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Oesophageal cancer

Published by Bupa's health information team, December 2008.

This factsheet is for people with oesophageal cancer, or who would like information about it.

Oesophageal cancer develops in the oesophagus - the pipe that carries food from your mouth to your stomach. Every year around 7,650 people are diagnosed with oesophageal cancer in the UK.

Oesophageal cancer is treated with surgery, radiotherapy or chemotherapy.

Animation - How cancer develops
About oesophageal cancer
Types of oesophageal cancer
Symptoms of oesophageal cancer
Causes of oesophageal cancer
Diagnosis of oesophageal cancer
Treatment of oesophageal cancer
Prevention of oesophageal cancer
Further information
Questions and answers
Related topics
Sources

How cancer develops

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About oesophageal cancer

Oesophageal cancer develops in the oesophagus, the pipe that goes from the mouth to the stomach. It is sometimes called the gullet. It's about 50cm long in adults.

In the past 30 years oesophageal cancer has become more common in the UK.

Types of oesophageal cancer

There are two main types of oesophageal cancer: squamous cell carcinoma and adenocarcinoma.

Squamous cell carcinoma

Squamous cell oesophageal carcinoma develops in the cells lining the oesophagus. About half of all oesophageal cancers are squamous cell carcinomas. It usually develops in the upper half of the oesophagus.

Adenocarcinoma

Oesophageal adenocarcinoma develops in the mucus-producing gland cells in the lining of the oesophagus. Around half of all oesophageal cancers are adenocarcinomas. It usually develops in the lower third of the oesophagus as it may be linked to acid from the stomach irritating the cells (see Causes).

Symptoms of oesophageal cancer

In the early stages of the disease, there are usually no symptoms. Later on, symptoms can include:

difficulty swallowing food (dysphagia) is the most common symptom - there may be pain, or food may feel like it's sticking in your throat
weight loss
pain between the shoulder blades, behind the breastbone or back
pain in your throat
indigestion
vomiting
hoarse voice and constant coughing
coughing up blood

These symptoms aren't always due to oesophageal cancer, but if you have them you should visit your GP.

Oesophageal cancer is malignant. This means if it isn't treated it may spread to another area of the body (metastasise). It may reach the lymph nodes (glands throughout your body that are part of your immune system) or other organs such as the liver or stomach.

Causes of oesophageal cancer

No one knows exactly what causes cancer of the oesophagus. There are many different causes. It is more than twice as common among men than women. It usually develops between the ages of 60 and 80. However, it can occur at any age. It is most commonly found in Asia although it's becoming more common in Europe and North America.

Certain factors make oesophageal cancer more likely to develop. These vary depending on the type of cancer.

Squamous cell carcinoma

Tobacco and alcohol. Smoking any type of tobacco and heavy alcohol consumption both increase the risk for this type of cancer. If you both smoke and drink your chance of developing this type of cancer is even greater. Chewing tobacco also increases the risk of cancer of the oesophagus.
Poor diet. If you don't eat enough fruit and vegetables your risk of developing this type of the cancer may increase. Other risks are thought to include eating a lot of fried or roasted meat, or drinking very hot drinks.

Less common causes include:

Achalasia. If you have achalasia, the valve between your stomach and the oesophagus doesn't open properly. This can cause food to build up in the oesophagus after you swallow it.
Human papilloma virus. Some strains of this wart-causing virus, which has been linked with cancer of the cervix in women, may also be related to squamous cell carcinoma of the oesophagus.
Tylosis. This is a rare, inherited skin condition that causes thickening of the skin on the palms and soles of your feet.
Plummer-Vinson syndrome. This condition causes anaemia and growths in your throat that can make swallowing difficult. It increases the risk of squamous cell carcinoma of the oesophagus.

Adenocarcinoma

Obesity. Being obese is thought to double your risk of adenocarcinoma of the oesophagus. Obesity may increase the risk of acid reflux, in which stomach acid leaks into the oesophagus. Acid reflux increases the risk of Barrett's oesophagus (See below).
Barrett's oesophagus. People with Barrett's oesophagus develop abnormal cells at the end of the oesophagus near the stomach. The cells aren't cancerous, but there is a small risk of them developing into adenocarcinoma of the oesophagus. Barrett's oesophagus may be caused by acid reflux from the stomach irritating the oesophageal lining over time. Most people with Barrett's oesophagus, however, will not get oesophageal cancer.

Diagnosis of oesophageal cancer

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. There are several different tests you may have.

Endoscopy. This allows your doctor or a nurse to look at the lining of your oesophagus and down into your stomach. The test is done using a narrow, flexible, tube-like telescopic camera called an endoscope, which you swallow. Your doctor may collect a sample of the cells lining the oesophagus through the tube for examination in a laboratory. You usually have an anaesthetic spray for your throat and take a sedative before this test.
Barium swallow. This test involves swallowing a drink containing barium (a substance which shows up on X-rays). X-ray images are taken as the barium travels to your stomach, showing any narrowing or lumps in your oesophagus clearly.

If your doctor thinks these tests show that you may have cancer, he or she will refer you to an oncologist, a doctor who specialises in cancer care. He or she may recommend further tests to find out if the cancer has spread, and if so how far. This is called 'staging'. These tests could include:

Computed tomography (CT) scan. This uses X-rays to make a three-dimensional image of your upper abdomen.
Endoscopic ultrasound scan. An ultrasound probe is attached to the end of an endoscope, which you swallow. The probe emits sound waves that are used to produce an image of the lining of your oesophagus.
Laparoscopy. This test is done under general anaesthetic. A surgeon makes a small cut in your abdomen and feeds a tiny tube-like camera in to look at the area around your lower oesophagus and stomach. Samples of tissue can also be taken through the tube for examination in a laboratory.

Treatment of oesophageal cancer

Treatment of oesophageal cancer depends on the type of cancer, how far the disease has progressed, and your general health. It may be treated with surgery, chemotherapy, radiotherapy, laser treatment, or a combination of these methods.

Surgery

If the cancerous growth (tumour) hasn't spread too far, it can be removed in an operation. This is the most common treatment for oesophageal cancer and it is carried out under general anaesthetic. Your surgeon will remove the tumour and a section of the oesophagus on either side of it. He or she will often remove nearby lymph nodes as well (which are sent to laboratories to be tested for signs of cancer).

In most people the stomach is moved up into the chest and joined to the remainder of the oesophagus. If your surgeon removes a large length of the oesophagus, he or she may use part of the bowel to replace it and attach it to the stomach. Surgery is often combined with chemotherapy and radiotherapy.

Stents

Sometimes your surgeon may find that the cancer has spread too far to remove with surgery. He or she may place a tube called a stent inside the oesophagus to make swallowing easier.

Laser treatment

If your surgeon can't remove the tumour, he or she may use a laser to destroy parts of the tumour blocking the oesophagus. This will make it easier for you to swallow. This is done with an endoscope (see Diagnosis of oesophageal cancer). It is usually carried out under sedation, which keeps you relaxed, and local anaesthetic, which numbs any pain. However, it is sometimes done under general anaesthetic.

Photodynamic therapy is a new type of laser treatment that can help people with advanced oesophageal cancer who have difficulty swallowing. Light-sensitive drugs that are absorbed by the tumour are taken. A low-powered laser is used to activate the drugs, which kill the cancerous cells.

Chemotherapy

Chemotherapy is a treatment to destroy cancer cells with medicines. There are many different types of chemotherapy agents. They are usually injected into a vein but sometimes tablets are used. Sometimes chemotherapy is given using a pump that feeds the drugs in slowly. You will need to carry the pump around with you under your clothing.

Chemotherapy can cause a variety of side-effects, such as making you feel tired or ill, or cause nausea or hair loss. Your doctor will advise you about what side-effects to expect.

Chemotherapy can be used in combination with surgery, or alone if the cancer has spread too far to be removed surgically. You may be offered a course of chemotherapy before and/or after your surgery to try and increase the chance of achieving a cure.

Radiotherapy

Radiotherapy uses radiation to kill cancer cells. It can be used instead of surgery in some cases or, more rarely, you can have it in combination with surgery. Often it is combined with chemotherapy. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. Several doses are required so you may need to return to the treatment centre for daily treatments over a number of days or even a few weeks.

If the cancer is advanced you may have internal radiotherapy (brachytherapy). A small piece of radioactive material is placed next to the tumour, usually via an endoscope, delivering a high dose of radiation directly to the tumour. Radiotherapy for oesophageal cancer may have side effects such as a sore throat, tiredness or nausea.

Prevention of oesophageal cancer

Not smoking or drinking excessive amounts of alcohol, eating a balanced diet with vegetables and fruit, and maintaining a healthy weight will all help cut your risk of developing oesophageal cancer.

Further information

Macmillan Cancer Support
0808 800 1234
www.cancerbackup.org.uk
Cancer Research UK
www.cancerresearchuk.org
The Oesophageal Patients Association
0121 704 9860
www.opa.org.uk