Oesophageal Cancer

Cancer of the oesophagus is a disease in which malignant cells arise from the tissues of the oesophagus (tube leading to stomach). These eventually grow and obstruct the oesophagus, and spread to other parts of the body, such as the liver.

There are two main types of oesophageal cancer: adenocarcinoma and squamous cell carcinoma. Most adenocarcinomas are now thought to arise in Barrett's mucosa (see Barrett's Oesophagus). Adenocarcinoma of the oesophagus is increasing in many Western countries.

Symptoms

The most common sign of cancer of the oesophagus is difficulty in swallowing (dysphagia). Pain in the chest may be felt when swallowing or at other times. Loss of appetite and weight loss will occur. As the oesophagus becomes obstructed, food which has not passed down the oesophagus may spill over into the lungs (aspiration), causing pneumonia.

Diagnosis

Oesophageal cancer is mainly diagnosed by endoscopy (oesophagoscopy, upper gastrointestinal endoscopy or gastroscopy). Very rarely, it is diagnosed by barium meal.

Endoscopy allows the diagnosis to be made with greater accuracy and also allows biopsies (samples of tissue) to be taken for examination by a pathologist under a microscope. A barium meal may be useful to indicate the degree and length of stricture when preparing the patient for endoscopic oesophageal stenting or surgery.

Other investigations such as blood tests and a CT or MRI scan of the chest and upper abdomen will be done to determine if the cancer has spread. Even if these investigations are negative for spread of cancer, the cells may have spread beyond the oesophagus into the lymph glands. The surgeon will determine this when operating on the oesophagus.

Medical Treatment

The decision regarding treatment is complex. There are several options:

- Surgery to remove the cancer, with intent to cure

- Surgery to remove the cancer, to provide palliation (relief)

- Radiotherapy and chemotherapy (alone or combined with surgery)

- Photodynamic therapy (for very early cancers in selected patients)

- Laser therapy (mainly palliative if the cancer is large)

- Stenting (insertion of a tube to prevent the cancer obstructing the oesophagus)

The choice of treatment depends on many factors including the size of the cancer and extent of spread, age and fitness of the patient, and the patient's wishes. The chance of recovery (prognosis) depends on the stage of the cancer (whether it is in the oesophagus or if it has spread outside to other tissues) and the patient's general state of health.

Even in patients who have inoperable oesophageal cancers or decide not to have curative type surgery, modern techniques allow for good control of symptoms and a good quality of life for a period of months or even years.