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Overview
- Oesophageal cancer is a cancer that's found anywhere in the oesophagus, sometimes called the gullet or food pipe.
- The oesophagus connects your mouth to your stomach.
- How serious oesophageal cancer is depends on where it is in the oesophagus, how big it is, if it has spread and your general health.
Symptoms
Main symptoms of oesophageal cancer:
There are many possible symptoms of oesophageal cancer, but they might be hard to spot.
They can affect your digestion, such as:
- having problems swallowing (dysphagia)
- feeling or being sick
- heartburn or acid reflux
- symptoms of indigestion, such as burping a lot
Other symptoms include:
- a cough that is not getting better
- a hoarse voice
- loss of appetite or losing weight without trying to
- feeling tired or having no energy
- pain in your throat or the middle of your chest, especially when swallowing
- black poo or coughing up blood (although these are uncommon)
If you have another condition, such as gastro-oesophageal reflux disease, you may get symptoms like these regularly.
You might find you get used to them. But it's important to be checked by a GP if your symptoms change, get worse, or do not feel normal for you.
Causes
It's not always clear what causes oesophageal cancer.
Anyone can get it, but you might be more at risk if you:
- are over the age of 75 (it's not very common in people under 45)
- are a man
- have certain conditions, such as long-term, severe acid reflux (gastro-oesophageal reflux disease), or Barrett's oesophagus
Many oesophageal cancers are also linked to lifestyle. For example, you're more likely to get it if you're overweight, smoke or drink too much alcohol.
Barrett's oesophagus
Barrett's oesophagus is a condition where some of the cells in your oesophagus grow abnormally.
If you have Barrett's oesophagus you're slightly more likely to get oesophageal cancer. But this is not common. It's sometimes called a pre-cancerous condition.
Barrett’s oesophagus often does not have any symptoms. But you may have symptoms of indigestion and heartburn.
Diagnosis
Main test for oesophageal cancer
If the GP or specialist thinks you might have oesophageal cancer, they will probably refer you for a test to look inside your oesophagus.
This test is called a gastroscopy (a type of endoscopy) or sometimes a camera test. It looks for any problems in your oesophagus or stomach, including oesophageal cancer.
During a gastroscopy:
- A long, thin, flexible tube with a small camera inside (called an endoscope) will be put into your mouth and down your oesophagus.
- A specialist will use the camera in the endoscope to look for any problems.
- A small sample of cells (called a biopsy) may be collected during the procedure. These cells will be sent to a laboratory to check for cancer.
The gastroscopy should take around 10 to 15 minutes, but you'll probably be in hospital for several hours.
The test should not be painful, but you might find it uncomfortable.
You may be offered things to make you more comfortable and make the test easier, such as:
- a spray to numb the back of your throat (local anaesthetic)
- sedation – medicine given through a small tube in your arm to help you relax
- putting you to sleep (general anaesthetic)
A gastroscopy can also help find problems in other nearby organs, such as your stomach and the first part of the bowels (small intestine).
Getting your results
You should get the results of a gastroscopy and biopsy within 2 weeks.
Try not to worry if your results are taking longer to get to you. It does not definitely mean anything is wrong.
You can call the hospital or GP if you're worried. They should be able to update you.
A specialist will explain what the results mean and what will happen next. You may want to bring someone with you for support.
Next steps
If you've been told you have oesophageal cancer, you will need more tests.
These, along with the camera test, will help the specialists find out the size of the cancer and how far it's spread (called the stage).
You may need:
- scans, like an ultrasound scan (sometimes from inside your body using an endoscope), CT scan, or PET-CT scan
- a small operation to look inside your tummy, called a laparoscopy
You may not have all these tests.
Treatment Options
Oesophageal cancer is often treatable. But it can be difficult to treat.
The treatment you have will depend on:
- the size and type of oesophageal cancer you have
- where it is
- if it has spread
- your general health
It may include surgery, chemotherapy, radiotherapy, and targeted medicines and immunotherapy.
The specialist care team looking after you will:
- explain the treatments, benefits and side effects
- work with you to create a treatment plan that is best for you
- help you manage any side effects, including changes to your diet
You'll have regular check-ups during and after any treatments. You may also have tests and scans.
If you have any symptoms or side effects that you're worried about, talk to your specialists. You do not need to wait for your next check-up.
Surgery
If oesophageal cancer is found early and it has not spread, you may be able to have surgery to remove it.
The surgeon will remove part or, in a small number of people, most of the oesophagus.
They may also need to remove parts of other organs around the oesophagus, such as the top of the stomach.
Chemotherapy
Chemotherapy uses medicines to kill cancer cells.
You may have chemotherapy for oesophageal cancer:
- before surgery to help make the cancer smaller
- after surgery to get rid of any remaining cancer and help stop the cancer coming back
- with radiotherapy (chemoradiotherapy) to treat early cancer, or if you're not able to have surgery
- to help control and improve the symptoms of advanced cancer
Radiotherapy
Radiotherapy uses high-energy rays of radiation to kill cancer cells.
You may have radiotherapy for oesophageal cancer:
- to treat early cancer, usually with chemotherapy (chemoradiotherapy)
- to help control and improve the symptoms of advanced cancer
Targeted medicines and immunotherapy
Targeted medicines and immunotherapy aim to stop the cancer growing and help your immune system attack the cancer.
You might have treatment with targeted medicines or immunotherapy:
- if the cancer has spread to another part of the body
- if the cancer cannot be cured
- to lower the risk of the cancer coming back after surgery to remove it
What happens if you've been told your cancer cannot be cured
If you have advanced oesophageal cancer it might be very hard to treat. It may not be possible to cure the cancer.
In this situation, the aim of your treatment will be to limit the cancer and its symptoms, and help you live longer.
Finding out the cancer cannot be cured can be very hard news to take in. You should be referred to a special team of doctors and nurses called the palliative care team or symptom control team.
They will work with you to help manage your symptoms and make you feel more comfortable.
Prevention Tips
You cannot always prevent oesophageal cancer. But making healthy changes can lower your chances of getting it.
Do
- try to lose weight if you're overweight
- let hot drinks cool down a bit before drinking, so they do not damage your oesophagus
- try to cut down on alcohol – avoid drinking more than 14 units a week
- try to quit smoking
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