What Is Oesophageal Cancer

Introduction

Oesophageal cancer is a type of cancer that is found in the food pipe which is a long, thin tube that connects the mouth to the stomach. The oesophagus has different layers of tissue inside its wall lining.¹ The cancer can start spreading from the inner layer (mucosa) towards the outer layers (made up of muscle and connective tissue). 

At advanced stages, the cancer can spread to other body parts (tissue and organs) like the lungs, diaphragm, and stomach.² According to NHS, the symptoms can include difficulty in swallowing, weight loss, indigestion, heartburn or long-term acid reflux, and pain in the throat or middle of the chest. Oesophageal cancer does not show obvious symptoms in the early stages and can progress to advanced stages silently and rapidly. 

This type of cancer is more common in people who are overweight, consume alcohol, smoke, or use tobacco. Men are more likely to be affected by oesophageal cancer than women. The treatment options include surgery, chemotherapy, radiotherapy, immunotherapy, or a combination of these.³

What is oesophagus

The oesophagus is a part of the digestive system. When we eat, the food goes down through this thin, long tube called a food pipe (oesophagus) and passes down to the stomach. The oesophagus is made up of different layers of muscles. These muscles tighten and then push down the food towards the stomach.¹

Types of oesophageal cancer

The cell that started the cancer in the body can be found by knowing the type of oesophageal cancer a person is diagnosed with.³ This can help the doctor to understand the condition and decide the treatment options available for the patient.

There are two types of oesophageal cancer which are as follows–

1. Adenocarcinoma

This type of cancer occurs in the lower part of the oesophagus.² People who suffer from Barrett’s oesophagus (some cells in the oesophagus have abnormal growth) and gastro-oesophageal reflux disease (long-term acid reflux from the stomach) are more likely to suffer from this type of cancer.⁴ This type of cancer is more common in men than women.³ 

The main risk factors of this type of cancer include 4

• Gastro-oesophageal reflux disease (GORD)
• Obesity or high body mass index⁵
• High intake of red meat
• Low intake of fruits and vegetables

2. Squamous cell carcinoma

This type of cancer occurs in the upper and middle parts of the oesophagus. This happens due to the cells present in the inner lining of the oesophagus.⁴ The main risk factors of this type of cancer include–⁶

• Tobacco smoking
• Alcohol: WHO states the chance of getting squamous cell carcinomas may be increased by variations in alcohol metabolism
• Drinking tea at high temperature 
• A diet rich in salted meat and salted fish
• Lack of fresh fruits and vegetables
• Lack of vitamins A and C⁷

3. Some rare types of oesophageal cancer²

• Small cell carcinoma
• Sarcoma
• Lymphoma
• Melanoma
• Choriocarcinoma

Symptoms of oesophageal cancer

According to NHS, some of the common symptoms may include– 

• Difficulty in swallowing (dysphagia)
• Heartburn or acid reflux
• Persistent indigestion
• Cough that is not getting better
• Hoarse voice
• Pain in the throat or middle of the chest while swallowing
• Unexplained weight loss
• Loss of appetite
• Tiredness

Challenges in early detection

It becomes difficult to detect oesophageal cancer in the early stages because cancer develops silently without showing noticeable symptoms in the early stages.⁸ When the symptoms do appear, like acid reflux, unexplained weight loss, or chronic cough, they can be considered general or could be confused for some other diseases. This type of cancer can then rapidly spread to nearby lymph nodes or distant organs. 

There is no effective screening test available to check for early detection for the general public until now, but research is ongoing.³ So, it is generally advised to visit your doctor for routine medical checkups so that early detection is possible.

Diagnosis of oesophageal cancer

After the doctor examines you, they may refer you to a specialist or ask to perform some tests to confirm whether you have oesophageal cancer. 

The tests used for diagnosis are–⁹

1. Gastroscopy (a type of endoscopy)

A thin, long, and flexible tube with a light and camera at the end is inserted from the mouth down the oesophagus to check for any growth or abnormal cells. 

2. Biopsy

If the doctor finds any growth of cells or abnormal formation, then they will take a sample and send it to a laboratory for further examination.

These tests help to confirm if you have oesophageal cancer or not. If the results are positive and your doctor confirms it, then further tests are performed to find out the size of the cancer and how far it has spread in the body.^3,10

Stages of oesophageal cancer 

The European Society for Medical Oncology publishes a clinical practice guideline that covers the diagnosis, treatment, and follow-up recommendations for managing oesophageal cancer. 

The stages of oesophageal cancer are divided into ways–¹¹

1. TNM system (Tumour, Node, Metastasis)

This system describes–³

• The size of the tumour (T)
• If cancer has spread to lymph nodes (N) 
• If cancer has spread to other parts of the body (M)

2. Number staging system

This type of system is used to find the similarity between normal cells and cancer cells. This type of grading helps the doctor determine how the cancer cells will behave and decide which treatment option would be suitable.

The grading is as follows–

• Grade 1 - Low grade where most cells look like normal cells
• Grade 2 - Cells look a bit like normal cells
• Grade 3 - High grade where cells look very abnormal and do not resemble normal cells³

Treatment of oesophageal cancer

The treatment options can depend on many factors such as–³

• Location of cancer in the oesophagus
• The extent to which cancer has spread
• Type of cancer 
• Stage of cancer found during the biopsy test

The main treatment options include–

1. Surgery

A surgical procedure is generally suggested for the early stages of cancer, where the abnormal cells are present only in the lining of the oesophagus and have not spread to other parts of the body.⁹ The most common procedure used for treatment is called endoscopic mucosal resection (EMR) where the doctors remove the abnormal cells inside the lining of the oesophagus by passing instruments through the tube.³ Endoscopic submucosal dissection (ESD) is used to find the degree to which the cancer has penetrated.⁹

In the case of later advanced stages of cancer, where cancer has spread to other organs, a surgery called oesophagectomy is performed to remove the oesophagus. There are different types of oesophagectomy which depend on the stage and location of your cancer including–³

• Oesophagectomy – This surgery removes the part of the oesophagus that is affected by cancer
• Total oesophagectomy – This surgery removes the whole oesophagus
• Oesophago-gastrectomy – This surgery removes the top part of the stomach and the part of the oesophagus containing cancer

2. Chemotherapy

In this type of treatment, anti-cancer drugs are given that enter the blood and kill the cancer cells or reduce the size of abnormal cells so that they can be taken out by endoscopy if possible. This is called neoadjuvant chemotherapy. 

This is used only for stage 2 and 3 types of cancer, and not in stage 1. CT and PET scans are used to decide the best possible option for treatment. If a person gets recurrent cancer (repeated) or cancer in some other part of the body, then adjuvant chemotherapy is used.¹¹

Different types of chemotherapy are used according to the type of oesophageal cancer a patient is diagnosed with.³ 

• For adenocarcinoma, chemotherapy and radiotherapy are used together called chemoradiotherapy. This type of chemotherapy can be done before and after the surgery, depending upon the treatment plan
• For squamous cell cancer, chemotherapy or chemoradiotherapy is done before the surgery, or it can be the only treatment

The drugs used for chemotherapy can include fluorouracil, capecitabine, cisplatin, oxaliplatin, carboplatin, paclitaxel, docetaxel, epirubicin, or a combination of 2 to 3 drugs, depending upon the condition and treatment plan.¹²

3. Radiotherapy and chemoradiotherapy

Radiotherapy uses high-energy waves similar to X-rays which are used to kill cancer cells. If the cancer is in its early stages, chemoradiotherapy may be used for treatment, whereas for advanced stages, radiotherapy can help in further spreading of the cancer cells in the body.³ It is found that squamous cell carcinoma is more sensitive to radiotherapy than adenocarcinoma. So, chemoradiotherapy is considered an effective treatment option for squamous cell carcinoma patients.⁴

4. Targeted cancer drugs and immunotherapy

In chemotherapy, normal cells are also killed along with the cancer cells, but targeted drugs can target only the cancer cells.¹² The drugs that help the immune system to fight cancer are called immunotherapy. Some of the drugs include trastuzumab, nivolumab, and pembrolizumab.¹³

5. Treatment for swallowing

Oesophageal cancer patients can suffer from difficulty in swallowing. Some treatments used for this are:³

• Oesophageal stent
• Oesophageal dilatation
• Laser therapy
• Argon plasma coagulation (APC) or heat treatment
• Photodynamic therapy

FAQ

What is the main cause of oesophagus cancer?

The main causes of oesophagal cancer for squamous cell carcinoma are heavy alcohol intake and use of tobacco. Adenocarcinoma can be caused by long-term acid reflux disease (GERD) leading to Barrett's oesophagus. Other factors can include obesity, diet, age, gender, and environmental factors. If the cancer is detected early detection through healthcare guidance then chances of survival are increased.

Is oesophagus cancer curable?

Oesophageal cancer's curability depends on its stage at diagnosis. If the cancer is detected at an early stage then the chances of survival through surgery, radiation, and chemotherapy treatments are higher. In advanced stages of cancer, chances of completely overcoming the cancer are low. However, proper treatment and care can help provide relief from its symptoms and extend the life of the patient. 

What is the most common first symptom of oesophageal cancer?

Difficulty in swallowing (dysphagia) is the most common first symptom of oesophagal cancer. This can include a sensation of food getting stuck or discomfort while swallowing. It is important to consult a doctor if experiencing persistent swallowing difficulties, as early detection improves treatment options and outcomes.

Who usually gets oesophageal cancer?

According to the NHS, people over the age of 75 have a higher chance of getting oesophageal cancer. It is not commonly found in people under the age of 45. Men have a higher chance of getting diagnosed with oesophageal cancer as compared to women. People who have certain conditions such as long-term acid reflux or Barett’s oesophagus, are more prone to getting this cancer.

Summary

Oesophageal cancer is a type of cancer in which abnormal cells can form in the food pipe or oesophagus which connects the mouth to the stomach. According to NHS, the symptoms of this type of cancer include difficulty in swallowing, acid reflux or heartburn, and sudden weight loss. The two types of oesophageal cancer are squamous cell carcinoma and adenocarcinoma.

The risk factors include smoking, heavy alcohol consumption, obesity, pain in your throat or middle of the chest and acid reflux. Treatment options may include surgery, chemotherapy, radiation, or a combination, depending on the stage and type of cancer. Early detection and lifestyle changes can play a vital role in reducing the risk and improving outcomes.