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 above 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), excess alcohol consumption, low intake of fruit and vegetables, also 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. 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.
For some 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 fairly new and normally only considered after discussion in multi-disciplinary team meetings. In the thoracic oesophagus for other early cancers, surgery alone with removal of part of the oesophagus and lymph nodes can be considered.
If a patient has surgery alone, radiation therapy usually in combination with chemotherapy may be considered if the cancer is more advanced than an early stage cancer or has features with a high risk of loco-regional recurrence (e.g. positive surgical margin). For other locally advanced cancers either chemo-radiation therapy alone is potentially curative.
For adenocarcinoma, chemotherapy or chemo-radiation therapy prior to surgery can have the best outcomes but has increased risks associated with that treatment.
What Are the Side Effects of Radiation Therapy?
Common side effects from radiation therapy include:
- Nausea can occur in some patients and depends on the type of chemotherapy being used with the radiation therapy.
- A lot of patients may develop discomfort while swallowing foods and occasionally a feeding tube may be required to help improve nutrition during treatment.
- Tiredness is common and some patients occasionally develop a mild radiation skin reaction , particularly on the back.
- Some patients may develop inflammation of lung which can present with shortness of breath or coughing several weeks after the end of radiation therapy but this depends on the amount of lung in the radiation field.
- If a patient is having an operation after radiation therapy there is a slight increased risk of breakdown of the join between the oesophagus and stomach .
Long term side effects from radiation therapy can occur and may include narrowing of the oesophagus and a slight increased risk of second cancers.
The best person to discuss radiation therapy for oesophageal cancer 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.
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