Oesophageal cancer

esophageal cancer is usually one of two types. Adenocarcinoma usually occurs in the lower oesophagus at the junction with the stomach and is linked to Barrett’s oesophagus, even if this has not already been diagnosed. The second type is squamous cell carcinoma which tends to affect the upper part of the oesophagus and is more strongly linked to smoking and alcohol.

Signs and symptoms

Worsening or persistent indigestion or heartburn

Difficulty swallowing

Weight loss without trying

Chest pain, pressure or burning

Coughing or hoarseness

Cause

Squamous Cell Carcinoma

Oesophageal squamous cell carcinoma arises through chronic irritation and inflammation of the oesophageal lining. The strongest associations are smoking and alcohol but consumption of hot beverages, high intake of barbecued meat and human papilloma virus infection have all been implicated.

Adenocarcinoma

Adenocarcinoma of the oesophagus is strongly associated with gastro-oesophageal reflux disease (GORD) often described as heartburn.  GORD is a common disease whereas adenocarcinoma of the oesophagus is not.  GORD affects 1 in 10 adults on a daily basis and up to 2 in 10 weekly.  Of these a further 1 in 10 will have Barrett's oesophagus, the only known precursor for adenocarcinoma.  The risk of progression to cancer in this population is around 1 in every 1000 patients per year.

Diagnosis

The first test performed is usually an endoscopy (a camera test to view the inside of the oesophagus and stomach) with biopsies (small samples of the lining are painlessly removed and examined under a microscope). The majority of patients are diagnosed with oesophageal cancer from their general practitioner (GP) or another hospital doctor (85%). A very small number (less than 1%) are identified because they are known to have Barrett’s oesophagus and undergo regular surveillance endoscopy. The remaining 14% present as an emergency.

Treatment

Once staging has been completed a management plan will be developed and tailored to individual patients. This will take into account the stage of disease, other medical conditions and the wishes of the patient and their family.

If oesophageal cancer is diagnosed early it can be cured. For the earliest stage cancers the tumour can be removed endoscopically (from the inside of the oesophagus in a similar way to the camera test used for diagnosis) without the need for major surgery or other treatments. If any Barrett’s oesophagus is present this will also be removed completely. More than one endoscopic treatment may be required.