Oesophageal Cancer

Upper GI Surgery

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Causes

Symptoms

Diagnosis & Assessment

Treatment Options

Prognosis

Causes

A tumour develops from abnormally growing cells within the lining of the oesophagus. It is thought that something damages or alters the genes within the cell. This makes the cell grow without any control and develop into a tumour.

Many people develop cancer of the oesophagus with no apparent reason. However, there are certain risk factors which are known to increase the chance of developing oesophageal cancer. These include:

Increased age
It is more common in older people. Most of our patients are aged over 55.
Diet
A high fat diet is thought to increase the risk of developing many gastrointestinal cancers – including cancer of the oesophagus. Eating a lot of fruit and green vegetables can reduce this risk. Obesity also increases the risk of developing cancer.
Smoking
This is probably the most significant risk factor for oesophageal cancer (as well as any other cancers).
Drinking a lot of alcohol
Longstanding reflux of acid from the stomach
This condition (known as gastro-oesophageal reflux disease) is quite common and causes inflammation at the lower end of the oesophagus. For the vast majority of people this inflammation causes no long term damage. However, in a very small number of people it does slightly increase the risk of developing cancer.
Barrett’s oesophagus
In this condition the cells lining the oesophagus have started to change to look more like cells lining the stomach. This is induced by longstanding acid reflux. People with Barrett’s oesophagus have an increased risk of developing cancer within the oesophagus. This risk is very small. Every year, 1 out of every 200 people with Barrett’s oesophagus will go on to develop cancer.

Symptoms

When an oesophageal cancer first develops it is small and usually causes no symptoms. As the cancer grows it will start to cause symptoms. These usually include one or more of the following:

Food getting stuck when swallowing (dysphagia). This is often the first symptom and is caused by narrowing of the oesophagus at the site where the tumour is growing. Food may feel as though it is sticking as you try to swallow. This can progress and drinks may also be difficult to swallow.
Regurgitation after eating. The narrowing in the oesophagus prevents food from passing through into the stomach and subsequently this can lead to regurgitation of food.
Pain in the chest or back. This can happen when trying to swallow.
Weight loss and lack of appetite.

Diagnosis & Assessment

Gastroscopy (Endoscopy)

Initial assessment usually involves a gastroscopy (endoscopy).

A gastroscope is a thin flexible telescope which is passed through the mouth into the oesophagus and down towards the stomach. The gastroscope contains fibre-optic channels down which light can be shone to visualize the lining of the oesophagus.

Biopsy

A Biopsy is performed to confirm the diagnosis.

A biopsy is a small sample of tissue taken from the part of the body being examined. The sample is examined under a microscope to look for any abnormal cells and help determine whether there is any evidence of cancer.

When having a gastroscopy, any abnormal tissue can be sampled in this manner using a thin biopsy instrument passed down one of the channels of the gastroscope.

Assessing the extent and spread (staging)

If cancer of the oesophagus has been diagnosed then further tests may be needed to assess in more detail the size of the cancer and to determine whether the cancer may have spread to any other part of the body.

The extent to which the cancer has spread is described as "the stage" of the cancer. Investigations used to determine the stage of the cancer are described as "staging investigations".

A number of different investigations may be used to fully stage the cancer. These might include:

CT scan (computerized tomography)

CT scan uses x-ray beams and a computer to take cross sectional images of the chest and abdomen. This type of examination is useful in looking for any evidence that the cancer may have spread from the oesophagus to other parts of the body – such as the lungs, liver or bones.
PET/CT scan

Positron Emission Tomography (PET) demonstrates biochemical activity arising from different tissues within the body. When looking at oesophageal cancer, a small amount of radioactive substance is used to tag on to natural compounds accumulating within cancer cells. As this substance decays it emits positrons which can be detected by special sensors. The images are reconstructed using a powerful computer. This information is then combined with images taken using the CT scanner.

This technique can be used to identify cancer earlier than other x-ray techniques. It can help distinguish between malignant and benign tumours. It is also very good at determining the location and extent of any cancer cells within the body, as well as indicating whether there is any spread to other areas of the body such as lymph nodes, liver or bones.
Endoscopic ultrasound (EUS)

Endoscopic ultrasound combines endoscopy and ultrasound to provide detailed information about the cancer. In particular, it can accurately assess its length and relationship to surrounding tissues and organs.

The oesophagus lies within the chest very close to the airways, lungs, spine and major blood vessels coming from the heart.

EUS is used to carefully examine whether the cancer is involving any of these structures. Also, it can look very closely at lymph glands next to the cancer, and to see if they are abnormally enlarged which may be an indication that cancer has spread to these lymph glands.

Treatment Options – Overview

Treatment options may include surgery, chemotherapy and radiotherapy. The treatment recommended in each case depends on both the stage of the cancer and your general health.

Some of the treatments are potentially quite dangerous, and for patients with poor health, may not be well tolerated.

These options are discussed in great detail with a specialist who will have discussed your case with other specialist colleagues through our Multi-Disciplinary Team. They will be able to discuss the pros and cons of each treatment, the likely success rates, possible side effects and other details about possible treatments.

Where possible, the aim of treatment would be to try and cure the cancer. Some cancers of the oesophagus can be cured – particularly if they are treated in the early stage of the disease.

However, in some cases, potentially curative treatment is not realistic. This may be because the cancer has spread too far to be cured by any form of treatment; or it may be that someone’s general health is so poor that any attempt at curative treatment would be too dangerous for them to tolerate. In these circumstances treatment would be aimed at trying to limit the growth or spread of the cancer and keep you free of symptoms for as long as possible.

Treatment Options

Surgery

Where oesophageal cancer has been detected at an early stage and remains confined to the oesophagus then it may be possible to operate to remove the section of oesophagus containing the cancer.

There are various ways that such an operation can be performed. Most of the time such surgery involves removing a significant part of the oesophagus and replacing it using part of the stomach. These operations are major procedures and carry some risk.
Chemotherapy

Chemotherapy uses anti-cancer drugs to kill cancer cells or stop them from growing.

Chemotherapy may be used in addition to other treatments such as surgery or radiotherapy. For example, in most cases where surgery is being considered, patients may be given a course of chemotherapy before their operation. The aim of this treatment is to kill any cancer cells which may have spread away from the site of the oesophageal cancer and to try and shrink the cancer and improve the success rates for operation.
Radiotherapy

Radiotherapy uses high energy x-ray beams focussed on to the cancer. This kills the cancer cells or stops them from growing. In cancer of the oesophagus, such treatment is often used in combination with either surgery or chemotherapy.

Prognosis

Without any treatment, a cancer of the oesophagus will eventually get larger, spread to other parts of the body and would be potentially fatal.

If it is diagnosed and treated at an early stage (before the cancer has spread away from the oesophagus into the lymph glands or other parts of the body) then there is a chance of curing the cancer with treatment.

Unfortunately, in many cases the cancer is not diagnosed at such an early stage, in which case treatment would be used to try and minimize symptoms and try and slow the growth of the cancer for as long as possible.

All treatments for cancer are constantly under review and any new developments are rapidly taken up by our specialists.

Our Cancer Team participates in national and international trials to look at new cancer treatments and many of these trials are available to our patients.

Each patient is assessed individually and your specialist will be able to give you a much more accurate assessment of your particular outlook.

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Upper GI Surgery