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oesophageal cancer

Alternative Names
cancer of the oesophagus

Cancer of the oesophagus is a tumour that grows in the lining of the oesophagus. The esophagus is the tube connecting the mouth and upper throat to the stomach.

What is going on in the body?
The oesophagus carries swallowed food to the stomach using a co-ordinated muscular effort. There is a muscular door called a sphincter between the oesophagus and the stomach. Oesophageal cancer can arise in the upper, mid, or lower portion of the lining of the oesophagus. Most oesophageal cancer is made up of squamous cells, which are flat and scaly. But some cells are adenocarcinoma, meaning they look like cells of the oesophagus.

The cancer arises in the inside of the tube opening, or lumen, and it grows through the muscular wall of the oesophagus. It can spread to other parts of the body early in the disease through the blood or lymphatic system. It has a poor survival rate.

Cancer of the oesophagus occurs 2 to 3 times more often in men than women and its peak age of incidence is between the ages of 50 and 60 years.

What are the signs and symptoms of the disease?
Possible symptoms include:
  • pain with swallowing
  • the inability to swallow solid foods and, eventually, liquids
  • weight loss
  • heartburn

Pain may or may not be present in other parts of the body. Since this type of cancer spreads easily to the liver, people can have symptoms of liver failure including:
  • pain
  • yellowing of the skin and eyes, known as jaundice
  • enlarged liver

What are the causes and risks of the disease?
There appear to be many causes and risk factors for oesophageal cancer. There are certain conditions that, if present for a long time, may lead to this kind of cancer. These include:
  • achalasia, a condition in which the oesophagus muscle cannot relax
  • Barrett's oesophagus, a condition in which a harmless ulcer-like area forms in the oesophagus
  • lye or burn-related damage
  • tylosis, a genetic skin problem
  • diverticuli, or pouches created by abnormalities in the lining of the oesophagus
People who smoke cigarettes, chew tobacco, and drink alcohol are at a higher risk for this cancer. It is thought that chronic and recurring irritation, such as drinking very hot liquids, eating pickled foods, and exposure to toxins can cause the normal oesophageal lining to become cancerous.

What can be done to prevent the disease?
The best way to prevent this disease is to avoid tobacco and alcohol use.

Barrett's oesophagus is a major risk factor. Individuals with Barrett's oesophagus need to be treated with aggressive treatment of gastro-oesophageal reflux. This can include:
  • antacids
  • antibiotics for certain bacterial infections
  • preventive surgery to remove the lower part of the oesophagus
Frequent endoscopy, which involves looking inside the body with a light to examine the oesophagus, and screening biopsies, which involve removing a piece of tissue, are sometimes needed. Using these measures, an early non-invasive cancer could be found and treated.

A procedure to strengthen the band of muscles between the stomach and the oesophagus may be helpful in cases of reflux and hiatal hernia problems.

How is the disease diagnosed?
Diagnosis is usually made by performing an endoscopy during which a doctor can view the oesophagus through a scope. If a tumour is seen, a piece of tissue is taken through the scope. If it is found to be cancerous, staging workup is done. This includes a physical examination, blood tests, and CAT scans of the chest and liver. This will give an indication of the size of the tumour, and if it has spread in the chest, lymph nodes, or liver. Sometimes it spreads to the lungs.

What are the long-term effects of the disease?
Oesophageal cancer is a deadly disease. The 5-year survival rate is poor, even with aggressive treatment. This type of cancer often recurs, despite surgery, chemotherapy, and/or radiation.

What are the risks to others?
This is not a contagious disease.

What are the treatments for the disease?
People are evaluated before surgery to determine the best course of treatment. Those with obvious spread of disease who cannot be cured with surgery can still benefit from radiation or chemotherapy. Radiation can be given by implant into the oesophageal tumour by endoscopy, by external beam radiation through the chest, or by a combination of both. Radiation does not help if the cancer has spread to the liver or lungs.

Intravenous chemotherapy has short-term benefit for cancer that has spread to other parts of the body. It can be combined with radiation therapy. It involves toxic drugs, and the potential benefit must be balanced with the side effects and expense.

Sometimes pre-operative evaluations show that the cancer can be completely removed with surgery. Some of the studies needed to indicate this include:
  • a thorough health history and physical examination
  • endoscopy of the oesophagus
  • bronchoscopy of the lung
  • a CAT scan of the chest and upper abdomen
  • a bone scan
  • an MRI to see the oesophageal cancer in relationship to the other chest organs
Sometimes a biopsy of the lymph nodes around the stomach and just below the diaphragm is needed prior to surgery. If these lymph nodes are cancerous, additional surgery may not help.

Surgery of the oesophagus is complicated. It usually involves removing the oesophagus, stomach, spleen, and lymph nodes inside the chest , in the space that contains all the chest organs except the lungs, and attaching another part of the lower bowel to serve as an oesophagus and stomach. People need to be in relatively good health to tolerate this surgery both during and after.

Whether or not pre-operative chemotherapy and/or radiation therapy can improve the cure rate with this extensive surgery is controversial and under study.

What are the side effects of the treatments?
The side effects of radiation include:
  • skin burning
  • irritation of the oesophagus
  • more difficulty swallowing
  • damage to the heart or lungs
  • nausea and anorexia, which is a loss of appetite resulting in the person being unable to eat
Chemotherapy can cause:
  • nausea and vomiting
  • hair loss
  • irritation of the mouth and intestines
  • diarrhoea
  • lower blood counts and need for transfusions or susceptibility to infections, or aggravation of radiation side effects
Surgery alone is associated with a 5% to 10% mortality rate. People need to eat a consistent diet to avoid any stress on the changed bowel configuration. Many other problems can occur not specifically linked to oesophageal cancer surgery.

What happens after treatment for the disease?
It may take several months to recover from these treatments. The person who may be cured can live a relatively normal lifestyle. He or she may not be able to eat certain foods. He or she also may not be able to absorb certain foods, iron, and vitamins. Most people, if they survive, do not have long-term effects from chemotherapy or radiation.

How is the disease monitored?
The disease is monitored with physical examinations, laboratory tests, endoscopies of the upper intestinal area, chest X-rays, and CAT scans or MRIs. This is done to check for any recurrent disease. This could occur within the reconnected bowel, the lymph nodes or chest area, the stomach, or liver.

Author: Thomas Fisher, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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