Oesophageal cancer is a rare type of cancer that grows in your oesophagus (the 'food pipe', or tube) that leads from the throat to the stomach. The earlier oesophageal cancer is diagnosed and treated, the better the outcome. So, how is this difficult and challenging type of cancer dealt with? Dr Aathavan Loganayagam, a leading gastroenterologist, presents a concise guide about oesophageal cancer.
What is oesophageal cancer?
Oesophageal cancer (sometimes spelled 'esophageal' cancer) occurs when cells grow out of control in the oesophagus. Usually, the tumour grows in the lower part of the tube, near the stomach.
It is a serious condition and the chance of surviving past 5 years after diagnosis is less than 1 in 5. This is because the cancer can spread to nearby lymph nodes (glands), or to other parts of the body.
Nearly 9,000 people get oesophageal cancer each year in the UK, and it is getting more common. Most people who get oesophageal cancer are over 60, and more men get it than women.
Risk factors for oesophageal cancer:
The exact causes of oesophageal cancer are not known but there are some things that may increase your risk:
- Having a condition called Barrett’s oesophagus or gastro-oesophageal reflux disease (GORD)
- Excessive alcohol consumption
- Being older than 60 years
- Low intake of fresh fruit and vegetables
- Eating a lot of smoked, salted or pickled food
- Drinking a lot of very hot liquids (above 65°C) frequently
- Being exposed to some chemicals
- Being overweight or obese
- Being infected with the human papillomavirus (HPV)
- Having a close relative who has had oesophageal cancer
Types of oesophageal cancer:
There are different types of oesophageal cancer. The most common type is called ‘adenocarcinoma’, which grows in the lower part of the oesophagus. This can happen if you have reflux and the oesophagus is constantly exposed to acid from your stomach.
Another common type is ‘squamous cell carcinoma’, which begins in the squamous cells that line the middle and upper part of the oesophagus.
Oesophageal cancer symptoms:
Oesophageal cancers are often not detected until they are quite advanced because there may not be any symptoms in the early stages of the disease. Symptoms of oesophageal cancer include:
- Difficulty or pain when swallowing
- Pain in the top part of the abdomen when eating
- Acid reflux or heartburn
- Food coming back up
- Weight loss
- Feeling very tired
- A hoarse voice or a cough that doesn’t go away
- Coughing or vomiting up blood
- Black or bloody bowel motions
All of these symptoms can be explained by something else but if you are worried, tell your doctor.
Oesophageal cancer diagnosis:
If your doctor suspects you have oesophageal cancer, they may order tests such as an endoscopy (where a flexible tube is used to look down your throat and into your stomach), a biopsy (where a small sample of tissue is removed to be examined in the lab), and scans including CT or PET.
You may also have a 'barium swallow', where you swallow a liquid that lights up your digestive system on an X-ray. You may also have scans of nearby organs to see if the cancer has spread.
Oesophageal cancer treatment:
The type of treatment will depend on the type of oesophageal cancer and how far it has spread (its 'stage').
For larger, more advanced tumours, the affected part of the oesophagus is removed in an operation call an ‘oesophagectomy’. Sometimes the lower part of the oesophagus and the top part of your stomach is removed (called an ‘oesophago-gastrectomy’). The surgeon will create a new oesophagus for you, either using what is left of your own oesophagus, or sometimes using part of your bowel.
Treatment might involve inserting an oesophageal stent. The stent is a small tube placed in the oesophagus to keep it open so that food and liquids can be swallowed.
Dr Aathavan Loganayagam is based at Blackheath Hospital, Shirley Oaks Hospital and LycaHealth Orpington and Canary Wharf.