Most patients with early and mid-stage esophageal cancer can be operated on, but patients with advanced disease often lose the opportunity for surgery, and chemotherapy becomes the primary type of treatment.
Does chemotherapy always prolong life?
Most patients with esophageal cancer in China have squamous cancer, which is less sensitive to chemotherapy than radiotherapy, but chemotherapy is still one of the powerful treatments. If you are well enough to tolerate it, then systemic chemotherapy is recommended.
There is no standard first-line chemotherapy regimen for esophageal squamous carcinoma, and platinum- and fluorouracil-based agents are currently used.
In the practice of Peking University Cancer Hospital, for example, cisplatin combined with paclitaxel as the first-line chemotherapy regimen for advanced esophageal squamous carcinoma was 48.6% effective, with an average overall survival time of about 13 months. This means that about half of the patients have a better response to chemotherapy and their survival time can be extended by six months or even longer. In contrast, the natural course of advanced squamous esophageal cancer is only 6 to 8 months, and the 5-year survival rate is about 5% to 7%.
How can I tell if I can have chemotherapy?
It is important to note that not all patients are candidates for systemic chemotherapy. Before chemotherapy, your doctor will evaluate both the tumor and your health. Once squamous esophageal cancer is clearly identified by histopathology or cytology testing, further imaging, such as CT, is needed to assess the extent of tumor invasion, the presence of distant metastases and metastatic sites, etc., to determine treatment goals.
These imaging studies also serve as “baseline tests” before treatment to facilitate post-treatment comparison and long-term follow-up.
Before treatment, your doctor usually uses the Eastern Cooperative Oncology Group s (ECOG) scales to assess your general condition and to refine blood work, liver and kidney function, and electrocardiogram results.
- Patients with an ECOG score of 0 to 1 and no significant abnormalities in various organ functions usually tolerate standard doses of chemotherapy and most adverse effects are within acceptable limits.
- Patients with an ECOG score of 2 need to be evaluated by a clinician to determine whether to administer chemotherapy and the dose of chemotherapy after a comprehensive status assessment.
- Patients with an ECOG score of 3 and above are no longer recommended for chemotherapy because of their poor general status, and optimal supportive therapy with adequate rest, nutrition, psychological guidance, and management of complications is recommended.
If you have a combination of active gastrointestinal bleeding, gastrointestinal obstruction, gastrointestinal perforation, or uncontrolled cardiopulmonary disease, chemotherapy may exacerbate the pre-existing disease or complications, and it is recommended that the pre-existing disease be corrected first or that you be seen in a relevant specialty for further evaluation and management of your medical condition.
How can I tell if chemotherapy is working? What happens if it doesn’t work?
If the tumor is sensitive to chemotherapy, then you will gradually feel a range of symptoms improve with the medication, such as reduced symptoms like dysphagia and pain, improved eating, weight gain, and a significantly better quality of life.
It is worth stating that not all patients will benefit from chemotherapy. Therefore, during chemotherapy, your doctor will set up a review schedule for you according to your chemotherapy cycle. You will need to follow this plan and review your imaging regularly (usually every 6 weeks) to assess the effectiveness of your treatment.
If the tumor is still growing at the first efficacy evaluation, it is a rare “primary chemoresistant” tumor, which means it is very insensitive to chemotherapy, has a high degree of malignancy, and has a relatively short survival. In this case, chemotherapy should be stopped and a new direction of treatment, such as radiotherapy or immunotherapy, should be actively sought as soon as possible.
At present, immunotherapy approaches for esophageal cancer are not approved in China and are still in preclinical studies or clinical trials. If you have the opportunity to participate in a relevant clinical trial, you may want to actively communicate with your doctor and try it. Please also be prepared that the malignancy of primary chemotherapy-resistant patients is generally very high, survival time is very short, and radiotherapy and immunotherapy may also be a drop in the bucket.
Many people say that chemotherapy is “worse than death” or “faster than death,” should I do it?
In reality, there is a tendency to “demonize” chemotherapy, leaving many oncology patients confused and even “avoiding” it.
As mentioned earlier, doctors usually use ECOG scores to assess your general condition and to complete blood tests, liver and kidney function, and electrocardiogram. The most common adverse effects are within the acceptable range, and the extreme situation of “life is worse than death” after chemotherapy does not occur.
Co-authored by:
Dr. Liu Chang, Department of Gastrointestinal Oncology, Peking University Cancer Hospital