We give just a very brief overview here of oesophageal cancer and its treatment. If you have oesophageal cancer, your doctor will discuss with you the tests and treatments that are best for you.
Types of oesophageal cancer
There are two main types of oesophageal cancer.
- Squamous cell carcinoma. This type develops in the cells that line your oesophagus. It usually starts in the upper two thirds of your oesophagus.
- Adenocarcinoma. This type develops in the mucus-producing gland cells in the lining of your oesophagus. It usually occurs in the lower two thirds of your oesophagus, including where it joins your stomach.
Symptoms of oesophageal cancer
In the early stages of oesophageal cancer you may have no symptoms.
The main symptom of oesophageal cancer is difficulty swallowing (dysphagia). This may come on gradually. You may notice solid foods sticking, and then find that you have problems swallowing even liquids. You may also have pain or discomfort on swallowing.
Other symptoms may include:
- food coming back up after you’ve swallowed it
- unexplained weight loss
- pain between your shoulder blades, behind your breastbone or in your back
- indigestion or heartburn that doesn’t go away
- a hoarse voice or a cough that won’t go away
- a lump in your neck
Having these symptoms doesn’t necessarily mean you’ve got oesophageal cancer. But if you have them, see your GP.
Diagnosis of oesophageal cancer
Your GP will ask about your symptoms and examine you. They may ask you about your medical history. Based on their assessment, your GP may investigate your symptoms with further tests, or may refer you to a specialist who will arrange testing.
Tests to diagnose oesophageal cancer
Gastroscopy. The most usual test is called a gastroscopy (a type of endoscopy). This is a procedure used to look at the lining of your oesophagus and inside your stomach. Your doctor or specialist nurse will pass a narrow, tube-like, telescopic camera through your mouth into your oesophagus and stomach. They may remove a sample of tissue (a biopsy). This will be sent to a laboratory for testing. You can find out more about this test from our page on gastroscopy.
Barium swallow. Another test which is sometimes used to tell if you have oesophageal cancer is a barium swallow. This test involves swallowing a drink containing barium (a substance which shows up on X-rays) and having an X-ray of your oesophagus. This test would only be offered by a hospital specialist. You can find out more about this test from our page on barium swallow.
Your doctor may also recommend 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 (called cancer staging). These may include the following.
- CT scan. This uses X-rays to make a three-dimensional image of part of your body.
- Endoscopic ultrasound. This is similar to an endoscopy but there’s an ultrasound scanner on the end of the endoscope. This uses sound waves to produce an image of the inside of your oesophagus. A biopsy of the cancer may be taken at the same time with a fine needle.
- PET-CT scan. This special scan combines a CT scan with a PET scan. In a PET scan a special medicine is used to show up parts of your body where cells are extremely active. These may be cancer cells.
- Laparoscopy. Your surgeon will look inside your abdomen using a thin tube (endoscope) while you’re asleep.
If your doctor recommends these or other tests they’ll carefully explain what each involves. Feel free to ask any questions you have.
If your results show signs of oesophageal cancer, you’ll usually see a surgeon. An oncologist (a doctor who specialises in cancer care) may also be involved in your care. They’ll work with a team of health professionals who specialise in cancer to assess the results of all the tests. See our FAQ below on treatment decisions.
Treatment of oesophageal cancer
The treatment your doctor offers you for your oesophageal cancer depends mainly on how far your cancer has spread (its ‘stage’) and your general health.
You’ll have a team of specialists involved in planning your care, including a surgeon, an oncologist and specialist cancer nurses. They help you to decide which treatment is best for you. See our FAQ on treatment decisions below for more information.
We just give a very brief overview of treatment of oesophageal cancer here. You can find out a lot more information about treatment of oesophageal cancer from the websites of Cancer Research UK and Macmillan.
Surgery is the most common treatment for oesophageal cancer and is usually carried out under general anaesthesia. This means you’ll be asleep during the operation.
Your surgeon will remove the section of your oesophagus affected by the cancer. They may remove nearby lymph nodes as well (these will be sent to a laboratory to be tested for signs of cancer). How simple or complicated your operation is will depend on the size and position of your cancer. If a small section of your oesophagus is removed, the remaining sections are reconnected to each other or to your stomach. If a large section of your oesophagus is removed, your surgeon may need to use part of your bowel to replace it. Your doctor will discuss your individual care with you before you have surgery.
Most people need to have all or part of their oesophagus removed. 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). You can ask your surgeon whether this is an option for you.
There are various non-surgical treatments which your doctor may offer you alongside, or instead of surgery. They’ll discuss with you whether these are an option in your particular circumstances. The most commonly used non-surgical treatments include the following.
- Chemotherapy uses medicines to destroy cancer cells. Chemotherapy is usually given before or sometimes after surgery, often with radiotherapy. When chemotherapy and radiotherapy are combined it’s called chemoradiotherapy.
- Radiotherapy uses radiation to destroy cancer cells. Radiotherapy is usually combined with chemotherapy and usually given either alone, or before surgery. A beam of radiation is targeted on the cancerous cells to shrink the tumour; it will require a number of treatment doses. In some circumstances you may be given radiotherapy from inside your oesophagus, called brachytherapy, which can be given as a single dose.
- Photodynamic therapy is when light-sensitive medicines are injected into your body and absorbed by the cancer cells. A laser is then used to activate the medicines and kill the cancer cells.
Advanced oesophageal cancer
Oesophageal cancer can be difficult to cure because often it doesn’t cause symptoms until it has already spread. When 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, cough, feeling sick and vomiting and poor appetite.
In advanced cancer, or even if your cancer can be treated with surgery, you may see a dietitian. This is to ensure that you’re eating enough – they can advise you if you can’t swallow solid food. If you have difficulty in swallowing, your surgeon may offer to place 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. This lets liquid food pass directly into your body.
See our FAQ below on hospice care.
Causes of oesophageal cancer
Doctors don’t yet fully understand what causes oesophageal cancer. However, certain factors make you more likely to develop it.
- Age – more than eight out of 10 people with oesophageal cancer are over 60.
- Being male – men are more than 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.
- Having a condition called Barrett’s oesophagus. This is where long-term acid reflux (leaking of acid from your stomach) causes changes in the cells lining your lower oesophagus.
- Being overweight or obese.
- Radiation therapy. If you’ve previously had treatment with radiation for another cancer, you may be at a slightly increased risk, but this is rare.
How cancer develops
Prevention of oesophageal cancer
See our section on causes of oesophageal cancer above to find out what factors increase your chance of getting it. 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 are overweight or obese. See our page on what is a healthy weight for adults.
Help and support
Being diagnosed with cancer and facing treatment 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. Talk to your doctor or nurse if you’re finding your feelings hard to cope with.
Everyone has their own way of coping. But for further support and advice you may find it helpful to contact one of the well known cancer organisations or visit their websites. They have information about most types of cancer – often in more detail than we can go into here. Some have a telephone helpline you can ring, or an online forum you can join for a chat with others in your position. There may also be local groups where you can meet other people with similar medical issues, or other carers. Your cancer team may know of some.
See our section ‘other helpful websites’ below for contact details of relevant organisations. You may also find our general cancer articles helpful, and we have a lot of useful tips and hints on dealing with cancer in our health blog.
FAQ: How will surgery affect my eating?
It’s natural to feel concerned about eating and drinking after you have surgery for oesophageal cancer.
In the first few days after surgery you won’t be able to drink. You’ll get the liquids you need through a drip into your vein. You may be allowed sips of water at first. When your surgeon is happy that your oesophagus is healing you’ll be allowed to drink normally. This may be after one or two days.
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 – you’ll usually have this removed after 4 to 6 weeks. Not everyone needs this tube.
You’ll gradually build up what you drink and eat, guided by your healthcare team. This will include a dietitian who can give you support and advice. You’ll usually be able to eat normally again after a few months, but it can take longer. You may find you need to eat smaller meals more frequently than before if you’ve had part of your stomach removed.
It’s common to lose weight in the first few weeks after surgery, but this should slow down as you begin to eat more. It’s also possible that you will have diarrhoea, sickness or indigestion. You’ll probably find that it helps to chew food well, eat meals slowly and drink plenty of fluids when you eat.
You can find out more about eating after oesophageal cancer treatment from the websites of Cancer Research UK and Macmillan.
FAQ: How will my treatment be decided?
Your treatment will be based on your individual circumstances, your general health, the type of cancer you have and how far it has spread. Your own wishes will be taken into account.
A team of doctors and other cancer specialists will discuss the best treatment and care for you in your particular circumstances. This group of people is called a multidisciplinary team (MDT). They’ll look at the type of cancer you have and whether it’s spread. They’ll also consider your general health. They may offer you a choice of options for treatment. It’s your decision what treatment and care you have.
You may find it helps to have a family member or friend with you when you talk to your doctor about treatment options. They may help you to remember what’s been said. You may also want to write down some questions before your appointment so that you don’t forget them.
Getting diagnosed when your cancer is still in the early stages can mean it’s easier to control and possibly cure. Surgery will probably be your main option to remove all of the cancer and reduce the risk of it spreading further. Your doctor may also recommend chemotherapy, radiotherapy or both.
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. You may choose not to have any treatment at all.
See our section on treatment of oesophageal cancer above for more information.
Making a decision about treatment can be very difficult. It’s important that you talk to the doctors and nurses and ask any questions that you have. You can find out a lot more information about the various treatments for oesophageal cancer from Cancer Research UK and Macmillan.
FAQ: What does hospice care involve?
If you have oesophageal cancer that can’t be cured and you need support to control your symptoms, your doctor may recommend hospice care. This is care which looks after your medical needs at a time when cure is not possible. But it also looks after your other needs – emotional, practical, social and spiritual – and supports your family.
You may be familiar with this type of care being given during a stay in a hospice, a special care home. But many people have hospice care in their own home, or as a day patient to a hospice.
For some people, a hospice is where they stay during the final stage of their illness. But many people go into a hospice for short periods to get their symptoms under control, and then return home. You may choose to have a short stay in a hospice to allow your carers to take a break. This is called respite care.
Hospices are usually smaller and quieter than hospitals and try to be more like home for you. You’ll be looked after by a team of specialist nurses and doctors who are experienced in the care of people with advanced cancer. They’ll work in partnership with your GP and cancer team to give you the best care.
Hospice care can include:
- control of pain and other symptoms
- psychological and social support for you and your carers
- practical and financial advice
- spiritual care
- support in bereavement
- complementary therapies
There is no cost to you for hospice care. It’s funded by charities, with some NHS funding too. You can find out about local hospices from your GP or district nurse. You can also contact the charity Hospice UK, who have an online list of hospice providers.
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- Oesophageal cancer. PatientPlus. patient.info/patientplus, last checked 24 November 2014
- Upper gastrointestinal cancer. Oxford handbook of oncology (online). Oxford Medicine Online. oxfordmedicine.com, published September 2015
- Map of Medicine. Upper gastrointestinal (GI) cancer. International View. London: Map of Medicine; 2015 (Issue 4)
- Oesophageal cancer. Cancer Research UK. www.cancerresearchuk, last reviewed 6 July 2016
- Lordick F, Mariette C, Haustermanns K, et al. Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up. Ann Oncol 2016; 27(5):v50–v57. doi: 10.1093/annonc/mdw329
- Oesophageal cancer. British Society of Gastroenterology. www.bsg.org.uk, accessed 23 May 2017
- Oesophageal (gullet) cancer. Macmillan. www.macmillan.org.uk, reviewed 28 March 2014
- What is hospice care? Hospice UK. www.hospiceuk.org, accessed 25 May 2017
- End of life care. NHS Choices. www.nhs.uk, last reviewed 9 July 2015
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