Oesophageal Cancer

The oesophagus is a long tube that delivers food, fluids and saliva from the mouth and throat to the stomach.

Adenocarcinoma is the most common type of oesophageal cancer and occurs in glandular tissue, most often in the lower part of the oesophagus near the stomach.

These are often associated with precancerous change as a result of long term reflux and acid damage to the lower oesophagus.

Squamous cell carcinoma occurs in the cells lining the oesophagus. This type of oesophageal cancer is more common in smokers, African-Americans and in people of Asian descent.

Statistics

Oesophageal cancer rates are fairly stable in Australia.

  • Approximately 1,697 men and women will be diagnosed with Oesophageal Cancer in 2019
  • Up to 1,470 men and women will die from Oesophageal Cancer in 2019.
  • There is only a 22% chance of surviving past 5 years

Data source: Australian Institute of Health and Welfare: Cancer in Australia 2019

Every patient is different, speak to your doctor or refer to our tips on how to find the right specialist to ensure you find the answers you are looking for.

Causes

Some risk factors associated with this cancer include:

  • Smoking: Long-term history of smoking.
  • Alcohol: Consumption of alcohol, especially when combined with smoking.
  • Barrett’s Oesophagus: a condition in which chronic acid reflux causes changes in the cells lining the lower oesophagus, increasing the risk of adenocarcinoma.
  • Achalasia: a disease in which the oesophagus fails to move food into the stomach properly.
  • Tylosis: a rare, inherited disorder that causes excess skin to grow on the soles of the feet and palms and has a near 100% chance of developing into oesophageal cancer.
  • Lye or other caustic substances: when ingested, such substances can cause scarring that may progress to cancer years later.

Symptoms

oesophageal-cancer-symptoms_for_web

Signs and symptoms of this type of cancer may include:

  • Difficulty swallowing
  • Pain, pressure or burning in the throat or chest
  • Weight loss
  • Vomiting
  • Harsh, raspy or strained voice

Tests

Various investigations may be performed depending on the symptoms leading to the diagnosis of cancer and for determination of the extent of cancer.

Some tests that may be performed according to the cancer type include:

  • Image tests
  • Barium swallow
  • MRI, CT and PET scan
  • Endoscopy

Treatment

Once the diagnosis is made, cancer removal when possible would be the best treatment option in the majority of cases.

Treatment for oesophageal cancer depends on the stage.  In the instance where an operation is not possible or beneficial, insertion of an oesophageal stent may be utilised for palliation of dysphagia.

Surgery is the most common treatment for esophageal cancer. There are two surgical techniques:

  • Open radical oesophagectomy: The cancerous portions of the oesophagus, top portion of the stomach and neighboring lymph nodes are removed.
  • Minimally invasive oesophagectomy: Keyhole operation to achieve similar results to the standard open radical approach.

Depending on the type of tumor, chemotherapy which involves the use of drugs to kill cancer cells, is most often combined with radiation therapy.

Endomucosal resection can be an option for very early tumors, particularly in patients unlikely to tolerate major surgery.

Other potential treatments available for pre-cancerous growths include Photodynamic therapy (PDT), Argon Plasma (APC) or Radio Frequency Ablation (RFA), each is explained below:

Photodynamic therapy: laser-sensitive chemicals are injected into the tumor site. A laser beam then targets the chemicals to destroy the tumor. This therapy is more commonly utilised for treatment of more pre-cancers in high risk regions or when surgery is not possible for palliative purposes.

Argon plasma: This therapy involves direct thermal injury to precancerous cells. The body then recovers and replenishes the area of injury with normal cells.

Radio Frequency Ablation: This utilises a radio frequency generator via a probe (device), the energy is transmitted to the target tissue causing it to heat up. The heat destroys the target tissue and the body replenishes it with normal cells.

Find a specialist

Click here to read our tips on finding the right specialist for you.

Questions to ask your doctor

It can become confusing and overwhelming when speaking to a number of doctors. It helps to write down a list of questions you wish to ask your doctor. Consider the following questions;

  • Do you typically treat patients with my type of cancers?
  • What are the outcomes or complications you have faced with my type of cancer?
  • Is there anything unique about my cancer that makes my prognosis better or worse?
  • What are all my treatment options?
  • How long will I need to receive treatment and how often?
  • How will I know if my treatment is working?
  • What are the side effects of my treatment?
  • Are there any alternative treatment options?
  • How can I prepare for the side effects of my treatment or prevent them?
  • How will treatment affect my daily activities?
  • Will I need to stop working?
  • Are there any clinical trials that are right for me?
  • What other health services would benefit me (for example; dietitian, social worker, physiotherapist) and how can I be proactive with my treatment?

Seeking a second opinion

You can seek a second, third and fourth opinion until you are satisfied and comfortable with the doctor you have chosen. Most doctors will encourage you to seek more than one opinion as they may confirm or suggest modifications to the proposed treatment plan.

It is sometimes difficult and uncomfortable to suggest to your doctor that you would like to seek a second opinion. It is best to be open and honest, suggest that you are satisfied with their decision and you would like to be as thoroughly informed as possible. It is also best to keep your doctor informed during this process as they can make your medical records, test results and x-rays available to the specialist who is giving the second opinion.