Oesophageal cancer (or esophageal cancer – U.S spelling) is a malignant tumour found anywhere in the oesophagus. In Australia it is most commonly found in the lower section of the oesophagus, adjoining the stomach. The main types of oesophageal cancer are:
- Squamous cell carcinoma which starts in the cells that line the oesophagus. (This is more common in Asia.)
- Adenocarcinoma which starts in the glandular tissue of the cells lining the oesophagus.
In 2013 there were 1434 new cases of oesophageal cancer diagnosed in Australia.
In 2014, there were 1198 deaths from oesophageal cancer in Australia.
Oesophageal cancer is slow- growing and usually detected in advanced stages, as there may not be any symptoms in the early stages. Symptoms of oesophageal cancer may include:
- pain or difficulty when swallowing
- vomiting blood
- black or bloody stools
- unexplained fatigue
- feeling of choking when swallowing
- discomfort in the upper abdomen particularly when eating
- weight loss.
Risk factors for oesophageal cancer include:
- high alcohol consumption
- smoking tobacco
- diet low in fresh fruit and vegetables
- eating smoked, salted or pickled food
- drinking very hot liquids (above 65°C) frequently
- exposure to certain chemical fumes
- family history of gastrointestinal disorders
- certain medical conditions such as Barrett’s oesophagus or gastro-intestinal reflux disease.
Recommended tests for oesophageal cancer are likely to depend on your symptoms. Tests to diagnose oesophageal cancer may include:
The most common investigation for oesophageal cancer is an endoscopy. Your doctor will use an endoscope (thin, flexible tube with a camera at the end) to look at your digestive tract. A small amount of tissue may also be removed (biopsy) and examined by a pathologist to check for signs of disease.
Endoscopic ultrasound uses an endoscope with a probe which releases soundwaves that bounce off anything solid such as a tumour or organ. This test may indicate if cancer has spread into the oesophageal wall or lymph nodes.
Scans or imaging tests such as CT/PET scans or a laparoscopy may be used to detect if the cancer has spread. Less frequently, tests such as a bone scan or an ultrasound may be used.
The type of treatment you have will depend on the extent of the cancer.
Tests for oesophageal cancer may also indicate the extent of the cancer and how far it has spread. This is called staging and will help your doctor decide on the best treatment for you.
Surgery is commonly used to treat oesophageal cancer. The type of surgery is likely to depend on the size and location of the tumour.
You may have chemotherapy and/or radiotherapy before surgery to shrink the tumour. This is known as neoadjuvant treatment.
In surgery, part or all of the oesophagus is removed. If part of the oesophagus is removed the surgeon will rejoin the remaining part to your stomach. If the whole oesophagus is removed, your stomach or part of your bowel may be used to replace it.
You may have chemotherapy and/or radiotherapy after surgery in order to destroy any remaining cancer cells.
Depending on the treatment you receive, you may see a number of different health professionals including:
- a GP who will arrange the first tests
- an endoscopist who diagnoses and treats diseases of the gastrointestinal tract
- an upper gastrointestinal surgeon specialising in surgery to treat gastrointestinal diseases
- a radiation oncologist to coordinate radiotherapy
- a medical oncologist to coordinate chemotherapy
- cancer nurses
- other allied health professionals such as physiotherapist, speech pathologist, social worker and dietitian.
Palliative care care aims to improve quality of life without trying to cure the disease, by alleviating symptoms of oesophageal cancer such as difficulty swallowing and nausea. Palliative care for oesophageal cancer may include radiotherapy, chemotherapy or other medications.
There is currently no screening for oesophageal cancer available in Australia.
Prognosis refers to the expected outcome of a disease. It is not possible for a doctor to predict the exact course of your cancer. However, your doctor may provide a guide to likely treatment outcomes based on your test results, the extent of the tumour and your overall health.
Lifestyle factors such as poor nutrition and high body mass, smoking tobacco and high alcohol consumption significantly increase the risk of oesophageal cancer.
Understanding Stomach and Oesophageal Cancer, Cancer Council Australia, ©2015. Last medical review of source booklet: November 2015
Cancer Research UK
Australian Institute of Health and Welfare (AIHW) 2017. Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. Canberra: AIHW.