Oesophageal cancer Dr Trisha Macnair Cancer of the oesophagus or gullet (the tube that carries food from your mouth into your stomach) is increasingly diagnosed in the UK – there are about 7,800 cases per year.

In this article

Causes Symptoms

Diagnosis Treatment

Introduction

There are two main types of oesophageal cancer, with different implications for treatment and prognosis. In the UK about half are a type called squamous cell carcinoma, which tend to occur mostly in the upper third and middle of the oesophagus, developing from the flat cells which line the tube.

Most of the other oesophageal cancers are adenocarcinomas, which develop from mucus-making cells, in the lower third of the oesophagus. These cases have risen considerably in recent years, probably related to an increase in acid indigestion and reflux of stomach contents up into the oesophagus.

It‘s not yet fully understood why oesophageal cancer develops, but risk factors may include :

• Age, like most cancers, it's more common in older people.
• Men are slightly more at risk than women.
• Smoking.
• Heavy alcohol consumption.
• Damage to the oesophagus by irritant substances.
• Being overweight.
• Poor diet, lacking in vitamins, particularly heavy in barbequed or roasted meats.
• Previous problems with a condition called Barrett's Oesophagus , where abnormal cells develop in the lining of the lower part, usually in people with a long history of acid reflux or heartburn. Although not a cancerous condition, the cells can occasionally lead to cancer, affecting two in 200 people in the UK, but only one per cent each year go on to develop cancer.

Because of the tumour’s location, many symptoms are related to eating food such as:

• Problems with swallowing
• Sensation that food is getting stuck on the way down
• Burning sensations when swallowing food
• Weight loss
• Acid indigestion and reflux (which can cause pain in the back or throat)
• Chronic cough or hoarse voice
• Nausea
• Vomiting
• Coughing or vomiting blood

However, it can be difficult to spot because many symptoms are typical of indigestion, which is very common and not usually serious, people may just keep taking antacids.

If GPs were to refer everyone with symptoms of indigestion for further investigation, the system would be overwhelmed. However, they should arrange an urgent referral to a specialist when there are other worrying symptoms such as weight loss, problems swallowing or coughing or vomiting blood.

The main diagnostic test is an endoscopy, where a long tube with a light and camera on the end is passed down into the oesophagus to look at the tissues and take samples (a biopsy) of any abnormal areas. This procedure is sometimes referred to as an oesophago-gastro-duodenscopy (OGD) when the doctor examines the whole of the upper bowel to check for problems. It’s usually (but not always) done under sedation, and with local anaesthetic to numb the throat.

Sometimes other tests are done such as a barium x-ray, blood tests to check for chemical markers of cancer or even a CT or MRI scan (which can be used to check other abdominal organs too).

As with most cancers, the first step is to work out the type of cancer and how far it has spread, called staging, which helps to plan the most appropriate treatment.

Treatments that you may be offered include :

• Surgery. This aims to remove the cancer, exactly what is done will depend on the stage it’s at, but it may involve removing all or part of the oesophagus.
• Laser treatment. May help to reduce the size of the tumour and relieve symptoms but is not curative. Laser treatment may be combined with the use of a light-sensitive drug (this is known as Photo-Dynamic Therapy or PDT)
• Insertion of a stent. This is a rigid tube which is placed in the oesophagus to help keep it open and allow food to pass through to the stomach, it can help deal with symptoms but does not treat the cancer itself.
• Chemotherapy. Drugs which relieve symptoms and may slow cancer growth may be used before surgery to shrink the tumour and make it easier to operate on, or when surgery is not an option because the tumour has spread.
• Radiotherapy. This involves using beams from a radioactive source to destroy the cancer cells. It may be given on its own, in combination with chemotherapy or after surgery to try to prevent recurrence.
• Biological therapies. These treatments are made from chemicals that occur naturally in the body such as antibodies, or substances that counteract the effect of the protein signalling molecules which naturally stimulate growth of the cells (known as growth factor blockers). Another type of biological therapy is a vaccine, which can stimulate the immune system to identify cancerous cells and destroy them.

Some of these treatments aren’t yet proven and may be available only as part of clinical research trials, to see if a more effective combination of therapies can be found.

Outlook

Unfortunately cancer of the oesophagus has often reached quite an advanced stage by the time it's diagnosed and it doesn’t usually respond very well to treatment.

But every case has different factors which influence their prognosis, including the type, stage and grade of their tumour. You should talk to your doctor to find out the relevant statistics for you.

This article was first published in October 2008.