Oesophageal (foodpipe/gullet) Cancer

What is oesophageal cancer?

Oesophageal cancer occurs when abnormal cells in the oesophagus multiply and spread uncontrollably. There are 2 main subtypes, squamous cell cancer (accounts for 80 – 90% of all oesophagal cancer worldwide) and adenocarcinoma. Squamous cell cancer arises from the cells that line the upper and mid part of the oesophagus. Adenocarcinoma is more prevalent in western societies and the incidence is increasing. It is related to obesity and the associated increase in gastro-oesophagaal reflux disease (GERD). Barret’s metaplasia develops at the gastro-oesphageal junction due to injurious effects of the acid reflux and is an important precursor for adenocarcinoma of the oesophagus.

What are the related oesophagal cancer symptoms?

Oesophagal cancer may go unnoticed in the early stages with symptoms only occurring once the cancer is at a fairly advanced stage.

Oesophagal cancer symptoms may include:

• Dysphagia (difficulty swallowing)
• Odynophagia (painful swallowing)
• Weight loss
• Pain in the chest
• Hoarseness
• Coughing after swallowing
• Indigestion and heartburn

Any suspicion of oesophageal cancer will lead to an upper gastrointestinal endoscopy (gastroscopy), and the diagnosis will be confirmed with a biopsy. After appropriate staging examinations (CT chest and abdomen +/- PET CT), Dr Cooper will recommend an appropriate treatment strategy.

Treatment options for oesophagal cancer:

Small and localized tumours are treated surgically with curative intent. An oesophagectomy is a major procedure with significant risks of complications and even death. Depending on the stage of cancer, it can be done through an abdominal, chest and neck incision or just through a neck and abdominal incision. During this procedure, the surgeon will remove the portion of the oesophagus affected by the cancer and the upper part of the stomach. The remaining oesophagus will then be reconnected by pulling the stomach up into the chest. Chemotherapy and radiotherapy will be needed before or after surgery to ensure the best possible prognosis.

Tumours that have already spread to distant organs or larger tumours that are inoperable are treated in order to palliate (lessen) symptoms. Their growth can still be delayed with chemotherapy, radiotherapy or a combination of the two. In some cases, chemotherapy and radiotherapy can render these larger tumours operable. In order to alleviate the symptom of dysphagia, a self-expanding metal stent can be placed with the use of a gastroscope. Prognosis depends on the extent of the disease and other medical problems but is generally fairly poor.