Oesophageal Cancer Metastatic

Metastatic oesophageal cancer means that cancer which started in the food pipe has spread to distant parts of the body. This advanced stage affects around half of all patients at the time of diagnosis and presents complex challenges that require comprehensive care and support.

Table of contents

• What is metastatic oesophageal cancer?
• Where the cancer spreads
• Symptoms
• Diagnosis
• Treatment options
• Supportive care and quality of life
• Outlook and survival

What is metastatic oesophageal cancer?

Metastatic oesophageal cancer starts in the oesophagus, the long tube that connects your mouth to your stomach, and then spreads to other distant areas of the body^[1]. The oesophagus is a muscular tube that helps move food from the back of your throat to your stomach^[4].

When cancer cells break away from their starting point in the oesophagus and travel through the blood or the lymphatic system (a network of vessels and organs that help fight infection), they can form new tumors in other parts of the body. This spreading process is called metastasis^[1]. Even when oesophageal cancer spreads to another area, such as the lungs, doctors still call it metastatic oesophageal cancer rather than lung cancer^[1].

Metastatic oesophageal cancer is classified as stage 4 or stage 4B in medical staging systems^[1]. Unfortunately, about half of people with oesophageal cancer already have distant metastasis when they receive their diagnosis^[5]. Advanced cancer usually cannot be cured, but treatment can help control it, reduce symptoms, and improve quality of life^[2].

There are two main types of oesophageal cancer. Squamous cell carcinoma begins in the flat cells that line the inside of the oesophagus and is most often found in the upper and middle parts^[1]. Adenocarcinoma begins in gland cells that produce mucus and usually forms in the lower part of the oesophagus, near the stomach^[1]. Both types can spread to other parts of the body^[1].

Where the cancer spreads

Metastatic oesophageal cancer tends to spread to specific parts of the body. The most common places where the cancer travels include the liver, lungs, lymph nodes, adrenal glands, bones, and brain^[1].

The liver and lungs are the most frequent sites where oesophageal cancer spreads. Research shows that about 23% of metastatic oesophageal cancer spreads to the liver and 31% spreads to the lungs^[1]. Scientists believe these organs may be the most common destinations because of how they connect through the body’s blood vessel system and because of the rich blood supply that flows between them^[1].

The cancer spreads through different pathways. It can grow directly into nearby tissues around the oesophagus, travel through the bloodstream to distant organs, or move through the lymphatic system to lymph nodes throughout the body^[6].

Symptoms

The most common symptoms of metastatic oesophageal cancer include feeling very tired, feeling generally unwell, problems swallowing, weight loss, and increased acid reflux^[2]. As the disease progresses and cancer spreads, symptoms tend to worsen^[22].

Difficulty swallowing often becomes more severe in advanced stages. Some people may reach the point where they can only consume liquids^[22]. Other symptoms may include increased cough and sore throat, difficulty breathing, hoarseness, hiccups, nausea and vomiting, and bone and joint pain^[22].

Pain is experienced by some people, though painkillers can usually control it well^[2]. Fatigue is common and may be caused by anemia from blood loss, certain medications and cancer treatments, or poor sleep due to pain or medication side effects^[22].

Other symptoms depend on where the cancer has spread in the body^[2]. Some people may experience bleeding in the digestive tract or infections caused by problems in the oesophagus^[22].

Diagnosis

Doctors use several tests to diagnose oesophageal cancer and determine whether it has spread to other parts of the body. Initial diagnosis may involve a physical examination, chest X-ray, and specialized procedures to look inside the oesophagus^[1].

An oesophagoscopy is a procedure where a doctor inserts a thin tube with a camera and light through the nose or mouth into the oesophagus to examine it^[1]. An upper endoscopy is similar but also examines the stomach^[1]. During these procedures, doctors may perform a biopsy, which involves removing a small sample of tissue to test for cancer cells^[1].

Once doctors have diagnosed oesophageal cancer, they perform additional tests to determine whether cancer cells have spread to other areas. This process is called staging^[1]. Staging tests may include CT scans, endoscopic ultrasound, PET scans, and MRI scans^[1]. These imaging tests help doctors see detailed pictures of the inside of your body to find where the cancer has spread.

Treatment options

Treatment for metastatic oesophageal cancer focuses on controlling the cancer, relieving symptoms, and improving quality of life^[2]. The specific treatments offered depend on various factors including the type of cancer, where it has spread, and the patient’s overall health^[11].

Procedures to relieve symptoms

Several procedures can help with symptoms, especially difficulty swallowing. These include radiofrequency ablation, laser surgery, photodynamic therapy, oesophageal dilation (stretching the oesophagus), and placement of an oesophageal stent (a tube that keeps the oesophagus open)^[11]. Doctors may also place a feeding tube to help with nutrition^[11].

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing. It is sometimes offered for metastatic oesophageal cancer. Adenocarcinoma tumors tend to respond better to chemotherapy than squamous cell carcinoma tumors^[11]. Many different chemotherapy drugs can be used, either alone or in combination^[11].

Radiation therapy

Sometimes chemotherapy is combined with radiation therapy in a treatment called chemoradiation. The two treatments are given during the same time period^[11]. Radiation therapy may help shrink the cancer or stop it from growing^[2].

Targeted therapy

Targeted therapy drugs work differently from chemotherapy by targeting specific features of cancer cells. These drugs may be used to treat certain types of metastatic oesophageal cancer, particularly adenocarcinoma tumors at the junction where the oesophagus meets the stomach^[11]. They are usually combined with chemotherapy.

Trastuzumab is used with chemotherapy drugs to treat tumors that test positive for a protein called HER2^[11]. Ramucirumab works by stopping cells from forming new blood vessels that tumors need to grow. It is given in combination with another drug called paclitaxel^[11]. Zolbetuximab works by attaching to a specific protein on the surface of cancer cells to stop their growth^[11].

Immunotherapy

Immunotherapy helps your own immune system fight cancer. Pembrolizumab may be offered in combination with chemotherapy as a first treatment for certain types of metastatic oesophageal cancer^[11]. Nivolumab is another immunotherapy drug that may be offered^[11].

Supportive care and quality of life

Supportive care is an essential part of treatment for people with metastatic oesophageal cancer. This type of care focuses on managing symptoms and improving quality of life throughout the illness^[24].

Palliative care

Palliative care is specialized medical care that focuses on providing relief from symptoms and stress of serious illness^[24]. It can be provided alongside cancer treatment and helps address physical, emotional, and spiritual needs^[24]. Palliative care teams include specially trained doctors, nurses, social workers, and other professionals who work together to provide comprehensive support.

Hospice care

When cancer can no longer be controlled and life expectancy is estimated at six months or less, hospice care may be appropriate^[22]. Hospice focuses on comfort care and quality of life rather than treating the cancer itself. Services can be provided at home, in hospitals, or in other healthcare facilities^[22].

Managing eating problems

Eating difficulties are common with oesophageal cancer and can significantly affect quality of life. A dietitian can provide valuable support in managing these challenges^[20]. Eating small amounts more often, choosing soft and moist foods, eating slowly, and taking sips of liquid between mouthfuls can all help^[20].

Building up nutrition is important. Adding butter, cream, or cheese to foods can increase calories. Using milk instead of water for drinks and soups adds nutrition. Liquid food supplements may be helpful if eating enough is difficult^[20]. In some cases, a feeding tube may be needed to ensure adequate nutrition^[20].

Emotional support

Dealing with metastatic cancer is emotionally challenging. It is normal to experience a range of feelings including shock, fear, anger, sadness, and uncertainty^[18]. Talking with family, friends, healthcare providers, or counselors can help. Support groups allow people to connect with others facing similar challenges. Many people find that having information about their condition and treatment options helps them cope better^[18].

Outlook and survival

The outlook for metastatic oesophageal cancer is challenging. The five-year relative survival rate for metastatic esophageal cancer is approximately 6%^[5]. This means that people with this cancer are about 6% as likely as people without this cancer to live for at least five years after diagnosis. However, survival varies for each person and depends on many factors.

Everyone is different, and there is no single right way to feel when facing this diagnosis^[2]. Your doctor is the best person to discuss your individual outlook because they have all the information about your specific cancer and health situation^[2].

While metastatic oesophageal cancer cannot usually be cured, treatments are available that can help control the disease, extend life, and maintain quality of life^[2]. Medical researchers continue working on new treatments to help people with this disease live longer and better^[10].

metastatic esophageal cancer, metastatic oesophageal cancer, advanced oesophageal cancer, stage 4 oesophageal cancer, stage 4 esophageal cancer, secondary oesophageal cancer

• Oesophagus (esophagus)
• Liver
• Lungs
• Lymph nodes
• Adrenal glands
• Bones
• Brain