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Oesophageal cancer


Expert reviewer, Dr Adam Dangoor, Consultant Medical Oncologist
Next review due January 2023

Oesophageal cancer is a cancer of the oesophagus, or gullet (the pipe that carries food and drink from your mouth to your stomach).

Around 9,100 people get oesophageal cancer each year in the UK, and it’s getting more common. Most people who get oesophageal cancer are over 60. It's very rare in people under 40, and more men get oesophageal cancer than women.

An image showing a diagram of the digestive system

Types of oesophageal cancer

There are two main types of oesophageal cancer.

  • Adenocarcinoma. This develops in the mucus-producing gland cells in the lining of your oesophagus. It’s usually in the lower part of your oesophagus.
  • Squamous cell carcinoma. This develops in the cells that line your oesophagus and usually starts in the upper and middle parts of your oesophagus.

Causes of oesophageal cancer

Doctors don’t yet fully understand what causes oesophageal cancer but some things can make you more likely to develop it.

  • Age – more than eight out of 10 people with oesophageal cancer are over 60.
  • Gender – men are more than twice as likely to develop oesophageal cancer as women.
  • Smoking or chewing any type of tobacco increases your risk.
  • Alcohol – drinking too much can increase your risk of oesophageal cancer.
  • Diet – eating a high-fat diet while not eating enough fruit and vegetables.
  • A condition called Barrett’s oesophagus, where long-term acid reflux (leaking acid from your stomach) changes cells that line your lower oesophagus, is linked to oesophageal cancer.
  • Being overweight or obese raises your risk.
  • Radiation therapy – if you’ve previously had treatment with radiation for another cancer, you may be at a slightly increased risk.
  • Human papilloma virus (HPV) infection. If you have this virus, it can increase your chance of getting oesophageal cancer. It’s important to get the vaccination as a teenager to help prevent this.

How cancer develops


Symptoms of oesophageal cancer

In the early stages of oesophageal cancer, you might not have any symptoms. As it progresses, the main symptom of oesophageal cancer is difficulty swallowing (dysphagia). This may come on gradually and you may notice solid foods sticking, and then find that you have problems swallowing even liquids. You may also have discomfort or pain when you swallow.

Other symptoms of oesophageal cancer may include:

  • food coming back up after you’ve swallowed it
  • unexplained weight loss
  • chest pain – the pain may be in the centre of your chest or less often, in your shoulder or back
  • indigestion or heartburn that doesn’t go away
  • a hoarse voice or a cough that won’t go away

If you have these symptoms, it doesn’t necessarily mean you’ve got oesophageal cancer but go and see your GP.

Diagnosis of oesophageal cancer

Your GP will ask about your symptoms and medical history, and will examine you. They may investigate your symptoms with some tests or refer you to a specialist who will arrange tests, which may include the following.

  • Gastroscopy. This is a procedure to look at the lining of your oesophagus and inside your stomach. At the same time, your doctor may take a sample of tissue to test.
  • Blood tests. Your doctor may recommend you have some blood tests.

Further tests for oesophageal cancer

If cancer is found, your doctor will offer you further tests to see how big your cancer is and if it’s spread. This is called cancer staging and may include the following tests.

  • CT scan. This uses X-rays to make a three-dimensional image of your body.
  • Endoscopic ultrasound. This is a procedure to look at the inside of your oesophagus using a thin tube (endoscope). There’s an ultrasound scanner on the end of the endoscope. The scanner uses sound waves to produce an image. A sample (biopsy) of the cancer may be taken at the same time.
  • PET-CT scan. This combines a CT scan with a PET scan. In a PET scan, a medicine is used to show up parts of your body where cells are extremely active, these may be cancer cells.
  • Laparoscopy. In this procedure, your surgeon will look inside your tummy (abdomen) using an endoscope.

If your results show signs of oesophageal cancer, you’ll usually see a surgeon. They’ll work with a team of health professionals who specialise in cancer to assess the results of your tests.

Treatment of oesophageal cancer

Your treatment for oesophageal cancer will depend mainly on how far your cancer has spread and your general health. A team of specialists called a multidisciplinary team (MDT) will be involved in planning your care. This will include a surgeon, an oncologist (a doctor who specialises in cancer care), a specialist radiologist and specialist cancer nurses. They may offer you a choice of options for oesophageal cancer treatment, but it’s your decision what treatment and care you have.

If you’re diagnosed when your cancer is still in the early stages, it can mean it’s easier to control and possibly cure. This may not be the case if your cancer is advanced. Sometimes treatment has to be balanced with the risk of side-effects and the effect this will have on your quality of life.

Making a decision about treatment can be very difficult but your doctors and nurses will support you and answer any questions you have.

Surgery

Oesophagectomy

Surgery is the most common treatment for oesophageal cancer and is usually done under general anaesthesia. This means you’ll be asleep during the operation. Most people need to have all or part of their oesophagus removed in an operation called an oesophagectomy.

Your surgeon will remove the section of your oesophagus that’s affected by cancer. They may remove nearby lymph nodes too. How simple or complicated your operation is will depend on the size and position of your cancer. If your surgeon removes a small section of your oesophagus, they’ll reconnect the remaining sections to each other or to your stomach. If they remove a large section of your oesophagus, your surgeon may need to use part of your stomach or bowel to replace it. It’s likely that you will have chemotherapy and/or radiotherapy as well as surgery to treat oesophageal cancer.

Endoscopic mucosal resection

If you have a very small, early cancer your surgeon may offer you a procedure to remove just the lining of your oesophagus or stomach. This is done through an endoscope and is called an endoscopic mucosal resection (EMR). Ask your surgeon if this is an option for you.

Non-surgical treatments

There are various treatments that your doctor may offer you alongside or instead of surgery. These include the following.

  • Chemotherapy uses medicines to destroy cancer cells. Usually, you have chemotherapy before or sometimes after surgery, often with radiotherapy (chemoradiotherapy).
  • Radiotherapy uses radiation to destroy cancer cells. Radiotherapy is usually combined with chemotherapy and given either alone, or before surgery. A beam of radiation is targeted on the cancerous cells to shrink the tumour. Less often, you may be given radiotherapy from inside your oesophagus – this is called brachytherapy.

Advanced oesophageal cancer

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

You may still 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, a cough, feeling sick and vomiting, and a poor appetite.

You may see a dietitian to ensure that you’re eating enough – they can help you if you can’t swallow solid food. If you have difficulty swallowing, your surgeon may offer to put a tube called a stent inside your oesophagus to make this easier. They may need to place a tube through your nose into your stomach (a nasogastric feeding tube) if you can’t swallow at all.

For more information about palliative care, see our FAQ: What does hospice care involve?

Prevention of oesophageal cancer

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

  • stopping smoking
  • cutting back on alcohol
  • eating a healthy balanced diet with at least five portions of fruit and vegetables a day
  • losing weight if you are overweight or obese. See our page on what is a healthy weight for adults
  • having the HPV vaccine as a teenager

Help and support

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, so talk to them if you’re finding it hard to cope.

You may also find it helpful to contact a cancer organisation –for more information, see our section: Other helpful websites. They have detailed information about oesophageal cancer and some have a helpline you can ring or an online forum where you can connect with others. There may also be local groups where you can meet other people with similar medical issues or other carers. Ask your cancer team if they can direct you to any.

You may find our general cancer information helpful, and we have many tips and hints on dealing with cancer in our health articles.

Frequently asked questions

  • It’s natural to worry about eating and drinking after you have surgery for oesophageal cancer. In the first day or two after surgery you won’t be able to drink so your hospital team will give you liquids through a drip into your vein. You can then try to sip water and gradually drink more.

    During surgery, your surgeon may have put a small feeding tube into your small bowel to feed you while you can’t eat or drink. This is temporary – and they’ll usually remove the tube after four to six weeks – and not everyone needs this tube. Alternatively, you may have parenteral nutrition – this is a way of getting nutrition into your body through your veins.

    You’ll gradually build what you drink and eat, guided by your healthcare team, which will include a dietitian who will give you support and advice. You’ll usually be able to eat normally again after a few months, but it may take longer.

    If you’ve had part of your stomach removed, you might find you need to eat smaller meals more often than before. And you may have some problems at first such as diarrhoea, sickness or indigestion. It might help to chew food well, eat meals slowly and drink plenty of fluids with your meals. It’s common to lose weight in the first few weeks after you have surgery, but this should slow down as you begin to eat more.

  • If your oesophageal cancer can’t be cured and you need support to control your symptoms, your doctor may recommend hospice care. This can help you to live as fully and as well as you can, however long that may be.

    Hospices are usually smaller and quieter than hospitals and aim to be more like home for you. A team of specialist nurses and doctors who are experienced in the care of people with advanced cancer will look after you. They’ll work in partnership with your GP and cancer team to give you the best care.

    Palliative care teams from the hospice can also provide care and support outside the hospice so you can be treated at home. Specialist nurses will visit you occasionally to provide the care you need.

    Hospice care can include:

    • control of pain and other symptoms
    • psychological and social support for you and your carers
    • counselling
    • practical and financial advice
    • spiritual care
    • complementary therapies

    There’s no cost to you for hospice care, and you can find out about local hospices from your GP or district nurse. You can also contact the charity Hospice UK, which has an online list of hospice providers.


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Related information

    • Oesophageal cancer. BMJ Best Practice. bestpractice.bmj.com, last reviewed October 2019
    • What is oesophageal cancer? Cancer Research UK. www.cancerresearchuk.org, last reviewed 1 August 2019
    • Oesophago-gastric cancer: assessment and management in adults. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published January 2018
    • Oesophageal cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed 5 May 2016
    • BMJ Best Practice. Oesophageal cancer. bestpractice.bmj.com, last reviewed October 2019
    • Oesophageal cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed 9 Aug 2019
    • Upper gastrointestinal cancer: oesophageal. Oxford handbook of oncology (online). Oxford Medicine Online. oxfordmedicine.com, published online October 2018
    • Allum WH, Blazeby JM, Griffin SM, et al. Guidelines for the management of oesophageal and gastric cancer. Gut. 2011; 60:1449
    • HPV: protecting against HPV infection to help reduce your risk of cancer. GOV.UK. gov.uk, published June 2019
    • Lordick F, Mariette C, Haustermans K, et al. Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27(supplement 5):v50–57
    • Managing symptoms and side-effects. Macmillan. www.macmillan.org.uk, reviewed 31 January 2019
    • Types of nutritional support. Macmillan. www.macmillan.org.uk, reviewed 31 August 2017
    • What happens after surgery? Macmillan. www.macmillan.org.uk, reviewed 31 May 2018
    • Enteral feeding. Patient. patient.info, last edited 21 May 2015
    • What is hospice care? Hospice UK. www.hospiceuk.org, accessed 7 November 2019
    • Choosing where to die. Cancer Research UK. www.cancerresearchuk.org, last reviewed 20 February 2019
    • How a hospice can help you. Marie Curie. www.mariecurie.org.uk, accessed 7 November 2019
    • Who can get hospice care? Hospice UK. www.hospiceuk.org, accessed 7 November 2019
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, Bupa Health Content Team, January 2020
    Expert reviewer, Dr Adam Dangoor, Consultant Medical Oncologist
    Next review due January 2023



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