What you need to know about cancer of the oesophagus

The oesophagus, commonly known as the gullet, is the muscular tube that the food and drink we swallow travels through to reach the stomach. Swallowing sets off an automatic process that propels food from the mouth, into the oesophagus, and then on to the stomach. Pain and other problems arise when food gets stuck in the oesophagus or when stomach contents flow back up into it.

Unfortunately, as with other organs, cancer can develop within the oesophagus. Here are the symptoms, risk factors and treatments of oesophageal cancer, as well as how you can prevent it.

Smoking and heavy alcohol consumption greatly increase the risk of oesophageal cancer; nicotine and alcohol appear to work together to produce the condition. According to the NHS, the overall incidence is highest among older (over age 75) men who both drink and smoke.

Also at increased risk are women who have undergone radiation treatments for breast cancer and persons with a history of chronic reflux (a backup of stomach acids into the oesophagus) and oesophageal narrowing (stricture) due to inflammation, ulceration, or swallowing a caustic substance.

Most oesophageal cancer starts in the surface cells that line the oesophagus; less often, the tumour arises in the mucus glands. As the tumour grows, it tends to encircle the oesophagus and invade the underlying muscle tissue; as the oesophagus becomes progressively narrowed, pain and difficulty swallowing develop.

The nearby lymph nodes over the left collarbone may swell; if untreated, the cancer eventually spreads to nearby organs and also travels through the lymph system and circulation to other parts of the body.

See a doctor as soon as possible if you develop a persistent sore throat and hoarseness and are coughing up blood. Oesophageal cancer usually is not detected until it is too advanced to cure; anyone with a long history of both drinking and smoking should undergo diagnostic tests if they develop any symptoms suggesting oesophageal cancer.

While undergoing treatment, you may need to adopt a liquid diet or even have a feeding tube inserted directly into the stomach to supply nutritional needs. It is imperative that you abstain from smoking and alcohol, both of which exacerbate the cancer and also hinder treatment.

Diagnostic studies for oesophageal cancer include one or more of the following:

At some point, most oesophageal cancers are treated with anti-cancer drugs; they may be given alone in inoperable cancer or administered in combination with surgery and/or radiation. Mild pain may be controlled with non-prescription painkillers or codeine; as the cancer advances, morphine or other more powerful narcotic medications may be needed.

Early oesophageal cancer that has not invaded the muscle tissue may be cured by removing the diseased portion and rejoining the two ends. This is more likely to be successful if the cancer is in the lower portion of the oesophagus. Surgery may be followed by radiation and/or chemotherapy to kill any remaining cancer cells. Unfortunately, very few oesophageal cancers are detected in this early, highly treatable stage.

Sometimes radiation treatments are administered before surgery to shrink a large tumour and make it easier to remove. If the entire oesophagus must be removed, a new food passageway may be created by moving the stomach up or using a portion of the small intestine or colon to reconstruct a tube that links the throat and stomach.

An inoperable tumour that is blocking the oesophagus and preventing swallowing may be relieved temporarily by inserting a tube through the cancer from above to allow liquids to flow into the stomach. A newer approach, developed by doctors at the University of Vienna, calls for implanting special expanding devices, called nitinol stents, in the oesophagus to keep it open and allow patients to swallow normally.

A laser—an intense light beam that vaporises tissues—is sometimes used to create an opening through the cancer, allowing fluids and perhaps food to pass through it. These approaches do not treat the underlying cancer, but they ease symptoms and allow patients to eat and drink more normally. If they cannot be done, a feeding tube can be inserted directly into the stomach through a small abdominal incision. Nutritional supplements are then poured into the tube.

A number of experimental treatments hold new hope for patients with advanced oesophageal cancer. Patients with oesophageal cancer are urged to investigate clinical studies; possibilities include:

Abstaining from smoking and heavy alcohol use are the best approaches to preventing oesophageal cancer. Other possible preventive measures include prompt treatment of oesophageal narrowing, inflammation, and chronic heartburn from gastro-oesophageal reflux disease (GORD).