Oesophageal cancer (Symptoms, Causes & Treatments)

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Oesophageal cancer

The oesophagus is part of the body's digestive system, the tube which links the stomach to the mouth.

Muscles in the oesophagus push food down into the stomach during the swallowing process.

It is thought that smoking and drinking alcohol to excess may run a higher risk of developing this cancer.

If undiscovered, oesophageal cancer can spread to involve the stomach, lungs and liver, as well as nearby parts of the body's lymphatic system called lymph nodes.

Unfortunately it is also one of the more difficult to treat.

Professor David Cunningham, an expert in oesophageal and stomach cancers from the Royal Marsden Hospital in London said: "Most of the survivors come from that group of patients, about 30% to 40% who have relatively localised cancers that are amenable to treatment.

"Cancers arising at the junction of the oesophagus and stomach are increasing at a fairly rapid rate in most of the Western civilisations - we're not entirely sure why this is taking place.

"Cancers higher up in the oesophagus may be associated with cigarette smoking and excessive alcohol."

Symptoms

The first sign of a tumour in the oesophagus is generally a problem with swallowing.

There may be a painful sensation when food is going down, particularly when swallowing larger pieces of food.

This is caused by the gradual expansion of the tumour to cause a partial blockage in the oesophagus.

Other symptoms which may lead to a diagnosis of oesophageal cancer include indigestion or heartburn, and frequent vomiting or choking.

Of course, all of these symptoms can mean something far less serious is wrong, but doctors urge patients with persistent symptoms of this kind to arrange an appointment.

As well as a general physical examination, the doctor, and subsequently a hospital specialist uses a variety of tests to try to locate the source of the problem.

A commonly used test is endoscopy, in which a narrow probe is passed down the throat. This sends back pictures of the tissues back to the doctor.

If any suspicious-looking areas are found, a sample of tissue, called a biopsy, can be taken for examination under a microscope.

The patient is generally given a local anaesthetic to the back of the throat before the tube is inserted, to prevent gagging.

The medical team may also use x-rays, perhaps after the patient has drunk a small quantity of liquid which shows up well under x-rays.

If a case of oesophageal cancer is found, it is important to find out what sort of cancer it is, and how far it has spread.

Cells nearer the top of the oesophagus are more similar to the body's skin cells, and cancers have different characteristics to those found lower down.

Cancer at the top of the oesophagus are generally "squamous cell carcinomas", and lower down "adenocarcinoma".

Causes

Heavy smokers and drinkers run a higher risk of developing cancers of the oesophagus.

Another health problem which is believed to be a contributory factor is "reflux". This is where food and stomach juices can pass back up into the oesophagus from the stomach.

Normally a valve stops this happening, and the juices can irritate the lining of the oesophagus.

Treatments

Unfortunately, early detection of oesophageal cancer is unlikely because smaller tumours produce fewer symptoms.

In later cases, many of the treatments offered aim to extend life and relieve symptoms rather than cure.

Surgery is a key option. Often the tumour is removed, along with nearby lymph nodes and other tissues. The tube then repaired so that the patient can swallow food.

Variants on this procedure include using a section of the lower intestine to replace the removed part, or to bypass a whole area of oesophagus if the tumour is too large.

Sometimes the main aim is to simply make sure the tube stays open by inserting a man-made tube inside it.

Some doctors will choose to use a dose of radiotherapy to shrink a tumour before operating.

Chemotherapy is also used, either before the operation or to try to "mop up" any cancer cells left afterwards.

Patients with oesophageal cancer are often encouraged to eat little and often, as large meals can be difficult to swallow.

Weight loss is a frequent result of problems eating caused by the cancer, and dietary supplements are sometimes given.