The oesophagus is the food pipe that runs from your pharynx to your stomach. It is also known as the gullet and lies behind the windpipe. Cancerous cells can cause a tumour to develop in any part of the oesophagus. 

There are two main types of oesophageal cancer:

• Adenocarcinoma of the oesophagus Usually starts in the lower third of the oesophagus or near to where your oesophagus joins up with your stomach. Doctors call this the gastro-oesophageal junction, and most tumours in this area are adenocarcinomas.
• Squamous cell carcinoma of the oesophagus Mostly found in the upper or middle part of the oesophagus and starts in cells that line the oesophagus. 

Oesophageal cancer may not cause symptoms in the early stages. As a result, it is often diagnosed in its more advanced stages. Symptoms may include:

• difficulty swallowing
• unexplained ongoing indigestion or heartburn
• unexplained weight loss
• unexplained fatigue
• pain behind the breastbone
• ongoing reflux
• black or bloody stools
• vomit with blood in it
• pain in the upper abdomen, mainly when eating
• ongoing cough or hoarseness

The above symptoms may be related to other conditions and don’t mean you have oesophageal cancer. But they are signs you should see your doctor for a check-up.

There is no clear reason for oesophageal cancer. However, some factors appear to increase the risk. These include:

• smoking¹
• excessive alcohol consumption²
• exposure to certain chemical substances such as asbestos and silica³
• obesity⁴
• certain medical conditions such as Barrett’s oesophagitis, a severe form of reflux⁵
• family history of oesophageal cancer⁶

Your GP will probably refer you to a specialist if they are concerned about your symptoms and risk factors for oesophageal cancer. Tests to diagnose oesophageal cancer may include:

• Endoscopy – This is a standard test that doctors use to investigate concerns about the oesophagus. An endoscope is a thin, flexible tube with a camera and a bright light at the end. It is passed down your mouth into your oesophagus to enable your doctor to look inside. You will standardly be given intravenous sedation so having no memory of the procedure afterwards.
• Biopsy – If any unusual tissue is detected during the endoscopy, a small amount of tissue will be removed so it can be examined under the microscope. This is called a biopsy and will usually be done at the same time as the endoscopy.
• Endoscopic ultrasound - An endoscope with an ultrasound probe is passed through your mouth into your oesophagus. It uses soundwaves to create detailed images of the lining and walls of the oesophagus. It is often used after a diagnosis to determine if cancer has spread.
• Laparoscopy – This is a minor surgical procedure that enables doctors to determine if cancer has spread from the oesophagus to the abdomen.
• Imaging tests - These might include a PET-CT scan to see if there are any other tumours or if cancer has spread to the lymph nodes

If you are diagnosed with oesophageal cancer, your doctor will explain how far your cancer has progressed. This is known as staging. Oesophageal cancer is commonly staged with the TNM system. These letters stand for:

• Tumour: Your doctors will measure the size of the tumour and how far it has grown into the oesophagus wall
• Nodes: Refers to whether cancer has spread to lymph nodes
• Metastasis: Refers to whether cancer has spread to other parts of the body

The treatment for oesophageal cancer will depend on how advanced it is. Treatments that may be offered include:

• chemotherapy
• endoscopic treatment
• radiation therapy
  
• surgery

We understand that a cancer diagnosis can be emotional and life-changing. It’s natural to feel disbelief, anxiety, sadness, anger and loneliness. At GenesisCare, we strive to strengthen your confidence, settle your emotions and create care experiences that give you the best possible outcomes.

Our care team will know your name and get to know who you are as a person. We don’t want you to feel alone when you’re with GenesisCare. Your nursing team and oncology team are here to support you before, during and after your cancer treatment. We are here to guide you to get you the support you need from experts such as psychologists, exercise physiologists, physiotherapists and dietitians.

Please contact your local GenesisCare centre for more details on the services available. View a list of our centres here.

Whether you experience side effects and how severe they are depends on the type and dose of chemotherapy treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short-term and can be managed. These may include:

• fatigue
• nausea or vomiting
• constipation or diarrhoea
• hair loss
• easily bruising or bleeding
• weight changes
• skin changes
• mood changes
• sores and pain around the mouth

These symptoms tend to improve gradually once treatment stops. Talk to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects.

• Get as much rest as possible
• Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
• Drink lots of water
• Reach out to support groups and others who have had chemotherapy
• Ask your team about topical treatments for your skin if you have irritation or pain
• Stay out of the sun as much as possible throughout your treatment
• Record your side effects in a diary or journal
• Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
• It is important to acknowledge when you are fatigued and rest when you need to
• Ask for and accept help from family, friends, and neighbours
• Be open with employers about your treatment and discuss flexible working options if you need them

General side effects can include:

• sore throat
• tiredness
• difficulty eating or drinking
• heartburn or reflux
• minor bleeding in your oesophagus

General side effects include:

• soreness and swelling around the treatment area
• tiredness and lethargy for a few weeks after you finish

Specific side effects (depending on the area being treated):

• difficulty or pain swallowing
• dry mouth
• nausea and indigestion, acid reflux symptoms

Most of these side effects will ease soon after treatment is finished. Your team will discuss any long-term considerations with you, depending on the tumour type.

General side effects include:

• swelling and pain
• difficulty eating and drinking for several days
• nausea
• tiredness
• reflux
• hoarse voice

Other oesophageal cancer information, resources and support services are available to assist you during your cancer journey. These include:

Cancer Council Australia

13 11 20

cancer.org.au

Australian Cancer Research Foundation

02 9223 7833

acrf.com.au

References

1. Smoking Cessation and Risk of Esophageal Cancer by Histological Type: Systematic Review and Meta-analysis. J Natl Cancer Inst 2017 Dec 1;109(12). doi: 10.1093/jnci/djx115. https://pubmed.ncbi.nlm.nih.gov/29933436/
2. Alcohol consumption and corresponding factors: A novel perspective on the risk factors of esophageal cancer. Oncol Lett. 2016 May; 11(5): 3231–3239. Published online 2016 Apr 1. doi: 10.3892/ol.2016.4401. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4840924/
3. Environmental Causes of Esophageal Cancer. Gastroenterol Clin North Am. 2009 Mar; 38(1): 27–vii. doi: 10.1016/j.gtc.2009.01.004. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2685172/
4. The role of obesity in oesophageal cancer development. Therap Adv Gastroenterol. 2014 Nov; 7(6): 247–268. doi: 10.1177/1756283X14538689. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212467/
5. Risk of oesophageal cancer in Barrett’s oesophagus and gastro-oesophageal reflux. University of Nottingham, Division of Epidemiology and Public Health, Queen’s Medical Centre. https://gut.bmj.com/content/53/8/1070
6. Family history of esophageal cancer increases the risk of esophageal squamous cell carcinoma. Sci Rep. 2015; 5: 16038. Published online 2015 Nov 3. doi: 10.1038/srep16038. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630623/#:~:text=The%20reconstructed%20cohort%20analysis%20showed,increases%20the%20risk%20for%20ESCC