Cancer of the Oesophagus
The oesophagus (pronounced e sof fa gus), is also known as the gullet. It is a long, muscular tube that connects your throat to your stomach. It is at least 12 inches (30cm) long in adults. When you swallow food it is carried down the oesophagus to the stomach, and the walls of the oesophagus contract to move the food down. At the upper part of the oesophagus it runs behind, but is separate from, the windpipe (trachea). The windpipe connects your mouth and nose with your lungs, enabling you to breathe. A tumour can occur anywhere along the length of the oesophagus.
The causes of cancer of the oesophagus
Cancer of the oesophagus is becoming more common in Europe and North America. Men are affected more than women and it occurs generally in older people. The cause is unknown but one type of oesophageal cancer, known as adenocarcinoma, appears to be more common in people who have long-term acid reflux (backflow of stomach acid into the oesophagus). Damage to the oesophagus caused by acid reflux is known as Barrett's oesophagus.
Barrett’s oesophagus is a condition where abnormal cells develop in the lining of the lower end of the oesophagus. It is not a cancer, but over a long period of time a small number of people with this condition (approximately 1 in 100) may develop a cancer of the oesophagus.
One type of oesophageal cancer called squamous carcinoma is more common among smokers and people who drink a lot of alcohol, especially spirits, or have a poor diet. Other conditions affecting the oesophagus, such as achalasia, may also very occasionally lead to cancer. Achalasia is where the muscle that controls the opening between the oesophagus and the stomach does not relax properly. This makes food build up in the oesophagus and stops it emptying into the stomach.
In most people, cancer of the oesophagus is not caused by an inherited faulty gene, and so other members of your family are not likely to be at risk of developing it
The symptoms of cancer of the oesophagus
Oesophageal cancer may cause no symptoms until it begins to obstruct passage of food and fluids down the gullet, or to make swallowing difficult. Difficulty in swallowing (dysphagia) is the most common symptom of oesophageal cancer. Usually, there is a feeling that food is sticking on its way down to the stomach, although liquids may be swallowed easily at first. There may also be some weight loss, and possibly some pain or discomfort behind the breastbone or in the back. There may be indigestion or a cough. Many of these symptoms can be caused by conditions other than cancer, but you should always tell your doctor, particularly if they do not go away after a couple of weeks.
How oesophageal cancer is diagnosed?
The following tests are commonly used to diagnose cancer of the oesophagus.
- Upper gastrointestinal endoscopy (oesophagoscopy)
- Barium swallow
If the tests show that you have cancer of the oesophagus, your doctor may want to carry out further tests.
Upper gastrointestinal endoscopy (oesophagoscopy)
This procedure enables the doctor to look directly at the oesophagus through a thin flexible tube called an endoscope. The endoscope has a tiny camera and a light on the end. If necessary, the doctor can take a small sample of the cells (a biopsy) to be examined under a microscope. This can usually confirm whether or not there is a cancer.
Endoscopy can usually be done as an outpatient, but occasionally an overnight stay in hospital is needed. Once you are lying on your side on the couch you may be given a sedative, usually injected into a vein in your arm, to make you feel sleepy and reduce any discomfort during the test. Alternatively, a local anaesthetic may be sprayed on to the back of the throat before the doctor passes an endoscope down into the oesophagus. Sometimes both an injection and the spray are used. The doctor then looks through the endoscope and examines the inside of the oesophagus.
A liquid barium solution is swallowed, which shows up on x-ray. Using an x-ray machine, the doctor can watch the barium as it flows down the oesophagus towards your stomach. At the same time x-ray pictures are taken of your oesophagus.
Cancer of the oesophagus can be treated using surgery, chemotherapy or radiotherapy. The choice of treatment will depend upon the exact type of oesophageal cancer, its stage, position and size, as well as your age and general health. The treatments can be used alone or in combination.
Other treatments may be used to ease any swallowing difficulties you may have. These include: intubation or stenting (inserting a tube into the oesophagus to keep it open), dilatation (stretching the oesophagus), laser treatment and photodynamic therapy. You may be offered one or more of these treatments.