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Oesophageal Cancer

FAQ's About Oesophageal Cancer

What is Oesophageal Cancer?

The oesophagus (also known as the food pipe) connects the mouth to the stomach. The food pipe pushes food and drink down into the stomach, where it begins to be digested. 

Oesophageal Cancer is fairly common in the UK, with almost 10,000 new cases diagnosed each year. The biggest risk factor for this cancer is having Gastro-Oesophageal Reflux Disease (GORD). While 1 in 3 of us suffer heartburn from time to time, 10% of the population have chronic reflux (experiencing heartburn almost daily). 5-10% of people with chronic GORD are diagnosed with a condition called Barrett’s Oesophagus and 1 in 10 Barrett’s patients may develop Oesophageal Cancer. 

Oesophageal cancer may not cause symptoms in its early stages, which is why it can be hard to detect. Many people who suffer from persistent heartburn (and are diagnosed with Barrett’s Oesophagus) will attend regular ‘surveillance’ screening to check their food pipe for signs of cancer.

As oesophageal cancer grows, there may be more obvious symptoms like difficulty swallowing (a sensation of food stuck in the throat), a pain in the chest or a squeezing sensation, bad heartburn which does not go away with the patient’s usual medication, a sour taste in the mouth, persistent coughing or wheezing, hoarseness or vocal changes and often unintentional weight loss.

People with advanced Oesophageal Cancer often report feeling unusually tired, complain of back and neck pain or notice swelling in their face or neck. It is important to consult a doctor if you are experiencing any of these symptoms – particularly if they last several weeks – as early diagnosis of Oesophageal Cancer improves patient outcomes vastly.

What causes Oesophageal Cancer?

Oesophageal Cancer can develop for several reasons, but it is important to understand the lifestyle factors that can increase your risk. Efforts to reduce risk factors like smoking, alcohol intake and an unhealthy diet may prevent Oesophageal Cancer (or even if you have been diagnosed, you could help prevent it coming back):

  • Smoking increases your risk (especially for squamous cell carcinoma of the oesophagus)
  • Alcohol, particularly heavy drinking on a regular basis, can damage the oesophagus and increase the risk (especially for squamous cell carcinoma)
  • A poor diet low in fruits and vegetables and high in processed foods or red meat may increase your risk (especially for squamous cell carcinoma)
  • Obesity can increase the risk of heartburn, GORD, Barrett’s Oesophagus and the risk of developing adenocarcinoma. This is likely due to dietary choices and/or ‘belly fat’ which can put the stomach under pressure and push digestive juices (acids) up into the food pipe

Oesophageal cancer is more common in the over 50s and men are three times as likely to be affected. If a person has a family history of oesophageal cancer, their risk is higher.

 

Heartburn and Oesophageal Cancer

Oeosphageal Cancer rates, in particular adenocarcinoma (the most common type of Oesophageal Cancer in the UK), is rising and many experts believe that this could be linked to modern diets. Many people in the UK are overweight or obese and there are more people on acid reflux medication than ever before. 

Over time acid reflux (better known as heartburn) can damage the delicate cell lining of the food pipe and cause damage. Long-term (chronic) acid reflux is called GORD and 5-10% of GORD patients will be diagnosed with a ‘pre-cancerous’ condition called Barrett’s Oesophagus. A person with Barrett’s has a much higher chance of developing adenocarcinoma (the most common form of Oesophageal Cancer). 

People with GORD or Barrett’s Oesophagus should quit smoking, limit their alcohol intake (e.g. to 1 drink only at special occasions), eat a diet full of fruit and vegetables, exercise to lose weight and take their acid reflux medications as prescribed, to stand the best chance of preventing Oesophageal Cancer.

Oesophageal Cancer - Andy Gaya Oncologist

Diagnosing Oesophageal Cancer

Usually a person worried about Oesophageal Cancer will be referred to hospital for diagnostics, but sometimes GPs do not suspect cancer and may not organise a referral. However if a patient strongly disagrees then they can organise further tests privately. Dr Andy Gaya recommends two approaches:

If Oesophageal Cancer is suspected, doctors will use a combination of tests to confirm the diagnosis:

  • Endoscopy is a thin flexible tube with a camera (endoscope) which is passed through the mouth of a sedated patient. It allows the doctor to look for any abnormal cells and a biopsy (a sample of cells) can be collected and checked in the lab for cancer
  • A barium swallow is a special kind of X-Ray which highlights any blockages, narrowing, or irregularities in the oesophagus that might indicate a tumour. It is often used in patients where capsule sponge or endoscopy is not suitable 
  • Capsule Sponge Testing (Endosign) is a new way to take a sample of cells from the entire food pipe. Patients swallow the ‘capsule on a string’ with a glass of water and after 15 minutes a doctor or nurse pulls out the sponge. It is sent to a lab for specialist analysis to detect Barrett’s Oesophagus or Oesophageal Cancer

After Oesophageal Cancer is diagnosed doctors will use a combination of tests to determine the cancer’s stage and guide treatment decisions, such as:

  • A CT Scan (Computed Tomography scan) gives a detailed cross section x-ray image of the body, where cancer is, its size and whether it’s spread to nearby organs or lymph gland. The scanner is a big ‘doughnut’ shaped machine and the patient lays in the centre.
ct scan
  • A PET Scan (Positron Emission Tomography) shows areas that indicate cancer spread (often used in combination with a CT scan). A PET scanner looks similar to a CT scanner. In a PET scan you are given an injection of radioactive glucose which produces a “sugar map” of the body. Cancer cells use more energy (and thus sugar) than normal cells and so take up more of the radioactive glucose and this is reflected in the images produced for the doctor.
  • An MRI scan (Magnetic Resonance Imaging) is another type of scan which produces detailed images of the oesophagus, nearby organs and lymph nodes. MRI scanners are big cylinder-shaped machines which are quite enclosed and can be quite loud. Some patients find listening to headphones during an MRI can help them feel more comfortable. MRI scanners do not use radiation, they create images using the effect of magnetic fields on the body.
  • Endoscopic Ultrasound uses sound waves to create detailed images of the oesophagus and surrounding tissues, showing the doctor how deeply the cancer has grown into the oesophagus and whether the cancer has spread. It is carried out endoscopically (a thin flexible tube passed down the back of the throat of a sedated patient) and it can also be used to take samples of the cancer (biopsies) to help treatment planning
  • Laparoscopy is a minimally invasive procedure where a small camera is inserted into the abdomen to check for signs of cancer spread to other organs (usually done before surgery)

Importance of Oesophageal Cancer tests

Early diagnosis of Barrett’s Oesophagus or Oesophageal Cancer is really important, as it can be treated and cured most easily in the early stages. Tests can determine if cancer (or pre-cancerous cells) are present and identify the type of cancer. Further tests will assess the extent of cancer and whether it has spread, guiding the doctor to make the best treatment decisions.

Are there different types of Oesophageal Cancer?

There are two main types of oesophageal cancer:

  1. Adenocarcinoma – the most common type of Oesophageal Cancer that is strongly linked to chronic acid reflux (GORD). This cancer is more common in people with Barrett’s Oesophagus and is also associated with obesity. It is most commonly found in the lower part of the oesophagus, near the stomach.
  2. Squamous cell carcinoma – the less common type in the UK (although it remains prevalent in Asia and Africa). It tends to affect the upper and middle parts of the oesophagus and is more strongly linked with smoking, alcohol intake and a diet low in fruits and vegetables

There are other much rarer types of cancer that can form in the food pipe, such as neuroendocrine carcinoma and melanoma. 

Staging of Oesophageal Cancer

Doctors use medical terminology to describe the extent and spread of oesophageal cancer (to determine the best treatment). The TNM system is based on three key factors:

  • T = Tumour size (T0 means no evidence of cancer, T1 is cancer of just the inner ‘mucosa’ layer, T2 is cancer that has spread to the food pipe’s muscle layer, T3 is cancer that has spread through the muscle to the outer layer of the food pipe and T4 is cancer that has spread to organs or tissue beyond the food pipe
  • N = stands for ‘Nodes’ and this measures how many lymph nodes (small glands all over the body) are affected by cancer (N0 means no cancer in any lymph nodes, N1 means cancer is in the lymph nodes close by and N2 means cancer has spread to further lymph nodes)
  • M = stands for ‘Metastasis’ and this is looking at if cancer cells are present in a different part of the body (so beyond the food pipe), (M0 means no spread and M1 means it has spread to another organ e.g. the liver or lungs)

By knowing this detail (T N M), a cancer doctor determines the stage of Oesophageal Cancer. This is summarised in the below table.

StageDescriptionTNM
Stage 0
Very early cancer in a very small placeT1N0M0
Stage ICancer is small and confined to the oesophagusT1-T2N0M0
Stage IICancer has spread to nearby tissues or some lymph nodesT3N1M0
Stage IIICancer has spread to nearby tissues/structures and lymph nodesT4N1-N2M0
Stage IVCancer has spread to distant organs (metastasis)Any TAny N
M1

Grading of Oesophageal Cancer

Doctors also ‘grade’ Oesophageal Cancer, this is information about how abnormal the cancer cells are by looking at them under a microscope. It helps predict how the cancer might behave to treatment. 

  • Grade 1 cells look quite normal and these usually grow slowly
  • Grade 2 cells look a little different and grow at a moderate rate
  • Grade 3 cells look very abnormal and tend to grow at a fast rate and may spread faster

Your treatment plan will depend on your cancer’s stage and grade, as well as your overall health. It’s important to discuss the results with your doctor to understand your specific situation.

About Dr Andrew Gaya

Dr Andrew Gaya is a Consultant Clinical Oncologist and one of the leading cancer doctors in Europe. He specialises in the treatment of gastrointestinal cancer, including Oesophageal Cancer.

If you are concerned about a recent diagnosis of Oesophageal Cancer and want to speak with Dr Andy Gaya, click here to make an appointment.

Read about the latest treatments for Oesophageal Cancer here