What is oesophageal cancer?The oesophagus (or gullet) is a tube that connects the mouth to the stomach, allowing for food to move to the stomach for digestion. Oesophageal cancer occurs when abnormal cells begin to form and multiply in the oesophagus. In 2015, oesophageal cancer accounted for 3% of all overall cancers. Oesophagal cancer usually begins in the cells that line the inside of the oesophagus. However, it can spread to other parts of the body, such as the lungs, liver and stomach. It can occur in anyone however habits such as smoking and drinking alcohol regularly can increase the risk of oesophageal cancer occurring. Unfortunately, oesophageal cancer remains asymptomatic (without symptoms) until it has progressed. However, common symptoms include difficulty swallowing, loss of weight and abdominal pain.
Types of oesophageal cancer:Oesophagus cancer is classified according to the type of cells it occurs in. There are two main types of oesophageal cancer:
- Adenocarcinoma – This form of cancer begins in small glands located inside the oesophagus. It usually occurs in the lower portion of the oesophagus.
- Squamous cell carcinoma – Squamous cell carcinoma affects the squamous cells. These cells make up the thin lining of the oesophagus.
Causes and risk factors of oesophageal cancer:Nobody knows what causes oesophageal cancer. However, there are several common risk factors associated with oesophagal cancer. A risk factor is something that increases the likelihood of cancer occurring. Oesophageal cancer can still occur in people who do not have any risk factors. Common risk factors include:
- Smoking – People who smoke tobacco are at a higher risk of developing oesophageal cancer, as well as other cancers in the lungs and throat.
- Regular alcohol use – If you drink alcohol on a regular basis, you are more prone to developing oesophagal cancer.
- Gastroesophageal reflux disease (GERD) – Gastroesophageal reflux disease is a digestive disease in which stomach acid or bile irritates the oesophageal lining. Suffers of this disease are at a much higher risk of developing oesophageal cancer.
- Obesity – People who are overweight are more at risk of developing oesophageal cancer.
- Malnutrition – People who do not have enough vitamins and minerals in their diet are at higher risk.
- Age – People over the age of 70 are at an increased risk of developing oesophageal cancer.
Symptoms of oesophageal cancer:An early diagnosis is crucial in treating oesophageal cancer. This is because it allows doctors to start treatment sooner. For this reason, it is important that you see a doctor if you notice any of the following symptoms:
- Difficulty swallowing – Oesophageal cancer can cause obstructions in the oesophageal passage, leading to problems swallowing.
- Indigestion – Sufferers of oesophageal cancer will often experience constant indigestion and heartburn, especially after eating.
- Coughing – Oesophageal cancer can cause you to develop a cough which does not go away with time. This can often be accompanied by hoarseness (loss of voice).
- Chest pain – Sufferers of oesophageal cancer may experience pressure or burning pains in their chest or abdomen.
- Loss of weight – Oesophageal cancer can explain an unexpected loss in body weight. This may be accompanied by a loss of appetite.
How is oesophageal cancer diagnosed?Physical examination: Usually, a doctor will start their diagnostic process by performing a physical examination. This includes learning about your symptoms, examining suspected areas and performing a blood test to check for levels. Following a physical examination, one or more of the following methods will be used: Endoscopy: During an endoscopy, a doctor will use a long, flexible tube called an endoscope to examine the oesophagus. The endoscope has a small camera and light located at its end. This allows doctors to see the insides of the oesophagus and spot any signs of cancer. The doctor may also take a small sample (biopsy) of cells during this process. This sample will then be sent to a lab for examination under a microscope. X-rays and imaging: Imaging tests such as x-rays may be used to examine the oesophagus. Before the x-ray takes place, a radiologist may recommend that you drink a white liquid called barium. This process is called a barium swallow. Barium sulfate is a metallic compound that shows up clearly on x-rays. When ingested, it allows doctors to see the oesophagus more clearly.
Treatment options for oesophageal cancer:When diagnosed with oesophageal cancer, a team of specialists will work together to create a treatment plan. The type of treatment plan you are given will depend on several factors, such as the location, stage and spread of cancer. Common treatment options for oesophageal cancer include:
Surgery:During surgery, surgeons will attempt to remove as much cancer as possible. A small section of surrounding tissue (called a margin) will also be removed. This reduces the chances of cancer reoccurring. Surgery may be used as a standalone treatment or in combination with other treatments. Below are the most common forms of surgery for oesophageal cancer:
- Removal of small tumours – If your tumour is still very small, it can usually be removed using an endoscope. This procedure is most effective when cancer is diagnosed early.
- Oesophagectomy – During an oesophagectomy, a portion of the oesophagus is removed. This portion will contain the tumour as well as nearby tissue and lymph nodes. A portion of the upper stomach may also be removed. What is left of the oesophagus is then connected to the stomach, allowing for correct flow of food post-surgery.
- Oesophagogastrectomy – During an oesophagogastrectomy, part of the oesophagus is removed as well as nearby lymph nodes and a larger part of the stomach. An oesophagogastrectomy is usually necessary for cancer that has spread to the stomach. Sometimes, skin from the colon is used to reattach the oesophagus to the stomach.
Radiation therapy:During radiation therapy (or radiotherapy), high-energy radiation is used to target and destroy cancer cells. This is usually via a machine which aims high-energy beams at the tumour. Radiation therapy is often used post-surgery to reduce the likelihood of cancer reoccurring. It is also sometimes combined with chemotherapy to increase its effectiveness. Radiation therapy can cause side effects. These include:
- Red, irritated skin around the targeted area (similar to sunburn).
- Fatigue and tiredness.
- Nausea and vomiting due to the treatment being close to the stomach.
Chemotherapy:Chemotherapy is the use of drugs to target, destroy and prevent the reproduction of cancer cells. Chemotherapy will often be combined with radiation therapy to increase its effectiveness. During chemotherapy, medication will be administered in a series of sessions. During each session, medication will be given either orally or intravenously, through a drip. The time between each session will give your body a chance to recover from side effects. Common side effects of chemotherapy include:
- Tiredness and fatigue
- Increased risk of infection
- Loss of hair
- /nausea and vomiting