Oesophageal cancer: what is it?
Oesophageal cancer (also called cancer of the oesophagus) is a malignant tumour that grows in the lining of the oesophagus.
The oesophagus (the gullet) is the tube that carries food from the mouth down into the stomach using a series of muscular movements.
Oesophageal cancer is more common in men than women, and usually affects people older than 60 years of age.
Symptoms of oesophageal cancer
Many people do not experience any discomfort or noticeable symptoms early on with oesophageal cancer. However, as the cancer progresses the following symptoms may develop.
- Difficult or painful swallowing that may be accompanied by a feeling that food or fluids are getting stuck in the throat. The difficulty swallowing is usually first noticed with solids and then progresses until there is difficulty swallowing soft foods and also liquids.
- Weight loss is common because of the difficulty in swallowing food and liquids.
- Regurgitation of food, or worsening indigestion or heartburn.
- Bleeding, which can result in vomiting or coughing up blood, black-coloured faeces (caused by blood that has passed through the digestive tract), and anaemia.
- Coughing or choking, usually after swallowing.
- Hoarseness of the voice.
- Chest or upper abdominal pain or discomfort, when swallowing or at other times.
You should always check with your doctor if you have any difficulty swallowing or have constant episodes of reflux, or if you experience any of the above symptoms.
Pneumonia is a possible complication of oesophageal cancer, caused by food going down the airway instead of the oesophagus and getting into the lungs (doctors call this aspiration pneumonia).
Types of oesophageal cancer
Two types of cancer, squamous cell carcinoma and adenocarcinoma, make up 90 per cent of all oesophageal cancers. Oesophageal cancer can occur in any section of the oesophagus.
Squamous cell carcinoma
Most cancers in the top or middle part of the oesophagus are squamous cell cancers. They are called this because the cells lining the top part of the oesophagus are squamous cells. Squamous means scaly.
Most cancers at the end of the oesophagus that joins the stomach are adenocarcinomas. Adenocarcinomas are often found in people who have a condition called Barrett’s oesophagus. In Barrett’s oesophagus, long term gastro-oesophageal reflux damages the normal squamous cells that line the oesophagus by repeatedly bathing them in acidic stomach contents. Over time the squamous cells are replaced by cells more like the ones in the stomach and small intestine. It is in these new cells, the so-called Barrett’s metaplasia, that adenocarcinomas can develop.
The cause of oesophageal cancer is not fully understood, but there are a number of risk factors and conditions that can increase your risk of oesophageal cancer. These include the following.
- Gastro-oesophageal reflux disease (GORD, or reflux).
- Barrett’s oesophagus (a condition caused by repeated episodes of reflux that results in changes to the usual cell lining of the oesophagus).
- Alcohol: drinking large quantities of alcohol on a regular basis.
- Eating a diet that is low in fresh fruits and vegetables.
- Regularly consuming very hot drinks or foods.
- Obesity or being overweight.
- Vitamin and other nutritional deficiencies.
- Being exposed to certain chemicals, such as nitrosamines.
- Achalasia — a condition where the muscles of the lower oesophageal sphincter (the ‘valve’ that controls food passing from the oesophagus to the stomach) can’t relax properly and so food builds up in the oesophagus and doesn’t pass to the stomach. Also, the normal waves of muscle contractions that propel food down the oesophagus don’t work properly, also adding to the build-up of food.
- Plummer-Vinson syndrome — a rare condition that causes anaemia, tongue abnormalities and oesophageal webs (abnormal protrusions of tissue into the oesophagus that interfere with swallowing).
Tests and diagnosis
Early detection of oesophageal cancer is extremely important as it improves the chance of successful treatment.
Based on your symptoms and physical examination, your doctor may recommend you have an endoscopy to examine the oesophagus. An endoscope is a narrow tube with a camera on the end that can be used to view the oesophagus and stomach and take small tissue samples (biopsies).
If oesophageal cancer is diagnosed, further tests, such as a CT scan, may be recommended to determine whether the cancer has spread. This is called staging, and will impact on the treatment that is recommended.
2. MayoClinic. Esophageal cancer (updated 15 May 2014). http://www.mayoclinic.com/health/esophageal-cancer/DS00500 http://www.mayoclinic.org/diseases-conditions/esophageal-cancer/basics/definition/con-20034316 (accessed Nov 2015).
3. NHS Choices. Oesophageal cancer (updated 30 Jun 2014). http://www.nhs.uk/conditions/cancer-of-the-oesophagus/pages/introduction.aspx (accessed Nov 2015).