Oesophageal Carcinoma
Oesophageal carcinoma is a cancer that starts in the oesophagus, the muscular tube that carries food from your throat to your stomach. Most people don’t notice symptoms until the disease has progressed, making early detection challenging but crucial for better outcomes.
Table of contents
- What is oesophageal carcinoma?
- Types of oesophageal cancer
- Signs and symptoms
- Causes and risk factors
- How is it diagnosed?
- Treatment options
- Living with oesophageal cancer
- Prevention
What is oesophageal carcinoma?
Oesophageal carcinoma is a cancer that develops in the oesophagus, the long, hollow tube that connects your throat to your stomach[1]. The oesophagus (also called the food pipe or gullet) is part of your digestive system and helps move swallowed food from the back of your throat to your stomach to be digested[6].
This cancer usually begins in the cells that line the inside of the oesophagus. It can occur anywhere along the oesophagus, which extends approximately 30 to 40 centimeters when measured from the front teeth[15]. The oesophagus is typically divided into four main segments: the cervical oesophagus, upper thoracic oesophagus, middle thoracic oesophagus, and lower thoracic oesophagus near where it meets the stomach[15].
Oesophageal cancer is the 10th most common cancer in the world and ranks as the fourth most common cancer affecting the digestive system in the United States, following colorectal, pancreatic, and liver cancers[2][4]. It is more common in men than in women[1].
- Oesophagus (food pipe)
- Throat
- Stomach
Types of oesophageal cancer
There are two main types of oesophageal cancer, named for the type of cells where they begin[5]:
Adenocarcinoma is the most common type of oesophageal cancer in the United States and Western Europe[2][4]. This cancer develops in the tissue that makes mucus that helps you swallow. It usually affects the lower part of the oesophagus, near the stomach[2][5]. Adenocarcinomas typically develop in specialized intestinal cells that have replaced normal oesophageal tissue, often as a result of a condition called Barrett’s oesophagus[7].
Squamous cell carcinoma begins in the thin, flat cells (squamous cells) that line the oesophagus[5]. This type of cancer is most often found in the upper and middle part of the oesophagus, but can occur anywhere along its length[5]. Squamous cell carcinoma is the most common type worldwide, particularly in Eastern Europe and Asia[9].
In recent decades, there has been a significant shift in the occurrence of these types. While squamous cell carcinoma was historically more prevalent in the United States, the incidence of adenocarcinoma has risen dramatically and is now more common in North America and Western European countries[4][9].
Signs and symptoms
Oesophageal cancer often does not cause symptoms in its early stages[1][6]. This is because the oesophagus is very flexible and stretches to make room for food. As a tumor grows, it starts to block the oesophagus opening, which is when symptoms typically appear[2]. Unfortunately, this means many people don’t notice symptoms until after the cancer has spread[2].
The most common symptom is difficulty swallowing (also called dysphagia), which progressively worsens over time[1][2]. You may have trouble swallowing or notice that it hurts to swallow[2][5].
Other signs and symptoms of oesophageal cancer include[1][2][5]:
- Weight loss without trying
- Chest pain, pressure or burning
- Pain in your throat or back, behind your breastbone or between your shoulder blades
- Worsening indigestion or heartburn
- Coughing or hoarseness
- Vomiting or coughing up blood
These symptoms may be caused by oesophageal cancer or by other conditions. If you have any symptoms that worry you, make an appointment with your doctor or other healthcare professional[1].
Causes and risk factors
Healthcare providers don’t know the exact cause of oesophageal cancer, but they have identified several risk factors that increase the chance of developing it[2][5]. A risk factor is anything that increases your risk of getting a disease. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer[5].
Risk factors for squamous cell carcinoma include smoking, alcohol consumption, and a diet low in fruits and vegetables[4][7]. More specifically:
- Tobacco use: This includes smoking and using smokeless tobacco[2][5]
- Alcohol use: Chronic and heavy use of alcohol increases the risk[2][5]
- Very hot drinks and chewing betel nut[7]
For adenocarcinoma, the most common risk factors are different[4][7]:
- Barrett’s oesophagus: A condition in which the cells lining the lower part of the oesophagus have changed or been replaced with abnormal cells that could lead to cancer. The most common cause of Barrett’s oesophagus is long-term gastric reflux (heartburn), also known as gastro-oesophageal reflux disease (GERD)[2][5][7]
- Obesity: Being overweight may cause inflammation in your oesophagus that could become cancer[2][7]
- Smoking tobacco[7]
- High body mass index[4]
Other risk factors that apply to both types include older age. Oesophageal cancer typically affects people who are age 60 or older[2][5].
How is it diagnosed?
Diagnosis of oesophageal cancer often begins with imaging tests to look at the oesophagus[10]. Several tests and procedures may be used[5][10]:
A physical exam and health history checks general signs of health, including checking for lumps or anything else that seems unusual. Your healthcare provider will also take a history of your health habits and past illnesses and treatments[5].
A barium swallow study is a test that uses X-rays to look at the digestive system. Before the test, you drink a white liquid called barium. The barium coats your oesophagus and makes it easier to see on X-rays. This test can show changes in the oesophagus, such as a growth that could be cancerous[10].
An upper endoscopy (also called oesophagoscopy) is a test to look at the upper digestive system. It uses a long, flexible tube with a camera at the end, called an endoscope, to see inside the body[5][10]. A healthcare professional passes the endoscope down the throat and into the oesophagus to look for signs of cancer[10].
A biopsy is a procedure to remove a sample of tissue for testing in a lab. To get the tissue sample, a healthcare professional passes special cutting tools through an endoscope and uses the tools to remove a very small amount of tissue from the inside of the oesophagus[10]. The tissue sample is sent to a lab to look for cancer cells. Confirmation of oesophageal cancer is obtained by biopsy[4].
Once cancer is diagnosed, additional imaging studies are used primarily to determine the extent of the disease (staging). These may include chest X-rays and other scans[4][5].
Treatment options
Treatment for oesophageal cancer depends on several factors, including the stage of your cancer, what type of oesophageal cancer you have, the size and location of the cancer, your general health, and your individual preferences[1][5][13]. You might have one or more treatments[13].
Surgery is the most common treatment if your cancer hasn’t spread[13]. Small localized cancers may be treated with surgery alone with the hope of a cure[18]. Surgeons remove all or part of your oesophagus in a procedure called an esophagectomy[13]. Sometimes, healthcare providers can do surgery to remove small tumors. Unfortunately, only 25 percent of people with this cancer receive a diagnosis before the cancer spreads[2].
For small, early-stage cancers, endoscopic therapy may be used. This includes techniques such as endoscopic mucosal resection, endoscopic submucosal dissection, or ablation[18].
Chemotherapy uses anti-cancer drugs to destroy cancer cells. You might have it before or after surgery for oesophageal cancer, or as your main treatment if your cancer is advanced[13]. In most cases other than very small localized cancers, chemotherapy with or without radiation therapy is used along with surgery[5].
Radiotherapy uses high energy waves similar to X-rays to destroy oesophageal cancer cells[13]. Larger tumors may have their growth slowed with chemotherapy and radiation therapy[7].
Chemoradiotherapy is chemotherapy combined with radiotherapy. You might have it on its own as your main treatment, or before surgery[13]. Treatment often involves surgery to remove the cancer, and other treatments may include a combination of chemotherapy and radiation[1].
Targeted therapy and immunotherapy are newer treatment options. These include drugs such as trastuzumab and nivolumab for oesophageal cancer[1][13]. Emerging data suggests there may be a benefit to adjuvant immunotherapy after standard chemotherapy and radiation[22].
When healthcare providers can’t cure the cancer, they focus on helping people live longer, easing symptoms and maintaining quality of life[2]. There are also treatments available that can make swallowing easier for people with oesophageal cancer, such as placement of an oesophageal stent or other endoscopic procedures[13].
Living with oesophageal cancer
Living with oesophageal cancer presents several challenges, and there is support available to help you cope during and after treatment[6].
Difficulty swallowing is a common problem. Most people with oesophageal cancer have difficulty swallowing, which can develop because the tumor blocks the oesophagus, because food doesn’t move down properly, or because the oesophagus is inflamed from treatment[25]. If you find swallowing difficult, you can try eating small amounts more often, eating soft moist foods, eating slowly and chewing your food well, and taking sips of a drink between mouthfuls[20].
Weight loss is another significant concern. Most people with oesophageal cancer will lose a lot of weight[25]. This can happen because of problems swallowing, side effects of treatment, or because of changes in how the body uses energy from food[25]. It’s important to eat well and maintain your weight during and after treatment. You can help maintain your weight by adding calories to everyday foods, such as having soft cereal with honey or sugar and cream, or making drinks with whole milk instead of water[20]. If you can’t eat and drink enough, you may need a feeding tube[20][25].
A dietitian can help you cope with eating problems and suggest ways of dealing with diet difficulties. There should be a dietitian in your hospital team who can support you from diagnosis, through treatment and afterwards[20]. If you are having trouble swallowing, you might also see a speech and language therapist who can assess your swallowing and teach exercises to help[20].
After surgery, your eating may return to normal after a few months, but this can take time, especially if you need more treatment. For some people, it takes up to two years[20]. If you’ve had part of your oesophagus or stomach removed, you may need to eat smaller meals more frequently throughout the day[22].
Emotional support is also important. Talking to your friends and relatives about your cancer can help and support you, though some people may find it difficult[19]. You might find it easier to talk to someone outside your own friends and family, such as a counselor or cancer information nurse[19].
Prevention
While not all cases of oesophageal cancer can be prevented, there are steps you can take to reduce your risk[7]:
Stop smoking: Avoiding tobacco products is one of the most important things you can do to reduce your risk of oesophageal cancer[5][7][24].
Reduce alcohol consumption: Limiting or avoiding alcohol can help decrease your risk[24].
Eat a healthy diet: Eating plenty of fruits and vegetables may help reduce risk[4][7].
Maintain a healthy weight: Being overweight or having obesity increases risk, so maintaining a healthy body weight is important[7][24].
Manage acid reflux: If you experience frequent or severe heartburn, speak with your healthcare provider about ways to control your gastro-oesophageal reflux disease (GERD) or acid reflux to reduce your risk of developing Barrett’s oesophagus and subsequently oesophageal cancer[24].
