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Oesophageal Cancer

Cancer of the oesophagus is uncommon in the UK.  However the numbers are increasing with about 7,800 cases in the last year. The most common type (adenocarcinoma) occurs when the mucus producing glands in the lining of the oesophagus become cancerous. 

The first sympton in most patients is difficulty with swallowing (dysphagia). Fluids and soft foods are usually tolerated while hard or bulky foods cause a burning sensation or a feeling of 'getting stuck' in the throat. Associated with this can be weight loss.   If any of these or the following symptoms are experienced, advice should be sought from a GP:

  • vomiting food and perhaps blood
  • severe acid indigestion or reflux
  • pain in the chest or back of the chest when swallowing
  • coughing, particularly when swallowing
  • unusually husky or raspy voice

There are certain risk factors which increase the chance of developing oesophageal cancer including:

  • age - the majority of patients are over 55 and more commonly male
  • poor diet, particularly a deficiency in zinc and vitamins
  • smoking and heavy alcohol use.  The risk increases if both apply
  • long-standing history of acid reflux (GORD) and its resultant Barrett's oesophagus
  • obesity - probably associated with the increase in reflux found in obese patients
  • long-term exposure to certain chemicals and pollutants that 'irritate' the oesophagus

Diagnosis is usually by gastroscopy in which a thin, flexible tube (endoscope) is passed down the oesophagus towards the stomach.  The endoscope contains a light and camera so the lining of the oesophagus can be observed.  A small sample of tissue (biopsy) may be taken for analysis. If cancerous cells are found, further tests are needed to determine the extent of the spread:

  • CT scan of the abdomen in which two or three-dimensional x-ray pictures are taken to highlight any abnormal tissue growth
  • PET scan in which a very small amount of radioactive tracer drug is injected and a scan of the body carried out over a period of about an hour
  • endoscopic ultrasound which combines endoscopy and ultrasound (sound waves) to build up a picture of the stomach wall

Treatment options include surgery, chemotherapy and radiotherapy. The treatment chosen depends on the patient's general health and the site, size and spread of the cancer. If the oesophagus is blocked, an expandable metallic stent can be inserted to keep it open. With a localised cancer, surgery to remove the oesophagus is usually recommended. Chemotherapy and radiotherapy may be given in addition to surgery to help 'shrink' the tumour and make it easier to remove.

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