Oesophageal cancer

There are two main types of oesophageal cancer:^1,2

• Adenocarcinoma of the oesophagus – usually begins in the lower part of the oesophagus or near where your oesophagus joins with your stomach. Doctors refer to this as the gastro-oesophageal junction, and most tumours in this area are adenocarcinomas.
• Squamous cell carcinoma of the oesophagus – most commonly found in the upper or middle part of the oesophagus and starts in the cells that line the oesophagus.

Oesophageal cancer may not cause symptoms in the early stages.² Symptoms may include:^1,2

• Difficulty swallowing
• A choking sensation when swallowing
• Heartburn or reflux that does not go away
• Unexplained weight loss
• Unexplained fatigue
• Black or bloody stools
• Vomiting blood
• Discomfort in the upper abdomen, mainly when eating

The above symptoms may be related to other conditions and do not necessarily mean you have oesophageal cancer. It’s recommended to speak with your GP or specialist for further information.^1,2

There is no clear causefor oesophageal cancer.¹ However, some factors appear to increase the risk. These may include:^1,2

• Smoking
• Drinking alcohol or frequently drinking very hot liquids
• Exposure to certain chemical fumes
• Obesity
• Certain medical conditions such as Barrett’s oesophagitis (a severe form of reflux)
• Family history of gastro-oesophageal disorders

• Endoscopy – an endoscope is passed into your mouth, down your throat and into your oesophagus to allow your doctor to examine the oesophagus. You may be given intravenous sedation, so you are unlikely to remember the procedure.
• Biopsy – if any unusual tissue is detected during the endoscopy, a small sample will be removed so it can be examined under the microscope. This is called a biopsy and may 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 and is used after diagnosis to assess the depth of the cancer and whether it has spread.
• Laparoscopy – a surgical procedure used to determine if the cancer has spread from the oesophagus to the abdomen.
• Imaging tests – these may include a PET-CT scan to assess whether there are any other tumours or if the cancer has spread to the lymph nodes.

If you are diagnosed with oesophageal cancer, your doctor will explain how far your cancer has progressed and will be able to help you with any further questions. This is known as staging. Oesophageal cancer is commonly staged with the TNM system.¹ This abbreviation refers to:¹

• 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

Chemotherapy is an approach to cancer therapy which involves the administration of medicine, usually orally or by injection, which is intended to kill cancer cells or minimise their growth and spread. Chemotherapy can be used in conjunction with other cancer treatments.³

Radiation therapy may be offered in the early stages of cancer treatment, or after it has started to spread. There are different radiation therapy techniques which may be suitable for different cancer types at different stages.4

There are two types of surgery for oesophageal cancer:^1,2

• Endoscopic resection – May be used in the very early stages of the disease. It involves using an endoscope (a long flexible tube) to remove the abnormal cells
• Oesophagectomy – Removes part or all of the oesophagus, depending on where the cancer is and how it has spread. If part of the oesophagus is removed, the remaining portion is joined to the stomach. If the whole oesophagus is removed, the stomach or part of your bowel may be used to replace it.