Cancerous tumour in the tissue of the oesophagus
- Rare before the age of 40; thereafter, the risk increases with age
- About twice as common in males
- Smoking and alcohol abuse are risk factors
- Genetics is not a significant factor
In the UK, cancer of the oesophagus is the 9th most common cancer, with more than 7,800 new cases in 2006. In certain other countries, such as Iran and China, the disease is much more common. In the UK, oesophageal cancer is about twice as common in men as in women and very few cases are diagnosed in the under-40s. However, death rates from the cancer are relatively high because it is often present for some time before is begins to cause symptoms. As a result, the cancer has often spread by the time medical help is sought.
What are the causes?
The exact cause of oesophageal cancer is unknown, but factors known to increase the risk of developing it include smoking and excessive alcohol consumption. In China, fungal toxins in food are thought to be responsible for the high rate of the cancer. People who have particular disorders of the oesophagus, such as gastro-oesophageal reflux disease and Barrett’s oesophagus (in which the lining of the stomach replaces part of the oesophageal lining), are at increased risk of developing oesophageal cancer. People who have long-term diseases of the oesophagus may benefit from regular endoscopy to look for early evidence of cancerous growths.
What are the symptoms?
Early in the disease, there are often no symptoms. They develop slowly over weeks or months as the oesophagus becomes obstructed and may include:
Difficulty swallowing solid foods.
Difficulty swallowing liquids as the oesophageal opening narrows further.
Regurgitation of recently eaten food.
Cough as a result of food that cannot be swallowed properly spilling into the lungs.
Loss of appetite and weight loss.
If the tumour spreads and involves the trachea, there may also be shortness of breath and coughing up blood.
How is it diagnosed?
Your doctor may arrange for a tissue sample to be taken during endoscopy, which involves passing a flexible viewing tube into the oesophagus (see Upper digestive tract endoscopy). A barium swallow may be performed to detect an obstruction in the oesophagus. Once the diagnosis has been confirmed, tests such as CT scanning may be carried out to determine if the tumour has spread. Tumour spread may also be investigated using endoscopic ultrasound, in which a special probe is passed down the oesophagus.
What is the treatment?
The treatment depends on whether the cancer is limited to the oesophagus or has spread. A localized cancer can be removed, but the operation is a major procedure and only a small proportion of affected people are diagnosed early enough to make surgery worthwhile. If surgery is performed, chemotherapy or radiotherapy may be given beforehand to maximize the chance of a cure.
If the cancer has spread or if general health is not good enough for surgery, treatment is given to ease symptoms. Insertion of a rigid tube (called a stent) into the narrowed area of the oesophagus can relieve swallowing difficulties (see Palliative surgery for cancer). Treatment may also involve radiotherapy and chemotherapy.
What is the prognosis?
About 1 in 3 people with oesophageal cancer survives for at least a year after diagnosis but only about 1 in 12 people survives for more than 5 years.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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