Cancer of the oesophagus

The oesophagus or gullet (also known as your food pipe) connects the mouth to the stomach. This important part of your digestive system is located between your trachea (windpipe) and spinal cord and enables food and liquids to pass through and into the stomach.

The oesophagus also contains lymph nodes.

This is a very efficient part of our anatomy but things can occasionally go wrong. One example is cancer of the oesophagus.

This type of throat cancer affects anyone although it is more commonly seen in older adults. It tends to affect men more than women.

The main cause of this cancer is lifestyle: in particular excess alcohol consumption and smoking.

Causes of cancer of the oesophagus

There are often many different reasons why this cancer occurs which makes it difficult to focus on an exact cause. It is the 9^th most common cancer in the UK.

Poor lifestyle choices as in drinking too much alcohol and smoking are the biggest risk factors. People who smoke are at increased risk of this cancer as are people who drink to excess. But people who both smoke and drink too much are at an even greater risk of cancer of the oesophagus.

In fact, these two lifestyle factors are often the main causes of many different types of cancer.

Chewing tobacco is just as risky as smoking it. This type of tobacco is very popular in South Asian countries where it is combined with the betel nut and other substances, wrapped in a leaf and then chewed.

But it contains as much if not more tobacco than cigarettes, is very addictive and can cause throat or oral cancer.

Other causes include:

• Poor diet
• Chronic anaemia
• Obesity
• Certain types of medication: for example medication for Parkinson’s disease which can relax the sphincter between the oesophagus and the stomach. This sphincter acts as a valve and is known as the lower oesophageal sphincter.
• Certain medical conditions: these include acid reflux and tylosis (rare skin condition).

Another possible cause is pollution and/or chemicals. If you work in an environment in which you are exposed to hazardous chemicals, for example silica dust then these can increase the risk of oesophageal cancer.

Symptoms of cancer of the oesophagus

One of the most obvious signs of this cancer is difficulty in swallowing. This will increase over time as the tumour grows.

If you have a tumour growing in your oesophagus then what happens is that this obstructs the passage of food down your gullet. It will feel as if there is something stuck in your chest or gullet and makes digesting food a lot harder.

Many people chew their food into ever smaller pieces to try and help with swallowing and digestion.

This leads to a reduction in the amount of food consumed. If you find it increasingly difficult to swallow food then you are likely to eat less because of this. This reduction in food intake means a reduction in calories which will lead to a loss of weight.

Other signs include:

• Weight loss
• Painful or difficulty in swallowing
• Coughing up blood
• Pain in the back or throat
• Nausea and vomiting
• Chronic cough
• Hoarseness
• Acid indigestion

It is important to remember that these symptoms may not mean that you have oesophageal cancer but have them checked out by your GP all the same.

Diagnosing cancer of the oesophagus

The first step is to visit your GP. He or she will examine you and ask you about your family history. This will be followed by referral to a specialist or an appointment for tests at hospital.

These tests will include X-rays and a blood test. You may also undergo a barium meal or enema. A barium meal involves you swallowing a chalky white liquid –consisting of barium sulphate which shows up the outline of your chest and abdomen on X-rays.

A barium meal will show if there is a tumour in your oesophagus.

Another procedure is an oesophagoscopy.

This is a type of endoscopy which uses a slim fibre optic tube with a camera and light attached at one end. You will be given a sedative beforehand to help you relax or your throat will be sprayed with a local anaesthetic. This helps to numb the area.

This tube is inserted into your mouth and you will be asked to swallow this. The specialist will be able to see inside your oesophagus by means of an eye piece or images relayed onto a video screen.

If he or she suspects an abnormal growth then a biopsy will be taken. A biopsy is where a small sample of tissue is removed and sent to a laboratory to see if contains cancerous cells or not.

You may undergo additional tests which include:

• Ultrasound
• Laparoscopy
• MRI scan
• CT scan
• PET-CT scan

(Source: Cancer Research UK: oesophageal cancer)

These additional tests are only performed if you have been diagnosed with oesophageal cancer. The aim with these is to determine the extent or ‘stage’of your cancer.

Ultrasound

This is performed in conjunction with endoscopy. This involves the normal endoscope procedure and an ultrasound scanner which are used to obtain more detailed images of the oesophagus.

It can also show if there are cancerous cells within the lymph nodes, near to the oesophagus.

Laparoscopy

This is a form of surgery in which a small incision is made in the abdomen before the insertion of a camera and light mounted tube. This is performed under a general anaesthetic.

This tube enables the surgeon to have a closer look at your oesophagus to see how far the cancer has spread.

This procedure is usually carried out if your specialist suspects that your cancer is located lower down your oesophagus, nearer your stomach.

MRI scan

An MRI scan (Magnetic Resonance Imaging scan) is able to show cross sections of a part of the body which includes the tissues. It can also show images of a part of the body from a series of different angles.

This type of scan is preferable to a CT scan although in some cases a CT scan gives a clearer image. It depends upon the type of cancer.

CT scan

A CT scan (Computerised Tomography scan) uses X-rays to obtain an image of inside your body. It takes these X-rays and using a computer, combines them together so that they show a cross section of the body.

This results in an accurate picture of the tumour and the extent of its growth.

PET-CT scan

A PET-CT scan (Positron Emission Tomography scan) is an advanced form of scanner which is able to provide accurate images of tissues within the body and how they function. This type of scanner is very expensive which means that only a few hospitals in the UK have them.

This type of scan will show the type of tumour and whether it has spread and where. This is known as establishing the stage of the cancer.

Your results from these tests

Once you have undergone a range of tests, such as those mentioned above then you will have a period of time to wait for the results.

This can be an anxious time but do not assume that a long wait means that you have cancer. The length of time you wait for these results will be the same whether you have cancer or not.

You may find it helpful to talk to someone during this time or speak to someone at a cancer support group.

Your results and treatment will be discussed with you by a multidisciplinary team. This team will include a cancer specialist, surgeons etc and is there to explain the best treatment options for you.

A major issue here is the extent of your cancer or what stage it is at. It is easier to treat cancer at an early stage but if your cancer is diagnosed at a later stage then it can still be effectively treated.

However the earlier it is detected the easier it is to treat and hopefully cure it. So if you have a sore throat and any of the symptoms mentioned in this section then see your GP as soon as possible.

Treatment for cancer of the oesophagus

Your treatment plan will be based around the following factors:

• General health
• Age
• Lifestyle
• Fitness
• The extent of your cancer

In the main if your cancer has not spread to the surrounding areas then surgery will be performed. This involves removing your oesophagus and is a major procedure.

Your treatment options are:

• Surgery
• Chemotherapy
• Radiotherapy

Surgery

This involves partial or full removal of your oesophagus and possibly the lymph nodes near to this area. The lymph nodes will be sent to a laboratory for analysis and to ascertain the extent of your cancer.

This will enable your team to see what stage your cancer is at.

Chemotherapy

Chemotherapy will be used to try and shrink your tumour/s. This may be done before surgery or used to control the spread of the cancer.

Radiotherapy

Radiotherapy is prescribed after surgery to help prevent a reoccurrence. This is arranged as a course of sessions over several weeks and the duration of this will depend upon the extent of the cancer.

If surgery is not appropriate then you will be offered a combination of chemotherapy and radiotherapy. Both of these are effective at shrinking tumours and relieving the symptoms.

You may undergo radiotherapy or chemotherapy - either of which on their own, or in conjunction with surgery.

Other treatments include laser therapy or photodynamic therapy to remove an obstruction caused by a tumour in your oesophagus.

Laser therapy consists of using high powered lasers to burn away your tumour. Photodynamic therapy is very similar in that it also uses lasers to destroy cancer cells although this is combined with a light sensitive drug.

Another option is a stent - a type of tube inserted into your airway to enable you to eat and drink.

All of these options will be discussed in great detail with you. The pros and cons of each will be thoroughly explained and you are encouraged to ask as many questions as you need to about this.