Surgery is the standard treatment for oesophageal cancers. Unfortunately this is one type of cancer that often only causes symptoms when it is already quite advanced. This means that for many people an operation is not possible because the cancer has already spread.

Even for those patients who are able to have surgery there is a considerable risk that tiny  microscopic cancer cells will have spread into the surrounding tissues and the cancer will return at a later date. This means that unfortunately the number of people with this cancer who are able to be cured are disappointingly low. In recent years it has been suggested that this situation could improved by giving chemotherapy before surgery to those patients for whom tests show no sign of the cancer having spread. The theory being that the chemotherapy would shrink the cancer, making surgery easier. It would also kill off any microscopic clumps of tumour cells in the surrounding tissues. This theory has been put to the test in a number of clinical trials.

Most of the trials have used two drugs called cisplatin and fluorouracil. The results from several studies have shown no benefit from the addition of chemotherapy prior to surgery.  However recent results from a large Medical Research Council trial in the UK show a clear advantage for giving chemotherapy before surgery with almost 30% more patients alive at 2 years after treatment in the chemotherapy plus surgery group than in the group receiving surgery alone.

These results do not absolutely prove the case for giving chemotherapy prior to surgery in this condition and further trials are in progress. But the findings of the Medical Research Council trial have led many surgeons to offer patients the chance of chemotherapy before their operation on the basis that there is at least some evidence that there might be a benefit in terms of increased life-expectancy.