Esophageal Cancer
The esophagus (also known as the gullet) is part of the body’s digestive system, the tube which links the stomach to the mouth. Muscles in the esophagus push food down into the stomach during the swallowing process.
There are two main types of esophageal cancer, with different implications for treatment and prognosis:
Types of Esophageal Cancer
Squamous cell carcinoma (SCC)
Tends to occur in the upper third and middle of the oesophagus, developing from the flat cells that line the tube
Adenocarcinoma (AC)
Develops from mucus-making cells in the lower third of the oesophagus. The incidence of AC has risen considerably in recent years,especially among men. The cause for this is not known but may be related to an increase in acid indigestion and reflux.
Esophageal Cancer Causes and Risk Factors
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, particularly after the age of 50 and onwards
- Gender – men are more vulnerable. Oesophageal cancer rates have increased by more than 60% among men in the last 30 years, compared to only a 14 per cent increase in women. Men are now more than twice as likely as women to develop this cancer
- Lifestyle: recent research suggests that nearly 90% of oesophageal cancers are due to lifestyle and environmental factors such as smoking (over 60 per cent in men and 70 per cent in women are thought to be due to smoking)
- Alcohol consumption: increases the risk of SCC by 18 per cent for every 100gm consumed. Smoking and drinking combined are particularly potent and may increase the risk by 20 fold or more
- Damage to the oesophagus by irritant substances
- Being overweight increases the risk of AC but not SCC
- Poor diet, especially if low in fruit and vegetables, lacking in vitamins and particularly heavy in barbecued or roasted meat
- 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 an adenocarcinoma (AC).
- Reflux, where food and stomach juices pass back up into the oesophagus from the stomach
- There are links with other conditions such as Plummer-Vinson Syndrome, Tylosis, achalasia, coeliac disease and possibly Human Papilloma Virus (HPV) infection
- Research suggests that in some areas of the world, very hot food and drink may increase the risk of SCC, as well as chemicals found in certain foods
Esophageal Cancer Symptoms
Due to the tumour’s location, many symptoms are related to eating food, including:
- Problems with swallowing, including burning sensations
- Sensation that food is getting stuck on the way down, particularly when swallowing larger pieces of food
- Weight loss
- Acid indigestion and reflux, which can cause pain in the back or throat
- Chronic cough or hoarse voice
- Nausea
- Heartburn
- Frequent vomiting or choking
- Coughing or vomiting blood
Of course, all of these symptoms can mean something far less serious is wrong. Many are typical of indigestion, which is very common and not usually serious. But because indigestion is common, many people just keep taking antacids when they should get symptoms checked. As a result an oesophageal cancer is often diagnosed at a later stage when cure is less likely.
Doctors urge patients with persistent symptoms of this kind to arrange an appointment. As well as a general physical examination, the doctor or a hospital specialist uses a variety of tests to try to locate the source of the problem
Esophageal Cancer Diagnosis
The main diagnostic test is an endoscopy, where a long tube with a light and camera on the end is passed down into the esophagus to look at the tissues and take samples (a biopsy) of any abnormal areas. This procedure is usually referred to as an esophageal-gastro-duodenscopy or OGD, as the doctor examines the whole of the upper gastro-intestinal tract to check for problems. The patient is generally given a local anaesthetic to the back of the throat before the tube is inserted, to prevent gagging, but heavier sedation or a general anaesthetic can be given if necessary.
Sometimes other tests are done such as a barium x-ray (called a Barium Swallow as a thick white liquid containing barium, which shows up on x-ray, has to be swallowed), 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).
Esophageal Cancer Treatments
As with most cancers, if a case of oesophageal cancer is found, the first step is to work out what type of cancer it is and how far it has spread. This is called staging, and it helps to predict how the cancer is likely to progress and which treatments are most appropriate. As with most cancers these days, a team of specialists including doctors, nurses, radiologists, oncologists, radiotherapists and others get together to review all the test results and then recommend a schedule of suitable treatment.
Treatments for Oesophageal Cancer include:
Esophageal Cancer Surgery
What exactly is done will depend on where the tumour is, the stage of the cancer and the person’s general level of fitness. In early stage cancer the lining of the oesophagus may simply be removed, but more often part (or all) of the oesophagus is taken away. Often nearby lymph nodes and other tissues must be removed too. The tube is then repaired so the patient can swallow food. Sometimes a section of the lower intestine may be used to replace the removed part of the oesophagus or to bypass a whole area if the tumour is too large
Chemotherapy for Oesophageal Cancer
Relieves symptoms and may slow cancer growth. It may be used to shrink the tumour before surgery or when surgery is not an option because the tumour has spread
Radiotherapy for Oesophageal Cancer
Maybe used to shrink a tumour before surgery. It may be given on its own, in combination with chemotherapy or after surgery to try to prevent recurrence.
Laser treatment for Oesophageal Cancer
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 (known as photo-dynamic therapy or PDT)
Insertion of a stent for Oesophageal Cancer
A rigid tube 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
Esophageal Cancer Biological Therapies
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.
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.
Unfortunately, early detection of oesophageal cancer is unlikely because smaller tumours produce fewer symptoms. The cancer has often reached an advanced stage by the time it’s diagnosed and it doesn’t usually respond very well to treatment. In later cases, many of the treatments offered aim to extend life and relieve symptoms.
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.
Esophageal Cancer Survival Rate
Survival rates are slowly improving as oesophageal cancers are being detected earlier and more effective treatments are developed, but even so they remain poor. Overall, about 40 per cent of people are still alive one year after diagnosis, but currently only about 1 in 8 survive to 5 years. Survival rates are, of course, better for those with early stage disease.