What is cancer of the oesophagus

What is cancer of the oesophagus?

• Cancer of the oesophagus or gullet develops as a result of cell changes in the lining of the oesophagus.
• There are two main types of cancer of the oesophagus: squamous carcinoma, which is more common at the upper end of the gullet, and adenocarcinoma, which is more common at the lower end, particularly around the junction between the gullet and the stomach.
• There has been a recent increase in the proportion of tumours arising close to the junction of the stomach and gullet, but the reasons for this are not yet known.

What are the symptoms of cancer of the oesophagus?

• The first symptom of the disease is almost always difficulty in swallowing. There is the feeling that food is getting stuck, often behind the lower end of the breastbone. At first the problem is only with solid food but later even semi-solids and liquids can cause problems.
• Pain felt between the shoulder blades can also be troublesome. This discomfort is sometimes triggered by eating.
• Another characteristic symptom is regurgitating unaltered food a few minutes after having difficulty swallowing the food. The patient often tries to handle these problems by eating less and avoiding solid food. This causes weight loss and fatigue.

How is cancer of the oesophagus diagnosed?

• It can be diagnosed by using X-rays using special dye. Before the X-ray picture is taken, the patient will be asked to swallow a beaker of a whitish fluid called barium. X-ray pictures are taken as the barium travels down the gullet and into the stomach.
• The procedure is completely painless and provides valuable information about the size of any abnormality present. It does not provide a firm diagnosis though any irregular narrowing of the gullet would strongly suggest that there may be a cancer present.
• The definitive diagnosis is made through direct vision using a camera attached to a flexible tube (an endoscope), which makes it possible to take a tissue sample (biopsy). The endoscopy (sometimes called a gastro copy) is carried out while the patient is under sedation.
• A long flexible tube, about the thickness of a fountain pen, is passed through the mouth, over the back of the tongue and down into the gullet and stomach. The tube is connected to a camera through which the doctor can inspect the lining of the gullet and assess whether or not it is normal.
• A sample will be taken from any abnormal or suspicious areas. After processing, these samples will be examined by a pathologist who will decide whether or not there are any cancer cells present. It usually takes 7 to 10 days after the test before the pathologist's report is ready.
• A CT scan is often performed to assess whether or not the disease has spread either locally or to the liver. This is a particularly important investigation if surgery is being considered.

How is cancer of the oesophagus treated?

• Treatment may consist of surgery, radiotherapy, chemotherapy or a combination of these.
• The best chance of cure is with surgery. Patients who are in good general condition and who have small tumours have more than a 25 per cent chance of cure with surgery.
• In fit patients with more advanced disease, the combination of chemotherapy and radiotherapy may be used - this can produce cure rates of around 20 per cent. The combination is sometimes used to shrink tumours in order to make subsequent surgery easier and more effective.
• Unfortunately the majority of patients are not fit for intensive treatment of this type. In their case treatment will be aimed simply at relieving symptoms.
• This can sometimes be done most easily using a stent. A stent is simply a kind of tube that is inserted inside the gullet to help keep it open and allow the passage of fluid and food. There are various kinds available, ranging from a simple plastic tube to a device made of metal mesh that expands once it has been put in place.
• Stents can be put in place as a simple procedure at the same time as an endoscopy is carried out.
• Radiotherapy can also be used to try and shrink the tumour and keep the gullet open for longer.

What is the prognosis?   

         

Overall, the outlook is very poor. The five-year survival rate for cancer of the oesophagus is less than 10 per cent. Survival rates are higher in younger patients who are fit enough for intensive treatment, with cure rates of 20 per cent or more.