Oesophageal cancer is a type of cancer caused by a malignant tumour found within your oesophagus, which is the long and hollow tube that connects the mouth to the digestive system. This condition can be broadly categorised into squamous cell carcinoma or adenocarcinoma – although there are other, rarer forms of this cancer – both of which affect the cells lining the oesophagus.

In Australia, tumours are most commonly located in the lower part of the oesophagus.

According to the Cancer Council of Australia, the five-year survival rate of oesophageal cancer is approximately 21%, making a positive prognosis dependent on early diagnosis and effective treatment from experienced medical professionals. It’s also believed to be the sixth most common cause of cancer-related deaths around the world.

Prevalence is known to be higher among men, compared to women. Incidence, however, may vary based on a number of factors including geography, lifestyle, health, and nutrition.

Types of Oesophageal cancer

Oesophageal cancer manifests itself in different forms and each type is classified according to the cells that are affected. Understandably, your treatment depends on the type of oesophageal cancer you are diagnosed with.

Adenocarcinoma

This type of cancer initially affects the cells within certain glands in the oesophagus, specifically those that secrete mucus. These are located in the lower section of the oesophagus.

Squamous cell carcinoma

If you are diagnosed with squamous cell carcinoma, it means that the cancer is affecting the upper and middle parts of your oesophagus. Squamous cells are the flat, thin cells that line the surface of the oesophagus. Squamous cell carcinomas are believed to be the most common type of oesophageal cancer.

Sarcoma

This type of cancer takes place in the soft tissue of the body, which includes body fat, muscles, nerves, deep skin tissue, the tissue surrounding your joints, and blood vessels. These also include gastrointestinal stromal tumours, which are considered one of the rarer forms of oesophageal cancer.

Apart from this, other rare types of oesophageal cancer include small cell cancer, melanoma, choriocarcinoma, and neuroendocrine cancer.

Causes, symptoms and complications

While exact causes are difficult to determine, oesophageal cancer is the direct result of mutations in your DNA, which causes cells to grow and divide without any control. Cancer metastasises when these abnormal cells invade nearby structures and spread to neighbouring parts of the body.

While specific causes may remain elusive, risk factors, which may trigger the onset of symptoms of oesophageal cancer have been identified and include:

• Excessive or chronic smoking
• Prolonged exposure to chemical fumes
• Alcohol consumption
• A diet lacking fruits and vegetables
• Being diagnosed with certain gastrointestinal conditions such as gastroesophageal reflux disease, achalasia (difficulty swallowing as a result of the oesophageal sphincter not being able to relax), Barrett’s oesophagus and bile reflux
• Radiation treatment targeting the chest or upper abdomen
• Frequently drinking very hot liquids
• Obesity

If you’re suffering from this condition, some of the symptoms you may experience include frequent heartburn, black or bloody stools, constant and inexplicable fatigue, discomfort in the upper abdomen while you eat, blood in your vomit, difficulty swallowing and feeling choked when swallowing, and unexplained or unintended weight loss.

In certain cases, complications can arise and cause considerable pain and discomfort if you aren’t receiving comprehensive treatment for oesophageal cancer. The most common of these include:

Fistulas

Fistulas refer to the abnormal channels that develop within the skin. If you’re suffering from oesophageal cancer, it’s possible that you may develop a tracheo-oesophageal fistula, which forms between the windpipe and the oesophagus.

These result in the development of holes in this area, allowing food and drink to enter the windpipe and eventually, the lungs. Symptoms include gagging, choking and coughing when you’re eating food.

Anaemia

In the event that oesophageal cancer causes bleeding, you may be diagnosed with anaemia, which is a condition caused by the reduction in number or quality of red blood cells. As a result, you may feel tired all the time, appear pale, feel dizzy, and experience difficulty concentrating, among other symptoms.

Weight loss

Weight loss usually takes place when the tumour becomes so big, you can’t swallow food easily through the oesophagus. This type of cancer can also affect your metabolism, which, again, can lead to unintended weight loss.

Metastases

This is the medical term for the spread of oesophageal cancer to other organs of the body. If your tumour metastasises, it can affect your lymph nodes, the organs surrounding the oesophagus, and, over time, your liver, lungs, and brain.

Pneumonia

This is a complication that could occur, especially if food and liquid are escaping into your windpipe as a result of oesophageal cancer. Here, you may develop aspiration pneumonia, which is a type of lung infection caused when you breathe in foreign material.

Diagnosis

Doctors may use different tests to determine the type of cancer, depending on the symptoms you’re experiencing. Some of the most common diagnosis techniques include:

Endoscopy

Here, a thin, flexible tube attached to a camera is used to examine your digestive tract. In certain cases, your specialist may also extract a biopsy and send it to a lab for further testing. An endoscopy is usually the first procedure a doctor will resort to accurately diagnose your symptoms.

Endoscopic ultrasound

During this type of procedure, a probe, which releases soundwaves that bounce off anything solid, such as an organ or tumour, is used to detect oesophageal cancer. This method can also tell doctors if the cancer has metastasised to nearby lymph nodes or the oesophageal wall, itself.

CT/PET scans

Here, contrast material is injected into the body, after which oesophageal cancer cells appear brighter than normal tissue when the scans are developed. PET scanners are now combined with CT scanners so that the PET images can be combined with the images developed by the CT scanner.

Among other goals, this improves the accuracy of this diagnostic method.

Ultrasounds

Ultrasound scans use high-frequency sound waves to render an image of certain parts of your body. Here, the ultrasound machine directs high-frequency sound waves towards the parts of the body being scanned and the echoes or reflected sound waves are then recorded to create an image.

This entire procedure is conducted using a handheld probe.

Thoracoscopy and laparoscopy

In these types of tests, insertions are made to allow doctors to examine the chest and abdomen, respectively, through the aid of a hollow and lighted tube. These are conducted under general anaesthesia.

As part of these procedures, doctors may, in certain cases, extract biopsies to check if the cancer has spread.

Treatment

Oesophageal cancer surgery

This type of surgery is done to remove the tumour or cancerous cells and may be pursued as a standalone solution or undertaken in conjunction with other types of treatment.

Here, surgery could be used to remove very small tumours, depending on their size and potential for metastasis, to remove a portion of the oesophagus or to remove part of your oesophagus and the upper part of your stomach.

Regardless of which surgery is recommended for you, these are usually conducted by creating large incisions or through several small incisions through which surgical tools are inserted. Thereafter, doctors will remove parts of your oesophagus, as required.

It’s important to remember that each of these surgeries carries a risk of certain severe complications including bleeding, infection, and potential leakage in the place where the oesophagus is reconnected to the stomach.

Chemotherapy

This is a type of drug treatment that kills cancer cells through the administration of certain chemicals. Chemotherapy can be conducted either before or after your surgery, depending on your symptoms and prognosis.

You may experience certain side effects as a result of this treatment, although it will depend on the type of chemicals/drugs administered.

Radiation

Here, high-powered x-ray beams are used to kill cancer cells by targeting radiation beams at the location of the cancer. This type of treatment can either be performed externally or internally.

This is usually combined with other types of oesophageal cancer treatment such as chemotherapy and is used in certain cases to treat complications of oesophageal cancer that has advanced to certain stages. Treatment generally takes place over a period of two to six weeks.

Chemotherapy is combined with radiation to make treatment more effective although it increases the likelihood and/or severity of the side effects you may experience.

Receive treatment for Oesophageal cancer from experienced gastroenterologists in Sydney

Given that the five-year survival rate of this condition is relatively low, receiving prompt and effective treatment for the symptoms of oesophageal cancer is crucial. By receiving guidance from medical professionals with experience and expertise in this area, you may be able to improve your prognosis and quality of life.

For more information on oesophageal cancer, including preventative care and comprehensive treatment, speak to a team of trained gastroenterologists at the Sydney Gut Clinic.