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Oesophageal Cancer

DrGanesh DP 2
Dr Ganesh Ramalingam

Specialist in General Surgery

Condition

Oesophageal Cancers In A Nutshell

  • Oesophageal cancer refers to cancer of the oesophagus. That is the tube that connects your mouth to your stomach.
  • Oesophageal cancers can occur in any part of your oesophagus, along the inner lining of the walls.
  • This form of cancer is more common in the elderly, where around 8 in 10 cases occur in people aged 60 and above.
  • One of the risk factors of oesophageal cancer is persistent heartburn and acid reflux.
  • An endoscopy can be performed to detect signs of abnormalities in the oesophagus.
  • Depending on the severity of the condition, laparoscopic surgery may be able to remove the cancerous tumour before it has spread to the oesophageal walls.
  • If cancer has spread, you may need to consider removing part of the oesophagus, this procedure is known as oesophagectomy.

Table of Contents

Oesophageal Cancer

What Is Oesophageal Cancer?

Your oesophagus (gullet) is a tube that connects your mouth to your stomach. When you swallow food, your oesophagus transports this food down to your stomach.

“Oesophageal cancer occurs when abnormal cells in the oesophagus develop uncontrollably. Cancers can occur in any part of your oesophagus as they develop along the inner lining of the oesophagus.”

Dr Ganesh Ramalingam

Oesophageal cancer is more common in the elderly, where around 8 in 10 cases occur in people aged 60 and above. The majority are above 60 when they are diagnosed with oesophageal cancer.

Cancers in the upper and middle portion of the oesophagus are usually squamous cell carcinomas. These cancers grow from cells that are found in the inner lining of your oesophagus.

Cancer in the lower part of your oesophagus are usually adenocarcinomas. These cancers develop from gland cells. Gland cells remove specific substances from the blood, processes them, and then either releases them for further use or eliminates it.

The lower portion of your oesophagus is joined to your stomach at the gastro-oesophageal junction. Cancers that occur here are called gastro-oesophageal junction cancers.

Delayed treatment of oesophageal cancer may lead to it becoming a terminal illness.

What Causes Oesophageal Cancer?

Oesophageal cancer happens when cells in your oesophagus undergo mutations (changes) in their DNA. These mutations cause cells to undergo uncontrolled cell division. The accumulating mass of abnormal cells forms a tumour in your oesophagus that can grow to spread to other parts of your body. Treating oesophageal cancers when they are in the early stage of development may save lives.

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What Are The Risk Factors Leading To Oesophageal Cancer?

Certain factors may increase your risk of developing oesophageal cancer. This includes:

  • Ageing (risk of developing oesophageal cancer increases with age)
  • Gastroesophageal Reflux Disease (GERD)
  • Barrett’s oesophagus (a condition that causes the damaging of the lining of the oesophagus)
  • Being overweight or obese
  • Consuming a diet that is low in fibre
  • Overconsumption of alcohol
  • Smoking

What Are The Symptoms Or Warning Signs If I Have Oesophageal Cancer?

Early-stage oesophageal cancer rarely causes symptoms, making early detection difficult. However, the symptoms start to manifest as the cancer progresses.

These symptoms may include:

  • Persistent heartburn or indigestion
  • Difficulty swallowing
  • Regurgitation of food
  • Loss of appetite and unintentional weight loss
  • Hoarse voice
  • Coughing blood
  • Chest or back pain

While some of the symptoms are common to other non-cancerous conditions such as GERD, it is recommended to seek medical advice to determine the cause of your symptoms and whether treatment is required.

For 70-year-old Les, the thought of oesophageal cancer never crossed his mind.

“I had sudden bouts of vomiting freshly chewed food, stomach pains and weight loss”, after which he visited a GP who initially prescribed medication to reduce stomach acid. However, after a month of continued symptoms, he was referred for an endoscopy, where the cancer was detected.

How Can Oesophageal Cancer Be Prevented?

Lifestyle and dietary changes may help to reduce your risk of developing oesophageal cancer.

These changes may include:

  • Consuming plenty of fibre-rich foods such as fruits, vegetables, and whole grains
  • Quitting smoking
  • Reducing your alcohol consumption

Early treatment of a condition called Gastroesophageal Reflux Disease (GERD) may also reduce the risk of developing oesophageal cancer. GERD is a condition diagnosed for severe acid reflux in which stomach acid moves up the oesophagus regularly.

This results in damaging the lining of the oesophagus, resulting in the weakening of the inner lining, making it more common for growths to form.

How Is Oesophageal Cancer Diagnosed?

An endoscopy is performed to detect signs of abnormalities in the oesophagus. Through an endoscopy, the doctor uses a long flexible tube called an endoscope with a tiny camera and light on the end to look inside your oesophagus.

The oesophagus is checked for growths or abnormal-looking areas. Tissue samples (biopsies) of any abnormal-looking structures may be taken and sent to the laboratory for examination using a microscope.

A barium swallow is another test for oesophagus cancer. The test shows the inside of your oesophagus, and doctors can use this test to diagnose oesophageal cancer along with the stage of cancer.

During this test, you will drink a white barium liquid. While you swallow the liquid, a radiographer takes many X-rays of your oesophagus. This test is used to show any tumours or abnormal-looking areas in your oesophagus.

A CT scan, PET scan, or MRI may also be used to see if cancer has spread to other parts of the body.

John, a patient with Leighton Hospital (UK), was diagnosed with oesophageal cancer after experiencing difficulty swallowing and minor bouts of acid reflux and gas.

His condition was confirmed after undergoing an endoscopic investigation. Thankfully, his condition was diagnosed early, and he was treated with laparoscopic surgery.

How Is Oesophageal Cancer Treated?

Oesophageal Cancer img1 scaled

While many oesophageal cancer cases may not be completely cured, it is still possible to relieve the symptoms while improving the quality of life using chemotherapy and, in some cases, radiotherapy and surgery.

Depending on the condition, your doctor may recommend one or more of the following treatment plans, including:

  • Chemotherapy
  • Radiation therapy
  • Surgery
  • Immunotherapy, such as vaccines and medication

Depending on the origin and development stage of the cancer, the treatment plan may differ for individuals. Each treatment option can be discussed and recommended by our doctor based on your age and overall health condition.

If surgery is an option, it is a recommended option as long as all cancerous tissue can be removed.

In the earlier stages of oesophageal cancer, your doctor may be able to remove cancerous tumours through surgery before it has spread.

Laparoscopic surgery may be used to remove the tumour. This method is minimally invasive and only requires several small incisions to be made.

If the cancer has spread to the oesophageal walls, your doctor may suggest removing part of the oesophagus along with neighbouring lymph nodes. This procedure is known as oesophagectomy.

The oesophagus’ cancerous parts will be removed, and our doctor will reattach the healthy portion to the stomach. In some cases, the top of the stomach may be removed as well.

Chemotherapy may also be recommended after surgery to help prevent the cancer from returning.

If oesophageal cancer is only diagnosed at a later stage, a cure may not be possible.

Taking the time to learn about your treatment options and talking to your doctor to make informed decisions is key to your treatment progress. By understanding the benefits and challenges or each treatment course, you can then work out the treatment that is suited to you.

Aside from treating cancer cells in the oesophagus, the treatment goal is to prevent the cells from spreading. Colorectal cancer, when left untreated, may spread to other parts of the body and is terminal.

What Is An Alternative Procedure For Oesophagectomy?

Laparoscopic oesophagectomy is an advancement to the typical open surgery. It is done through minimally invasive incisions to the patient. Four to six minor cuts are made in your stomach.

A long tube called a laparoscope is used. It is connected to a camera that shows your internal organs through a video screen. This helps your surgeon put instruments into your body through the other incisions. Using the laparoscope and the other instruments, your surgeon frees the stomach so that it can be moved into the chest.

The tumour is removed, and your stomach joined to the remaining oesophagus. Laparoscopic surgery avoids the trauma of a large wound associated with conventional surgery and results in less pain and much quicker recovery for our patients.

The advantages of laparoscopic surgery for oesophageal cancer are:

  • Reduced pain
  • Speedier recovery
  • Reduced risk of chest infection and post-operative complications
  • Shorter hospital stay
  • Possible improvement in long term survival for selected patients

When Lyn Alraimouny learned she had oesophagal cancer in 2012, her doctor referred her to a different surgeon located at a New York City hospital, who laid out a detailed plan to treat her stage 3 disease.

She experienced difficulty swallowing food and felt that she might need to slow down her eating and chewing. However, her diagnosis was confirmed after Lyn’s biopsy result, and scans of her oesophagus returned. Her doctor proposed a treatment involving chemotherapy and radiation before minimally invasive robotic-assisted surgery to remove whatever tumour remained.

This proved effective, and within three months of the surgery, Lyn was back to work.