Oesophageal cancer

What is oesophageal cancer?

Oesophageal cancer (sometimes spelled ‘esophageal’ cancer) happens when cells grow in an uncontrolled way in the oesophagus. The oesophagus is a muscular tube that carries food from your mouth to your stomach.

Oesophageal cancer can spread to nearby lymph nodes (glands), or to other parts of the body, if it is not diagnosed and treated early.

What are the types of oesophageal cancer?

There are different types of oesophageal cancer.

The most common type is called oesophageal adenocarcinoma, which usually grows in the lower part of the oesophagus. This is more common if you have reflux (also known as gastro-oesophageal reflux disease or GORD).

If you have reflux, the oesophagus is exposed to acid from your stomach. This can cause you to develop a condition called Barrett’s oesophagus, which over time can lead to oesophageal cancer.

Squamous cell carcinoma begins in the cells that line the middle and upper part of the oesophagus.

What are the symptoms of oesophageal cancer?

In the early stages of the disease, there may not be any symptoms, so oesophageal cancer is often not detected until it is quite advanced.

If you do have symptoms, they may include:

• difficulty or pain when swallowing
• pain in the top part of the abdomen when eating
• heartburn or reflux that doesn’t go away, especially if you haven’t had it before
• food getting caught in your throat and coming back up (regurgitation)
• choking while swallowing
• a hoarse voice or a cough that doesn’t go away

You may have general symptoms of cancer including:

• unexplained weight loss
• poor appetite
• fatigue

You may also have symptoms related to bleeding in your oesophagus caused by the cancer:

• coughing or vomiting up blood
• black or bloody bowel motions (poo)

All of these symptoms can also happen for other reasons, so having these symptoms doesn’t always mean you have cancer. If you are worried, tell your doctor — they can examine you and refer you for tests to better understand your condition.

What causes oesophageal cancer?

The exact causes of oesophageal cancer are not known, but there are some factors that may increase your risk:

• smoking
• drinking too much alcohol
• not eating enough fresh fruit and vegetables
• being overweight or obese
• being exposed to certain chemicals
• some genetic conditions
• having certain medical conditions, such as Barrett’s oesphagus

How is oesophageal cancer diagnosed?

Your doctor will ask about your symptoms and examine you.

You may be referred for tests including:

• blood tests to assess your general health
• imaging tests such as ultrasound, CT or PET scans
• endoscopy — where a flexible tube with a camera at the end is used to look down your oesophagus and into your stomach
• biopsy — during endoscopy, the doctor can remove a small sample of tissue to be checked in the lab for signs of cancer

Sometimes laparoscopy (keyhole surgery) may be used to look inside your abdomen (tummy area) and check if the cancer has spread.

How is oesophageal cancer treated?

The type of treatment will depend on the type of oesophageal cancer and how far it has spread (its ‘stage’).

Very small tumours can sometimes be removed during an endoscopy. This procedure is called an ‘endoscopic resection’.

Depending on your condition, surgery can remove part of, or all of, the oesophagus. Sometimes part of the stomach will be removed as well.

If you need to have your oesophagus removed, your surgeon will form a new oesophagus for you, using what is left of your own oesophagus and/or part of your bowel.

Treatment might also 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 pass through.

You might also have chemotherapy or radiotherapy or immunotherapy.

Living with oesophageal cancer

Surgery for oesophageal cancer can make it hard to swallow and eat for a while. It’s important to have enough to eat and drink so you stay healthy and don’t lose weight. Your doctor will usually work with a dietitian to help you plan meals and ensure that you are eating a healthy diet.

You may need to eat soft foods. It’s often better to eat small, regular meals, and avoid eating late in the day.

After treatment has finished, you will still need ongoing tests and regular checks with your specialists. After you have been treated for cancer, it’s normal to feel afraid that the cancer will return. If you are struggling, it is important to seek support from your doctor, a therapist or other people who have been through cancer.