Oesophageal cancer (cancer of the oesophagus)
What is oesophageal cancer?
Oesophageal cancer, or cancer of the oesophagus, may also be referred to as cancer of the gullet or food pipe.
The oesophagus is a muscular tube measuring 20-25 cm (8-10 in) long and 2-3 cm (0.75-1.25 in) wide that serves as a conduit for moving food and drink from the mouth to the stomach. Two major types of oesophageal cancers exist, as follows:
- Squamous cell carcinoma arises from the epithelial cells that line the oesophagus.
- Adenocarcinoma arises from the oesophageal glands or within a segment of Barrett's oesophagus.
Most tumours occur in the lower oesophagus.
- 40% occur in the lowest third.
- 45% occur in the middle third.
- 15% occur in the upper third.
Risk factors for oesophageal cancer include alcohol abuse, smoking, obesity, poor diet and nutrition and age – being over 55.
Long-term exposure to some chemicals may play a role, as does having the condition Barrett's oesophagus or gastro-oesophageal reflux disease ( GORD).
Symptoms of oesophageal cancer
Symptoms of oesophageal cancer usually do not show up until the disease has reached an advanced stage.
The most common symptom is difficulty swallowing (dysphagia).
- Initially, swallowing solids is difficult.
- Over time, even swallowing liquids becomes difficult.
The following symptoms may accompany cancer of the oesophagus. Any of these symptoms are indications of advanced disease and should be considered as a sign to get medical attention.
Diagnosis of cancer of the oesophagus
The best diagnosis is based on findings from an endoscopic examination of the oesophagus.
- The doctor administers a topical anaesthetic to the throat to suppress the gag reflex. Doctors frequently give intravenous (IV) sedation just before the procedure.
- The doctor then inserts an endoscope into the oesophagus. An endoscope is a thin, flexible plastic tube that contains fibre optic bundles.
- Using a tiny camera in the endoscope, the doctor searches the surface of the oesophagus for areas of concern.
Doctors define oesophageal tumours in terms of their size and location.
- Stage 1 - Cancer limited to the top layers of the cell lining
- Stage 2 - Cancer extending deeper into muscle layers of the oesophagus and may have spread into adjacent lymph nodes
- Stage 3 - Cancer has spread through the wall of the oesophagus and into adjacent tissues and lymph nodes
- Stage 4 - Cancer has spread to other parts of the body such as the liver or lungs
The doctor can take biopsies to confirm whether the abnormality is a cancer and to determine its type.
Upper gastrointestinal (GI) barium contrast studies help the doctor to detect cancers but may fail to detect small tumours more easily seen through endoscopy.
Once the presence of cancer has been confirmed, the doctor tries to determine the spread of the malignancy beyond the oesophagus. Doctors may use the following imaging tests: