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Oesophageal cancer

The oesophagus (gullet) is part of the digestive system, which is sometimes called the gastrointestinal tract (GI tract. The oesophagus is a muscular tube connecting your mouth to your stomach. When you swallow food, it is carried down the oesophagus to the stomach and the walls of the oesophagus contract to move the food downwards. The upper part of the oesophagus runs behind, but is separate from, the windpipe (trachea). The windpipe connects your mouth and nose with your lungs, enabling you to breathe.​

Cancer can develop anywhere in the oesophagus. Various lymph nodes (which filter fluid and can trap bacteria, viruses and cancer cells) are near the oesophagus, in your neck, in the middle of your chest and near the area where the oesophagus joins the stomach.

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There are two main types of oesophageal cancer:

  • Adenocarcinoma (the most common type) occurs when the mucus-producing glands in the lining of the oesophagus become cancerous. It generally develops in the upper or middle oesophagus and is often linked with Barrett’s oesophagus.

  • Squamous cell carcinoma (less common)– this develops in the thin, flat cells of the mucosa lining the oesophagus and most commonly occurs in the upper and middle regions of the oesophagus and the area where the oesophagus joins the stomach.

 

Whilst most oesophageal cancers are either adenocarcinoma or squamous cell carcinoma, there are other, rarer types of oesophageal cancer. These include:

  • Poorly differentiated neuroendocrine cancer.

  • Small cell cancer.

  • Soft tissue sarcomas, such as gastro-intestinal stromal tumours (GISTs).

 

Oesophageal cancers tend to develop slowly at first, meaning symptoms are difficult to detect. But when more advanced they can grow and spread relatively quickly, which is why early diagnosis is so important in treating these cancers effectively. 

Oesophageal cancer occurrence

 

Cancer of the oesophagus is uncommon in the UK. Each year, approximately one person in 7,000 will develop oesophageal specific cancer, totalling around 9,000 cases nationally each year. However, the numbers are increasing with approximately 9,100 new oesophageal cancer cases diagnosed in the UK every year (2014-2016).​

​Causes and risk factors

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In most people, cancer of the oesophagus is not caused by an inherited faulty gene and so other members of your family are not likely to be at risk of developing it. However, a very small number of people, who have a rare inherited skin condition known as tylosis, may develop oesophageal cancer.

 

Oesophageal cancers are more common in men, who are approximately three times more likely than women to develop these cancers. The average age of diagnosis is around seventy; however patients as young as forty-five can develop these cancers. 

 

Older age is the main risk factor for oesophageal cancer but several other factors can increase risk. For example, smoking, obesity and alcohol have been identified as contributing to the risk of oesophageal cancer.

 

Reflux (when stomach acid escapes from the stomach into the oesophagus) is also associated with an increased risk of getting oesophageal cancer although most people who experience reflux will not go on to develop oesophageal cancer.

 

So, having an overall healthy lifestyle will undoubtedly help to reduce the risk of developing oesophageal cancer. However, no statistical studies have conclusively proven that any specific lifestyle choice causes oesophageal cancer. In fact, many patients are non-smokers, non-drinkers and keep themselves generally fit and healthy. Until studies are more conclusive, oesophageal cancer can best be described as a ‘bad luck’ cancer. 

Symptoms/initial signs

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In the earliest stage of oesophageal cancer there are very often there are no symptoms whatsoever, or just mild symptoms such as occasional acid reflux or heartburn. Such mild symptoms could easily be mistaken for other far more common and likely ailments, including stomach bacterial infections or ulcers.

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Signs and symptoms of Oesophogastric (OG) cancer vary from person to person, depending on individual circumstances, however symptoms shouldn’t be ignored, especially those that are relatively common amongst OG cancer patients.

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Symptoms of oesophageal cancer can include:

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The most prominent sympton is having difficulty swallowing food, the technical term for this is ‘dysphagia’ - usually, there is a feeling that food is sticking on its way down to the stomach, although liquids may be swallowed easily at first.

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In these circumstances it is strongly advisable to see a GP immediatley and request an emergency referreal for an endoscopic investigation.  It might well be a false alaram, the problem being something other than cancer altogether, but it is very important to rule it out.

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Other signs and symptoms that together should be investigated include:

  • discomfort during, or soon after eating. This might be a sensation of food being temporarily stuck or lodged in the lower oesophagus, but eventually passing through. In more advanced cases, it can become almost impossible to swallow normal food. 

  • notable unexplained weight loss over a period of weeks and months, coupled with loss of appetite and the feeling bloated soon after eating.

  • any pain or discomfort behind the breastbone or in the back. 

  • other combinations of ‘low grade’ or recurring symptoms that could be attributed to a long list of other ailments, including a persistent cough, shortness of breath,  nasuea, stomach or back pain, indigestion, reflux or hearburn, lack of energy and fatigue.  

 

Whilst many of these symptoms can be caused by many things other than cancer such as indigestion or a cough, because these are relatively common symptoms of Oesophageal cancer, and EARLY DIAGNOSIS IS SO IMPORTANT, it is also strongly advisable to see a GP and seek help from the earliest signs of these symptoms, particularly if they persist beyond a couple of weeks or become more acute or frequent.

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As cancer develops, the physical nature of the tumour may begin to (but not always) block the passage of food through the oesophagus and or stomach, which leads to increases in the common symptoms of:

  • difficulty in swallowing (dysphagia).

  • discomfort during, or soon after eating. 

Survival Rates

 

Survival figures quoted online are too often poorly explained and appear considerably worse than the reality for many individuals.  OOSO recommends not looking around at different survival statistics because they can be unnecessarily upsetting. In our experience Cancer Research UK (CRUK) provides the most robust and accurate figures, with reasonably clear descriptions of the various risk factors involved, and variations between age groups and cancer types. 

 

You can visit CRUK’s webpage here: Survival for oesophageal cancer | Cancer Research UK

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It is important to remain positive because everyone’s circumstances are different, and treatments are becoming increasingly more effective year on year. According to CRUK, survival rates for oesophageal cancer has quadrupled over the last 40 years.

 

Sadly, however, long-term overall survival rates beyond 5 years remains fairly low, with approximately 15% expected to survive (source CRUK and ONS, 2019), and 10% surviving beyond 10 years. It is important to note however, that these are ‘overall’ figures, and do not take into account the severity of the cancer, whether it has spread or not or the age and fitness of the patient.  It is quite possible that an individual’s prospects are considerably brighter than one might initially think, so it is important to stay calm and listen to expert clinicians who will from experience advise the best course of action for each individual. 

 

It is important to note that from the outset, treatment plans in most cases are very effective at prolonging life expectancy.  

Transmissibility

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Oesophageal cancer is not hereditary nor infectious and CANNOT be passed from one person to another.

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