Introduction
The oesophagus (or 'esophagus' in American English) is the tube that connects the throat to the stomach, and food, when swallowed, travels down the oesophagus to the stomach. It is often referred to informally as the 'food pipe' or 'gullet'.
Oesophageal cancer develops when cells in the oesophagus start to reproduce abnormally, creating a tumour. Although oesphageal cancer can develop anywhere from the throat to the stomach, in Australia the commonest site for developing this type of cancer is in the lower section of the oesophagus, near to the stomach.
As with other types of cancer, if oesophageal cancer is not detected relatively early, it may spread through the body via the lymphatic system in a process known as 'metastasis'. The condition is more prevalent in men than in women and in Australia is classified as a rare form of cancer.
There are two main forms of oesophageal cancer:
Adenocarcinoma
This type develops in cells in glands that secrete mucus in the oesophagus and is generally more prevalent in the lower section of the oesophagus. This type of cancer is more common in caucasian men than in other sections of the population.
Squamous Cell Carcinoma
This type develops in the 'squamous cells' which are the flat cells lining the inner surface of the oesophagus. This type of cancer is generally more prevalent in the middle and upper sections of the oesophagus. It is more common in Asian populations.
There are also some other, much rarer forms of cancer that affect the oesophagus, such as choriocarcinoma, lymphoma, melanoma, sarcoma and small cell carcinoma.
Causes
Although medical science does not know the precise mechanisms that cause oesophageal cancer, there are a number of known risk factors for the condition, all of which relate to things that can irritate the oesophagus and which over time can increase the risk of developing the condition.
The following are known risks for oesophageal cancer...
- Some pre-existing medical conditions affecting the oesophagus, such as GORD (gastro-oesophageal reflux disease), Barrett's Oesophagus or Oesophageal Achalasia (where the lower sphincter muscle at the junction of the stomach and lower oesophagus remains closed when it should open).
- Family history of gastrointestinal conditions.
- Regular incidents of reflux.
- Smoking.
- Alcohol consumption (high levels).
- Consuming hot drinks (i.e. over 65°C) frequently.
- Low fibre diet (i.e. low in fruit and vegetables).
- High consumption of processed or pickled, salty or smoked foods.
- Exposure to some specific chemical fumes.
- Obesity.
- Radiation therapy to chest/upper abdomen.
Symptoms
There may be no symptoms during the early stages of the condition, as it generally develops over a long period of time. The most common symptom of the condition is difficulty swallowing (also called 'dysphagia'), or sometimes pain or a choking feeling when swallowing. Other symptoms may include...
- Chronic cough.
- Hoarse voice.
- Hiccups.
- Vomiting (and vomiting blood).
- Discomfort in the upper abdomen when eating.
- Reflux / heartburn.
- Bowel motions that are black or with some blood.
- Bone pain.
- Reduction in appetite.
- Fatigue.
- Weight loss (that is otherwise unexplained).
Tests/ Diagnosis
There are a number of tests that can help diagnose oesophageal cancer. These would generally include:
Endoscopy
An endoscope is a long thin flexible tube equipped with a video camera and a light at the tip. The doctor inserts the endoscope via the mouth into the oesophagus to examine the inner surface. During an endoscopy the doctor may also take a small tissue sample (biopsy).
Endoscopic Ultrasound
This involves an endoscope with an ultrasound probe attached that can detect any solid tissue such as a tumour. It is sometimes recommended to detect if cancer has spread into the oesophageal wall or into the lymphatic system.
Imaging
It may be necessary to conduct either a CT (Computed Tomography) scan or a PET (Positron Emission Tomography) scan as well.
Treatment
Treatment for oesophageal cancer depends on many factors, including where the cancer is located and how advanced it is (i.e. what 'stage' cancer it is).
Options to treat the condition include:
- Surgery to either remove the tumour(s), remove a section of the oesophagus (oesophagectomy) or in some cases a section of the upper stomach as well (oesophagogastrectomy).
- Chemotherapy.
- Radiotherapy.
- Immunotherapy – a relatively new area of medical treatment, where a person’s own immune system is stimulated to find and destroy cancer cells. It can be used to treat some people with Oesophageal Cancer.
Frequently these treatments are used in combination to provide the most effective treatment, in fact it is common to combine radiotherapy and chemotherapy in treatment oesophageal cancer, and often before or after surgery.
