Oesophageal Cancer

Oesophageal cancer involves malignant cells that form in the tissues of the esophagus, the long, hollow tube that runs from your throat to your stomach. It helps move the food you swallow from the back of your throat to your stomach to be digested. Esophageal cancer typically starts in the cells lining the inside of the esophagus and can occur anywhere along the oesophagus.

Types of Oesophageal Cancer

There are two main types of oesophageal cancer, classified based on the type of cells that are involved:

Squamous Cell Carcinoma:
- This type originates from the squamous cells that line the esophagus. It is more commonly found in the upper and middle part of the esophagus and is the most prevalent type globally.
Adenocarcinoma:
- This type begins in the glandular cells that are present at the lower part of the oesophagus near the stomach. In Western countries, adenocarcinoma has become more common, often associated with Barrett’s esophagus, a condition caused by chronic acid reflux.

Symptoms of Oesophageal Cancer

Symptoms typically do not appear until the cancer has become advanced, making early detection challenging. Common symptoms include:

Difficulty swallowing (dysphagia)
Unexplained weight loss
Chest pain, pressure, or burning
Worsening indigestion or heartburn
Coughing or hoarseness
Vomiting blood

Risk Factors

Factors that can increase the risk of esophageal cancer include:

Chronic gastroesophageal reflux disease (GERD):
- Frequent acid reflux can lead to Barrett’s esophagus, which increases the risk of adenocarcinoma.
Smoking and alcohol use:
- Both are significant risk factors, especially for squamous cell carcinoma.
Obesity
- Being overweight increases the risk of adenocarcinoma of the esophagus.
Diet
- A diet low in fruits and vegetables can increase the risk of esophageal cancer.
Achalasia
- A rare disorder where the lower esophageal sphincter does not relax properly

Diagnosis

Diagnosis of oesophageal cancer typically involves several steps:

Barium Swallow X-ray:
- Involves swallowing a barium solution that coats the lining of the oesophagus, making the outline of the esophagus visible on an X-ray.
Endoscopy:
- A flexible tube equipped with a light and camera (endoscope) is passed down your throat to examine the inside of your oesophagus and stomach.
Biopsy:
- During an endoscopy, a sample of tissue can be collected for analysis to confirm the presence of cancer cells.

Treatment Options

Treatment for oesophageal cancer depends on the stage of the cancer, the patient's overall health, and other factors, and may include:

Surgery:
- To remove the part of the oesophagus with cancer and nearby lymph nodes.
Chemotherapy:
- Often used in combination with radiation therapy before surgery to shrink the tumor or as the main treatment when surgery isn't feasible.
Radiation Therapy:
- Used alongside chemotherapy for advanced oesophageal cancer or to relieve symptoms.
Targeted Therapy:
- Drugs that specifically target certain aspects of cancer cells, used primarily for cancers that have specific genetic markers.

Oesophageal cancer is a challenging disease due to its late presentation and complex treatment needs. Lifestyle changes, such as maintaining a healthy weight, eating a balanced diet, reducing alcohol consumption, and quitting smoking, are important preventive measures. In the UK, several dedicated resources provide comprehensive care and support for individuals affected by this condition, facilitating better outcomes and support throughout the disease course.