The relationship between cancer and psychological distress is widely recognised and reflected by the large and growing body of psycho-oncology research. Oesophageal cancer is an aggressive malignant disease which is most frequently diagnosed once too advanced for curative treatment. For a small proportion of patients, a risky and invasive oesophagectomy operation can attempt to remove the cancer. The treatment process is physically and emotionally gruelling, yet little research has focused on the experience for patients. The majority of existing research has used quantitative methods. This study aimed to increase understanding of how people with oesophageal cancer experience the pre-operative treatment process and the approaching, yet uncertain, surgery. Qualitative semi-structured interviews were carried out with seven patients and eight members of their cancer centre’s multidisciplinary team. This intended to increase insight into patients’ personal experiences and staff’s accounts of diverse patients with whom they have worked. Analysis was conducted using a critical realist epistemology and thematic analysis. Three overarching patient themes were identified of ‘fear and the unknown’, ‘treatment brings hope and uncertainty’ and ‘committing to getting through treatment’. Patient participants described determinedly following medical advice whilst feeling fearful about surgery and its aftermath. Staff spoke more directly about the risks, dilemmas and often harrowing effects of treatment, as well as their efforts to support patients with this. Two main staff themes were developed of ‘between the devil and the deep blue sea’ and ‘predicting the unpredictable’. The findings suggest a need to consider decision-making in this particular context. In clinical practice, healthcare professionals must facilitate careful consideration of the subjective complexity central to treatment decisions. Further research should examine the transmission of information about the risks and potential consequences of surgery, the psychological processes involved in patients’ decisions and methods for improving psychological preparation for surgery.