Oesophageal Cancer Treatment
Oesophageal cancer is a disease of the oesophagus or “gullet” starting just below the voice box to the junction of the stomach and oesophagus.
Due to the large length of the oesophagus, cancers are usually designated as cervical, upper thoracic or lower thoracic oesophageal cancers. Cervical cancers occur behind the clavicles in the low part of the neck, whilst upper thoracic cancers occur in the upper half of the chest and lower thoracic cancers occur in the lower half of the chest.
Oesophageal cancers usually occur from abnormal squamous or glandular cells, termed squamous cell carcinomas or adenocarcinomas respectively. Adenocarcinomas commonly occur in the lower oesophagus or at the gastro-oesophageal junction, whereas squamous cell carcinomas typically occur in the middle or upper thirds of the oesophagus.
Overall oesophageal cancer is relatively rare with about 1300 new cases being diagnosed in Australia each year. The rate is gradually increasing, particularly for adenocarcinomas.
What Are the Causes of Oesophageal Cancer?
The risk factors for oesophageal cancers are different for squamous cell carcinomas and adenocarcinomas. Men overall have an increased risk over women of developing oesophageal cancers.
Risk factors for oesophageal adenocarcinomas are:
Cigarette smoking, alcohol intake, obesity, low intake of fresh fruit and vegetables and gastro-oesophageal reflux disease.
Risk factors for oesophageal squamous cell carcinoma are:
Cigarette smoking is a very strong risk factor (more than for adenocarcinomas) and it is related to viral exposure (human papilloma virus). Also, excess alcohol consumption, low intake of fruit and vegetables, increase the risk of developing this cancer.
What Are the Symptoms of Oesophageal Cancer?
Some patients do not have symptoms from oesophageal cancer until the tumour is advanced. In many patients however, symptoms may present several months before a diagnosis is made.
Common symptoms include:
- Difficulty swallowing food or the sensation that food is getting stuck in the oesophagus
- Discomfort or pain when swallowing food
- Weight loss or loss of appetite
Occasionally people may develop symptoms of coughing, a hoarse voice, vomiting or coughing of blood.
What Are the Treatments for Oesophageal Cancer?
Treatments for oesophageal cancer are different depending on where the cancer is situated and whether it is early stage or advanced stage (spread).
Cervical oesophagus: For cancers in the cervical oesophagus, use of combined radiation therapy and chemotherapy is the main treatment used to cure the cancer due to the risks and complications of operations performed in this area.
Use of radiation therapy and chemotherapy has similar cure rates to surgery in this setting.
Thoracic oesophagus: Treatment depends on whether surgery is possible.
In the thoracic oesophagus for early cancers, surgery alone with the removal of part of the oesophagus and lymph nodes can be considered. For some scenarios with very superficial, early stage cancers some patients may be treated with the removal of the lining of the oesophagus by an endoscope. This treatment is only considered after discussion in multi-disciplinary team meetings.
For more advanced stages, radiation therapy and chemotherapy before surgery is often used and combined with surgery. Combination therapy can increase the side effects of treatment
If surgery is not possible (for example the patient is not fit enough), radiation therapy with or without chemotherapy is used as a curative treatment.
What Are the Side Effects of Radiation Therapy?
The side effects of radiation therapy are described as acute or late.
Acute side effects are those that happen during and within a few weeks after treatment. They are usually more temporary and tend to resolve, although this is not always the case. Sometimes severe acute side effects can result in late effects
Late side effects are side effects that can occur 3 months after completing radiotherapy. Late side effects are less common. They may not show themselves during or immediately after radiotherapy but occur later on. The risk with late side effects is that they could be permanent or irreversible and become a more long term situation
www.eviq.org.au is a resource for patients written by oncologists that provides detailed information on side effects.
Acute side effects
- Nausea and vomiting
- Loss of appetite
- Loss of taste
- Trouble swallowing
- Painful swallowing
- Loss of weight
- Skin reaction
- Rarely – irritation of the food pipe or stomach that can cause bleeding
Some patients cannot get enough nutrition while the above side effects occur and occasionally need a feeding tube either via the nose (naso-gastric tube) or stomach (gastrostomy tube) to support them while they are having treatment.
Late side effects
- Inflammation or scarring on the lungs that can cause cough and shortness of breath
- Inflammation of the covering of the heart (called the pericardium)
- Narrowing of the food pipe, causing trouble swallowing
- Ulceration of the food pipe or stomach that can cause bleeding
- Very rare – another tumour in years to come as a result of the radiation therapy
The best person to discuss radiation therapy for oesophageal cancer with is a radiation oncologist. You can ask your Surgeon or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a suitable treatment option for you.
Find your closest radiation oncology Treatment Centre
Page last updated: 28/10/2020