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Oesophageal Cancer

oesophageal cancer


The oesophagus is part of the gut (gastrointestinal tract). When we eat, food goes down the oesophagus into the stomach.The upper section of oesophagus lies behind the windpipe (trachea). The lower section lies between the heart and the spine.There are layers of muscle in the wall of the oesophagus. These contract to propel food down into the stomach.There is a thickened circular band of muscle (a sphincter) at the junction between the oesophagus and stomach. This relaxes to allow food down, but normally tightens up and stops food and acid leaking back up into the oesophagus.

What is oesophageal cancer?

Oesophageal cancer is uncommon. There are two main types:

  • Adenocarcinoma of the oesophagus.
  • Squamous cell carcinoma of the oesophagus.

The symptoms, treatment and outlook are similar for both of these types.

What causes oesophageal cancer?

A cancerous tumour starts from one abnormal cell. Many people develop oesophageal cancer for no apparent reason. However, certain risk factors increase the chance that oesophageal cancer may develop.

  • Ageing. It is more common in older people.
  • A high-fat diet is thought to increase the risk and eating a lot of fruit and green vegetables is thought to reduce the risk.
  • Oesophageal cancer is much more common in China and certain other Far Eastern countries than in Europe.
  • Smoking.
  • Drinking a lot of alcohol, especially spirits.
  • Long-standing acid reflux from the stomach (gastro-oesophageal reflux disease (GORD)).
  • Barrett's oesophagus. This is a condition at the lower end of the oesophagus where the cells which line the oesophagus have become changed. In many cases this is related to long-term inflammation caused by acid reflux.
  • Other uncommon conditions are associated with an increased risk and include: achalasia (a condition which causes a widening at the bottom of the oesophagus); tylosis (a very rare inherited skin condition); and Paterson Brown-Kelly syndrome (a rare syndrome which includes iron deficiency and changes in the mouth or oesophagus).

Oesophageal cancer is not inherited so does not run in families

What are the symptoms of oesophageal cancer?

  • Difficulty with swallowing .
  • Vomiting after eating.
  • Pain in the chest or in the back of the chest when you swallow (odynophagia).
  • Weight loss.
  • Vomiting blood.
  • Coughing.
  • A hoarse voice.

How is oesophageal cancer diagnosed and assessed?

Initial assessment and gastroscopy
If a doctor suspects that you may have oesophageal cancer, he or she will examine you to look for signs such as a lump in your abdomen. A gastroscope (endoscope) is a thin, flexible, telescope. It is passed through the mouth, into the oesophagus and down towards the stomach.

Biopsy - to confirm the diagnosis
A biopsy is when a small sample of tissue is removed from a part of the body. When you have a gastroscopy, if anything abnormal is seen then the doctor or nurse can take a biopsy.

Assessing the extent and spread
If you are confirmed to have oesophageal cancer, further tests aredone. A special ultrasound scan, which uses a probe at the end of a gastroscope, can assess how far the cancer has grown through the wall of the oesophagus.

Other tests are arranged to see if the cancer has spread to other parts of the body. A CT scan, an ultrasound scan of the abdomen, or other tests. This assessment is called staging of the cancer. The aim of staging is to find out:

  • How much the tumour in the oesophagus has grown, and whether it has grown partially or fully through the wall of the oesophagus.
  • Whether the cancer has spread to local lymph nodes.
  • Whether the cancer has spread to other areas of the body (metastasised).

What are the treatment options for oesophageal cancer?

Treatment options which may be considered include surgery, chemotherapy and radiotherapy.

Surgery

It may be possible to remove the tumour. To do this, the operation is to remove part or all of the oesophagus, depending on the site and size of the tumour.

If the lower part of the oesophagus is removed, it may be possible to sew the stomach back on to the remaining part of oesophagus if the stomach is brought up into the chest area. If all of the oesophagus is removed, the surgeon may use a section of your intestine to create a new artificial oesophagus.
Even if the cancer is advanced and it is not possible to remove it, some surgical techniques may still have a place to ease symptoms. For example, a blockage may be eased by using laser surgery, by inserting a rigid stent (tube), or by stretching the oesophagus (dilatation), which allows food and drink to pass through the blockage to the stomach.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells, or stop them from multiplying.  Following surgery you may be given a course of chemotherapy. This aims to kill any cancer cells which may have spread away from the primary tumour. When chemotherapy is used after surgery it is called adjuvant chemotherapy. In some cases chemotherapy is given before surgery, to shrink a large tumour so that surgery is more likely to be successful. This is called neoadjuvant chemotherapy.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. When radiotherapy is used to treat cancer of the oesophagus it is commonly used in addition to either surgery or chemotherapy.

Two types of radiotherapy are used for oesophageal cancer - external and internal:

  • External radiotherapy. This is where radiation is targeted on the cancer from a machine.
  • Internal radiotherapy (brachytherapy). This treatment involves placing a small radioactive implant next to the cancerous tumour for a short time and then it is removed.

A newer treatment called photodynamic therapy (PDT) uses low-powered lasers combined with a light-sensitive medicine to destroy cancer cells.

What is the prognosis?

Without treatment, oesophageal cancer is likely to get larger, and spread to other parts of the body. If it is diagnosed and treated at an early stage (before growing through the wall of the oesophagus or spreading to lymph nodes or other areas of the body) then there is a chance of a cure with treatment.


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