Cancer of the Oesophagus
This information will help you understand cancer of the oesophagus. It is an agreed view on this cancer by medical experts. We hope that it will answer some questions and concerns you might have. The information on this page is brief but more details are given in a booklet called ‘Understanding Cancer of the Oesophagus’ from the Irish Cancer Society. You can download a copy of the booklet by pressing the Download Booklet button below.
Frequently Asked Questions:
What is cancer?
The body is made up of tiny building blocks called cells which form the organs and tissues of the body. Cancer can affect cell growth and cause them to grow and divide without control or order. These groups of abnormal cells can form a tumour. Tumours can be benign or malignant. A benign tumour is not cancer and can usually be removed. Benign tumours do not spread to other parts of the body. A malignant tumour is cancer. Cancer cells can spread by breaking away and entering the bloodstream or lymphatic system. The lymphatic system drains away excess fluids (called lymph) from the tissues. Cancer cells can then invade other tissues and organs.
Each year, about 300 people in Ireland learn that they have cancer of the oesophagus.
What is the oesophagus?
The oesophagus (food pipe) is a long muscular tube that connects your throat to your stomach. It is also known as the gullet. It is about 12 inches (30 cm) long in adults. When you swallow, food is pushed down the oesophagus to the stomach by contraction of these muscles. The upper part of the oesophagus runs behind, but is separate from, the trachea (windpipe) which connects your mouth and nose to your lungs and allows you to breathe. The windpipe joins the top part of the oesophagus. A valve here prevents food contents in the oesophagus from coming back up and entering the windpipe.
This picture shows the mouth, oesophagus and other parts of the digestive system.
Risk factors for cancer of the oesophagus
A risk factor is anything that increases a person’s chance of getting a disease such as cancer. The exact cause of cancer of the oesophagus is unknown, but there are certain factors that can increase your risk.
Age: The risk of getting oesophageal cancer increases with age. Most people who develop it are over the age of 60.
Gender: Men have a higher rate of oesophageal cancer than women.
Tobacco: Cigarettes, cigars, pipes and other tobacco products are major risk factors.
Alcohol: Long-term heavy drinkers of alcohol have an increased risk. People who use both tobacco and alcohol are at an even greater risk of oesophageal cancer.
Food: Diets that lack fruit and vegetables and vitamins A, C and riboflavin may increase the risk of developing this cancer.
Obesity: Obesity is also a risk factor for some types of oesophageal cancer.
Very hot liquids: Frequent drinking of very hot liquids is thought to increase the risk of oesophageal cancer.
Occupational exposures: Exposure to the chemical perchloroethylene used in dry cleaning may also increase a person’s risk of oesophageal cancer.
Medical conditions: Some medical conditions carry a higher risk of oesophageal cancer.
- Barrett’s oesophagus – In this condition there is long-term reflux (backflow) of stomach acid into the oesophagus. Over time cells in the bottom part of the oesophagus may change and start to look like cells that line the stomach.
- Reflux disease or GORD – Heartburn is one of the main symptoms of gastroesophageal reflux disease (GORD). But the condition can also occur without symptoms. Long-term GORD increases the risk of oesophageal cancer, even if Barrett’s oesophagus has been diagnosed or not.
- Other conditions such as achalasia and tylosis are quite rare, but carry an increased risk for this cancer.
How can I reduce my risk of developing cancer of the oesophagus?
Nobody knows what causes oesophageal cancer. But there are steps you can take to reduce your risk of getting it.
- If you smoke, set a date to stop. Do not smoke in the presence of others. Advice and support on quitting is widely available. You can call the National Smokers Quitline at Callsave 1850 201 203.
- If you drink alcohol, cut down on the amount you drink. Aim for no more than 21 drinks for men and 14 for women per week, with some alcohol-free days. One standard drink is equal to a half pint of beer, one small glass of wine or one pub measure of spirits. Avoiding these two risk factors is the best way to reduce the risk of oesophageal cancer.
- Eat a healthy diet rich in fruit and vegetables. It is recommended that you eat five or more portions of fruit and vegetables every day. Eat foods that are low in fat and high in fibre.
- Keep within a healthy weight range. Do this by being more active every day and eating less fatty foods. Aim for 30 minutes of physical activity per day. You can spread the activity over one or more sessions.
Cancer of the oesophagus
When cancer occurs, cells in part of the lining of the oesophagus change to form a tumour. Tumours can develop anywhere along the oesophagus. They can also start from the inner layer and grow outwards. The tumour may cause few symptoms at first, but as it grows it can interfere with the breaking down of food in the oesophagus. This can give rise to certain symptoms.
What are the warning signs/symptoms?
- Difficult or painful swallowing (dysphagia)
- Weight loss or poor appetite
- Pain or discomfort behind the breastbone or between the shoulder blades
- Discomfort in the throat or back
- Acid indigestion or heartburn that does not go away
- Frequent hiccoughs or belching
- Ongoing cough
These signs and symptoms do not always mean cancer. But if you have any signs, especially for some weeks and for no good reason, get your doctor to check them to be certain.
There are no early detection methods to screen (test) the general population for oesophageal cancer. People who are at high risk, e.g. those with Barrett’s oesophagus, should be followed closely so that any abnormal changes can be treated early.
How is cancer of the oesophagus diagnosed?
Most people begin by visiting their family doctor or GP. If your GP has concerns, you will be sent to a hospital doctor for tests. After checking your general health, some special tests are done in hospital.
Barium swallow is a special X-ray of your oesophagus. A white drink called barium is swallowed which helps to outline your oesophagus. While you are drinking the barium, X-rays are taken. This test takes about 15 minutes and is not painful.
Other tests include endoscopy, where a flexible tube is passed down your throat, along the oesophagus and into your stomach. Small pieces of the lining of your oesophagus can be removed for an examination called a biopsy. The doctor can look through the tube and check for anything unusual.
Blood tests and a chest X-ray are also done.
Staging and further tests
Staging means doing tests to find out the exact size of the tumour and whether it has spread to other parts of the body. Sometimes further tests are needed and can include the following:
Liver ultrasound scan: This test is carried out in the X-ray department of the hospital. Once you are lying comfortably on your back, a gel is spread onto your abdomen. A small probe like a flat microphone, which produces sound waves, is then passed over the area. Sound waves are then used to give a picture of your liver.
Endoscopic ultrasound: This test is similar to an endoscopy. A small ultrasound probe is connected to the scope (tube) while in your oesophagus. Sound waves are then used to give a picture of the parts of your body from inside your oesophagus.
CT scan (CAT scan): This is a special type of X-ray which gives a detailed picture of the inside of your body. It lasts about 30 minutes. Sometimes you are given a drink or an injection to help show a particular part of your body.
MRI scan: This scan uses magnetic fields and may need to be done before treatment begins. It is painless and very noisy. Some people find it claustrophobic, but it is possible to bring someone in with you while having it done. If you have a pacemaker or any type of metal device placed in your body, it is important to tell the person doing the scan.
When cancer of the oesophagus is diagnosed?
After cancer is diagnosed, shock, disbelief and anxiety are natural reactions. This can result in confusion. You may find it hard to think of what you want to ask the doctor. Sometimes there is a lot of information to take in, which might be difficult to remember later. It helps to make a list of questions and write down what the doctor says. It is a good idea to take a family member or friend along when meeting the doctor.
Treatment for cancer of the oesophagus
The type of treatment you get will depend on the size of the tumour, where it is found and whether it has spread to the lymph nodes (groups of cells) near the oesophagus or to other parts of the body.
It is important to find out from your doctor or nurse how the different treatments work, how long they will last and what are the side-effects? Sometimes there may be a choice between treatments. When talking about treatments, find out about taking part in a type of research study called clinical trials.
Surgery, radiotherapy and chemotherapy are all used on their own or in combination to treat cancer of the oesophagus. Very often radiotherapy and chemotherapy are given before surgery. This is to shrink the tumour and may make surgery more effective.
Surgery is the main treatment for cancer of the oesophagus. The type of surgery you have will depend on:
- The type of tumour
- Its location in the oesophagus
- The size of the tumour
- If it has spread to other parts of the body.
If the tumour is only in a small section of the oesophagus, the whole tumour can be removed along with part of the oesophagus. The most common type of operation is where the tumour section in the oesophagus is removed and the stomach is then joined to the remaining length of oesophagus.
Depending on where the tumour is, surgery may also be needed on the abdomen and the chest. This is so that the affected part of the oesophagus can be removed.
During these operations, the top part of the stomach is usually removed. As it will now be higher up than before, you will need to eat smaller meals and more often. You may find that you feel sick or very full if you eat too quickly.
Usually a change in diet is needed. You may also need a special diet for a few weeks or months, or permanently. Ask your doctor or dietitian (a nutrition specialist) to explain the changes you should make to your diet. Eating well means getting enough calories and protein to prevent weight loss, to build up strength and rebuild normal tissues. This is important for people with cancer of the oesophagus. More information on diet is available in a free booklet called Diet and the Cancer Patient from the Irish Cancer Society.
Chemotherapy is used to treat cancer of the oesophagus. This type of treatment involves the use of drugs to kill cancer cells. It can often be given after surgery to prevent the cancer coming back. This is called adjuvant chemotherapy. Usually this type of treatment is given in cycles for about six months. Chemotherapy is also given to treat cancer of the oesophagus when surgery is not possible or the cancer has spread.
More information on chemotherapy and its side-effects is available from the Irish Cancer Society in a booklet called Chemotherapy. You can also call the National Cancer Helpline on 1800 200 700.
Radiotherapy is the use of powerful X-rays to treat cancer. It is commonly used to treat oesophagus cancer. It can also be used to ease distressing symptoms like difficult and painful swallowing caused by the tumour. More information on radiotherapy and its side-effects is available from the Irish Cancer Society in a free booklet called Radiotherapy. You can also call the National Cancer Helpline on 1800 200 700.
If you or someone you know is diagnosed with cancer of the oesophagus, more detailed information about the symptoms, diagnosis and treatment is available in a booklet called Understanding Cancer of the Oesophagus. This booklet can help you understand the feelings and distress that can arise with a cancer diagnosis. It is available free of charge from the Irish Cancer Society by calling the helpline on 1800 200 700.
The Halo System
The objective for 2008 is to focus on early detection and treatment of a pre-cancerous condition known as Barrett’s oesophagus. This means that the lining of the oesophagus is changed by acid damage (heartburn, regurgitation) over many years.
The condition is quite common, and a person with Barrett’s has a 40-fold increased risk of getting oesophageal cancer. If the changed lining can be removed or controlled, then logically the cancer risk may be reduced or eliminated. The Halo System is designed to remove the Barrett’s epithelium in a short, well tolerated endoscopic (camera test) procedure. This means that the patient can be treated as a day case without the need to be admitted to hospital for surgery.
The entire cost is including medical training is €100,000.