the cancer. Your treatment will be carefully planned. This first aspect of your radiotherapy may require several visits to see a radiotherapist.

The treatment is given each day Monday to Friday. The total treatment time may vary. It could last two weeks or less. It may last four to five weeks.

Depending on where your cancer is in the oesophagus, external radiotherapy will be directed at a part of your chest or neck while you lie on a couch beneath the radiotherapy machine. Doctors will plan your treatment carefully so that normal tissue can be avoided as much as possible. This will help to keep the unwanted side-effects to a minimum.

The treatment will only take a few minutes, and you will be left alone in the room. You will need to lie very still.

Radical chemotherapy/radiotherapy

You may be offered chemotherapy and radiotherapy together. The two treatments given together can reduce the size of the cancer and give a better result than one of the treatments alone.

Your doctor will explain in detail how the unwanted side-effects of chemotherapy and radiotherapy can be limited and controlled.

Internal radiotherapy (brachytherapy)

Brachytherapy is the name given to internal radiotherapy. It may also be called intraluminal radiotherapy.

The treatment lasts several hours. You will be admitted for an overnight stay in hospital. During the time you are in the treatment area you will not be able to have visitors with you.

An endoscope is positioned close to the tumour in the oesophagus, and radioactive wires are placed near to the cells that need to be treated. This lasts five or 10 minutes.

Internal radiotherapy is given from the centre of the cancerous area outwards. The cancer receives a lot of radiation, but only a very small amount reaches other, normal parts of your body.

Once the wires have been removed, you will no longer have a radioactive source inside you, and you are no longer radioactive. Relatives and friends will be able to visit you after the treatment is over.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. You may be given chemotherapy before surgery, with the aim of making the surgery more successful.

The drugs are given by an injection into a vein. This may be into a small arm vein or through a Hickman line, which is a tube placed into the vein in the chest. Usually this is the vein which lies just under your collar bone. Part of the tube runs just under the skin in a 'tunnel' to reach the vein. The Hickman line can stay in place for weeks or months if necessary

Chemotherapy may be used alone as the main treatment if your cancer has spread, or if an operation is not possible.

Neo adjuvant chemotherapy

This is a treatment you may receive before your surgery. It is a course of chemotherapy. If you are offered this treatment, it means that it would be difficult to safely remove all of the cancer in an operation. There is concern that any tissue or cancer cells left behind after surgery would continue to cause problems in the future.

The aim of this treatment is to reduce the size of the cancer before surgery and to start treating the cancer cells that have spread elsewhere as soon as possible.

Laser treatment

A camera is passed into the oesophagus, in the same way as for an endoscopy. A special fibre is passed down the endoscope. This fibre is connected to a machine that sends a laser beam down the fibre. The laser beam is aimed at the cancerous areas that are narrowing your oesophagus. It heats the area up and burns away the unwanted cells and tissue.

Stenting

A tube may be placed in the oesophagus, through the site of the narrowing, to hold it open. It will enable food and fluids to be swallowed and keep a passageway open between your mouth and stomach.

You may be offered chemotherapy or radiotherapy after stenting.