Oesophageal cancer

Published by Bupa's Health Information Team, February 2011.

This factsheet is for people who have oesophageal cancer, or who would like information about it.

Oesophageal cancer is a lump created by an uncontrolled growth of cells in the oesophagus. This is the pipe that carries food from the mouth to the stomach, and is sometimes called the gullet.

Animation - How cancer develops

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About oesophageal cancer

Every year around 7,900 people are diagnosed with oesophageal cancer in the UK. Over the past 25 years, the number of men who have been diagnosed with oesophageal cancer in the UK has doubled.

Oesophageal cancer is a malignant tumour. This type of tumour invades the local tissues and spreads to other parts of the body such as the liver or stomach. Metastasis describes the spread of a cancer through the body.

                               The different parts of the digestive system

Types of oesophageal cancer

There are two main types of oesophageal cancer.

• Squamous cell carcinoma – this type develops in the cells lining your oesophagus. It usually develops in the upper half of your oesophagus.
• Adenocarcinoma – this type develops in the mucus-producing gland cells in the lining of your oesophagus. It usually develops in the lower third of your oesophagus including in the junction where it joins your stomach.

Symptoms of oesophageal cancer

Symptoms may include:

• a gradually increasing difficulty in swallowing food (dysphagia)
• food coming back up after you have swallowed it
• weight loss
• pain between your shoulder blades, behind your breastbone, or in your back
• pain in your throat
• indigestion
• vomiting
• a hoarse voice and constant coughing
• coughing up blood

These symptoms aren’t always due to oesophageal cancer, but if you have them see your GP.

Causes of oesophageal cancer

The exact reasons why you may develop oesophageal cancer aren’t fully understood at present. However, certain factors make oesophageal cancer more likely to develop.

• Age – oesophageal cancer is more common in those over 45.
• Being male – men are twice as likely to develop it as women.
• Smoking or chewing any type of tobacco.
• Drinking too much alcohol.
• Not eating enough fruit and vegetables.
• Barrett’s oesophagus – this is when long-term acid reflux (leaking of acid from the stomach) causes changes in the cells lining the lower part of the oesophagus.
• Being overweight.
• Taking certain medicines for osteoporosis and other bone diseases – some research suggests that if you take oral bisphosphonates for longer than five years, you double your risk.
• Coeliac disease can increase your risk.
• Viral or bacterial infections. Helicobacter pylori and the human papilloma virus (HPV) slightly increase your risk of squamous cell carcinoma.

It’s suggested that drinking very hot drinks and eating lots of fried and roasted meat could make you more likely to develop oesophageal cancer. However, more research is needed to confirm a link.

Diagnosis of oesophageal cancer

Your doctor will ask about your symptoms and examine you. He or she may ask about your medical history.

You may have the following tests to confirm a diagnosis, to find out the type of cancer you have, and to discover if the cancer has spread (this is called cancer staging).

• Blood tests.
• Gastroscopy – this is a procedure used to look at the lining of your oesophagus and inside your stomach. A narrow tube-like telescopic camera is passed through your mouth into your oesophagus and stomach. Your doctor may remove a sample of tissue (a biopsy). This will be sent to a laboratory for testing to determine the type of oesophageal cancer.
• Barium meal X-ray – this test involves swallowing a drink containing barium (a substance which shows up on X-ray film) and having an X-ray of the oesophagus.
• CT scan – this uses X-rays to make a three-dimensional image of the body.

If your results show signs of oesophageal cancer, you will usually be referred a surgeon or an oncologist (a doctor who specialises in cancer care).

Treatment of oesophageal cancer

Treatment of oesophageal cancer depends on the type of cancer, how far the disease has progressed, and your general health.

Surgery

Surgery is the most common treatment for early stage oesophageal cancer. The operation is usually carried out under general anaesthesia. This means you will be asleep during the operation.

Your surgeon will remove the section of the oesophagus affected by the cancer. He or she may remove nearby lymph nodes as well (which will be sent to a laboratory to be tested for signs of cancer).

Your operation may be very simple or very complicated depending on the size and position of the tumour. If a small section of the oesophagus is removed, the remaining sections are reconnected to each other or to the stomach and the operation is completed. If a large section of the oesophagus is removed, your surgeon may need to use part of your bowel to replace it and attach it to your stomach. Your doctor will discuss your individual care with you.

Surgery is often combined with chemotherapy and radiotherapy.

Non-surgical treatments

• Chemotherapy uses medicines to destroy cancer cells. You may have chemotherapy alone, before or after surgery or with radiotherapy.
• Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous cells to shrink the tumour. You may have radiotherapy alone, before or after surgery or with chemotherapy.
• Radiofrequency ablation (laser therapy) is when a high-energy beam of light is used to destroy cancer cells. It’s suitable if you have early stage cancer or you don’t want or can’t have surgery.
• Photodynamic therapy is when light-sensitive medicines are injected into your body and absorbed by the cancer cells. A low-powered laser is used to activate the medicines. This treatment is suitable when you don’t want or can’t have surgery.

Advanced oesophageal cancer

Oesophageal cancer can be difficult to cure because often it doesn’t cause symptoms until it has already spread. Where a cure isn’t possible, your treatment will aim to give you as much quality of life as possible. This is known as palliative care.

You may be offered a combination of the treatments listed above to help shrink the tumour and control your symptoms. Medicines are also available to help improve other symptoms such as pain, cough, nausea and vomiting, and poor appetite.

If you have difficulty in swallowing, your surgeon may offer to place a tube called a stent inside your oesophagus to make swallowing easier.

Prevention of oesophageal cancer

You can reduce your risk of developing oesophageal cancer by making certain lifestyle changes such as:

• stopping smoking
• not drinking excessive amounts of alcohol
• eating a balanced diet with at least five portions of fruit and vegetables a day
• losing weight if you have a body mass index (BMI) of 30 or above

Getting enough vitamin D may reduce your risk of developing a number of cancers, including oesophageal cancer – although more research needs to be done to be certain. Vitamin D is also well known to be important for bone health.

Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, do not let your skin redden. If you don't get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough.

Always read the patient information leaflet that comes with your supplements and if you are pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

Help and support

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.