Oesophageal Cancer: What You Need to Know

What is Oesophageal Cancer?

Oesophageal cancer is a disease where cancer cells (tumours) form in the lining of the oesophagus. The oesophagus is a long tube which connects and helps to transfer food from the throat to the stomach.

This disease is more common in men than women, ranking as the 7th most common cancer in men and the 13th most common in women worldwide.

The symptoms of oesophageal cancer are usually only noticeable once the cancer has spread. This disease has been associated with smoking, drinking alcohol, and conditions such as Barrett oesophagus.

Types of Oesophageal Cancer

Here are two common types of oesophageal cancer:

Adenocarcinoma

This cancer starts in the glandular cells in the lining of the oesophagus, which produce fluids such as mucus. It usually develops in the lower part of the oesophagus.

Adenocarcinoma is the most common type of oesophageal cancer. This condition has been linked to Barrett’s Oesophagus, obesity, and gastroesophageal reflux disease (GERD).

Squamous cell carcinoma

This cancer starts in the squamous cells, which are thin, flat cells on the lining of the oesophagus. It usually develops in the upper and middle part of the oesophagus.

This disease has been linked with smoking and drinking excessive amounts of alcohol.

Stages of Oesophageal Cancer

There are two systems which provide insight into the severity and extent of cancer spread. These systems assist doctors in deciding the best treatment for you.

The TNM System

This system is the most common method used in staging oesophageal cancer. TNM stands for tumour, node, and metastasis:

• Tumour (T): Indicates the size of the tumour. Grading from T1 to T4, with higher grades denoting larger tumour size.
• Node (N): Indicates whether the cancer has spread to the lymph nodes. Grading from N0 to N3, with higher grades denoting a higher number of affected lymph nodes.
• Metastasis (M): Indicates whether the cancer has spread to other body parts. Grading from M0 to M1, with M1 denoting that the cancer has spread to other parts of the body.

The Number System

This system comprises 5 main stages, from stage 0 (High grade dysplasia) to stage 4:

• Stage 0 (High grade dysplasia): Highly abnormal cells are found in the inner lining of the oesophagus.
• Stage I: The cancer is confined to the thick muscle wall of the oesophagus.
• Stage II: The cancer may have reached the outer layer of the oesophagus and 1 or 2 nearby lymph nodes.
• Stage III: The cancer may have spread beyond the oesophagus into nearby tissues and up to 6 nearby lymph nodes.
• Stage IV: The cancer is advanced, possibly spreading to other organs or body structures, lymph nodes or body parts (e.g., lungs or liver).

Symptoms

Here are a few symptoms of oesophageal cancer:

• Difficulty swallowing
• (Unexplained) Weight loss
• Chest pain or pressure
• Cough or hoarseness
• Indigestion or heartburn
• Vomit with blood
• Stools that are black or bloody
• A lump under the skin

Do note that these symptoms could also be caused by other medical conditions. Consult your doctor immediately if you notice any of these signs, and obtain a proper diagnosis.

Curious to learn more about cancer works? Check out our in-depth article on the 9 most common cancers.

Causes and Risk Factors

The exact cause of oesophageal cancer has not been found. However, doctors have found that the following factors may increase the risk of this disease:

• Smoking
• Drinking alcohol
• Eating a diet low in fruits and vegetables
• Drinking very hot drinks regularly
• Obesity
• Being exposed to certain chemical fumes (e.g., dry cleaning solvents)
• Human papillomavirus (HPV) infection
• Inherited genetic conditions (e.g., Cowden syndrome)
• Medical conditions (e.g., Barrett’s oesophagus, gastroesophageal reflux disease, achalasia)
• Personal or family history of cancer

Therefore, if you fall into any one of these categories, discuss with your doctor to decide the next step. We also recommend scheduling a health screening to ensure early detection.

Interested to know more? We provide a further discussion of the risk factors in this section.

Diagnosis

Your healthcare provider may use the following methods to diagnose oesophageal cancer:

• Physical Exam and Medical History: A physical examination of the body is done, where the doctor checks for possible signs of cancer. They will also take note of any past diseases and treatments.
• Barium Swallow Test: You will need to swallow a liquid called barium. The radiographer will perform an X-ray while you are swallowing. Barium can make your oesophagus appear more clearly on the image, helping doctors identify any abnormal formations in your oesophagus.
• Computed Tomography (CT) Scan: This imaging test creates a detailed picture of your body. It helps the doctor check if the oesophageal cancer has spread to different parts of the body, like your chest and stomach.
• Gastroscopy: A thin, flexible tube with a lens at the end (endoscope) is inserted into your mouth and down the oesophagus. The specialist will search for any issues. They may collect a small sample (biopsy) which will be sent to the laboratory and checked for cancer.

How is Oesophageal Cancer Treated?

The type of treatment will depend on the stage of the cancer. Here are some treatments your doctor may choose:

• Surgery: Surgery is often recommended, especially in early-stage oesophageal cancer. The goal is to remove the tumour and surrounding affected tissues. The surgeon may remove part or most of the oesophagus, and other parts of nearby organs – where the cancer has spread.
• Radiation Therapy: Uses high-energy beams to destroy cancer cells. It may be used alone or in combination with chemotherapy to treat early-stage cancer. It can also be used to alleviate the symptoms of advanced cancer.
• Chemotherapy: Involves the use of medications to kill cancer cells or slow their growth. It is often used in combination with other treatments, such as surgery or radiotherapy, to improve outcomes. Similar to radiotherapy, it can also be used to alleviate the symptoms of advanced cancer.
• Targeted Therapy: Uses medicines that attack certain mutations in cancer cells, causing them to die. It may be used alongside chemotherapy to treat advanced cancer cases that can’t be surgically removed, or recurrent oesophageal cancer cases.
• Immunotherapy: Uses medicines that help your immune system find and kill the cancer cells. It may be used before or after surgery. Similar to targeted therapy, it can also be used to treat advanced cancer cases where surgery is not an option, or recurrent oesophageal cancer cases.

Living with Oesophageal Cancer

Oesophageal cancer can cause drastic changes to your life. Here are a few ways to manage and navigate this period:

Problems with Eating

Oesophageal cancer can make eating more difficult. Therefore, we recommend breaking up your meals into smaller, more frequent amounts. It is also advisable to eat slowly, and take a sip of water in between bites.

Another good solution is a soft diet, where the food is much easier to swallow.

For example, softening meat and vegetables (cooking them longer), adding more sauces and gravies to food, and finely dicing meats and vegetables. Your diet may also include more soups and smoothies.

To make the process easier, dieticians can provide support and coping methods, ensuring your body gets all the necessary nutrients.

You may ask your doctor to refer you to a licensed dietician, who will then provide tailored solutions throughout the diagnosis, treatment, and aftercare stages.

Mental Health and Support

Receiving news about the diagnosis, undergoing the treatment, and coping with life after treatment can be tough on your mental health.

You may experience feelings of loss, worry, anger, and fear throughout this time. These are all perfectly normal responses, and will affect each individual differently.

Therefore, it’s important to meet up with people who can support you throughout this time, such as mental health professionals, trusted friends and family, or cancer support groups.

You may also voice these feelings out to your doctor, who can share relevant resources and direct you to the right professionals.

Measures to Prevent Oesophageal Cancer

Here are a few ways to reduce your risk of oesophageal cancer, and enhance overall health:

1. Regular oesophageal cancer screening

If you have Barrett oesophagus, consider scheduling regular screenings with your healthcare provider. The reason being: this precancerous condition increases the risk of oesophageal cancer.

During the screening, the doctor may perform tests such as a CT scan or endoscopy to check your oesophagus for signs of cancer.

2. Maintain a healthy weight

Individuals who are overweight have a higher chance of getting GERD, as the excess weight may force acid into the oesophagus. This increases the likelihood of developing oesophageal cancer.

Therefore, incorporate a balanced diet and regular exercise in your daily routine. You may consult a doctor or dietician to help create an effective weight management plan.

3. Limit or stop alcohol intake

Drinking excessive amounts of alcohol increases your risk of squamous cell oesophageal cancer. Therefore, we recommend limiting or stopping this habit entirely.

Here is a guideline for moderate drinking: men should limit themselves to a maximum of two drinks a day, while women should stick to just one drink.

4. Include more fruits and vegetables in your meals

Fruits and vegetables have been found to have an anticarcinogenic effect, thus reducing the risk of developing oesophageal cancer. Therefore, eat a healthy diet rich in this food category.

5. Stop smoking

Smoking increases your risk of squamous cell oesophageal cancer. We recommend consulting your doctor on methods to quit smoking. They may recommend nicotine replacement products and medicines to help ease the process.

6. Prevent HPV Infection

HPV infections, specifically the ones contracted via oral sex, can increase your risk of oesophageal cancer. Therefore, practise safe sex (e.g., using condoms) and get vaccinated (if you are eligible) to reduce this risk.

7. Manage medical conditions that put you at risk

Get treatment for certain conditions, such as GERD and achalasia, which are known to impact the oesophagus and increase the risk for oesophageal cancer. These conditions can be treated with medication, injections, and surgery.

Island Hospital: Your Trusted Partner for Oesophageal Cancer Solutions

At Island Hospital, our renowned oncologists, experienced nurses, and dedicated paramedical support are always here to guide you throughout your oesophageal cancer journey.

From precise diagnostic testing to cutting-edge treatments and compassionate support services, our Clinical Oncology and Haemato-Oncology Centre is equipped to help you fight back against cancer.

Moreover, our Gastroenterology Centre provides comprehensive high-end care for a wide range of gastrointestinal disorders. We aim to provide the best treatment and care for your digestive system.

Start your journey to recovery with Island Hospital.

FAQ

How do you know if you have oesophageal cancer?

Symptoms such as difficulty swallowing, persistent indigestion or heartburn, unexplained weight loss, and chest pain may indicate oesophageal cancer. A doctor can diagnose it through various tests like a CT scan or endoscopy.

If you suspect you have oesophageal cancer, schedule an appointment with your doctor. And learn more about the symptoms in this section.

How to detect oesophageal cancer early?

Early detection of oesophageal cancer involves regular screenings, especially for individuals with risk factors like smoking, heavy alcohol consumption, and certain genetic or medical conditions.

Endoscopic examinations and imaging tests play a crucial role in detecting it at an early stage.

Learn more about the diagnosis process in this section.

How long can someone live with oesophageal cancer?

Survival rates for oesophageal cancer vary depending on factors like the stage at diagnosis and treatment received. Generally, the five-year survival rate (whether a patient is still alive within five years of diagnosis) is less than 20%.

Do note that every case is unique, and surviving beyond the five years is not impossible.

Is cancer in the oesophagus curable?

The curability of oesophageal cancer depends on the stage at which it’s diagnosed and treated. Early-stage cancers are more likely to be cured through treatments like surgery, chemotherapy, and radiation therapy.

Be sure to obtain a diagnosis as soon as possible, and discuss treatment options with your healthcare provider.

Does oesophageal cancer spread fast?

Oesophageal cancer can spread rapidly, particularly in advanced stages. Early detection and treatment are crucial for improving prognosis and preventing further spread.

Learn more about the stages of cancer in this section.