Overview

Cancer of the oesophagus
Cancer of the oesophagus

Oesophageal cancer is a type of cancer affecting the food pipe (oesophagus), the long tube that carries food from the throat to the stomach.

It mainly affects people in their 60s and 70s, and is more common in men than women.

Symptoms of oesophageal cancer

Oesophageal cancer does not usually cause any symptoms in the early stages when the tumour is small.

It's only when it gets bigger that symptoms tend to develop.

Symptoms of oesophageal cancer can include:

Read more about the symptoms of oesophageal cancer.

When to get medical advice

See a GP if you have:

  • swallowing difficulties
  • heartburn on most days for 3 weeks or more
  • any other unusual or persistent symptoms

The symptoms can be caused by several conditions and in many cases will not be caused by cancer, but it's a good idea to get them checked out.

If your GP thinks you need to have some tests, they can refer you to a hospital specialist.

Read about how oesophageal cancer is diagnosed.

Causes of oesophageal cancer

The exact cause of oesophageal cancer is unknown, but the following things can increase your risk:

  • persistent acid reflux (gastro-oesophageal reflux disease, or GORD)
  • smoking
  • drinking too much alcohol over many years
  • being overweight
  • having an unhealthy diet that's low in fruit and vegetables

Stopping smoking, cutting down on alcohol, losing weight and having a healthy diet may help reduce your risk of developing oesophageal cancer.

Read more about the causes of oesophageal cancer.

Treatments for oesophageal cancer

If oesophageal cancer is diagnosed at an early stage, it may be possible to cure it with:

  • surgery to remove the affected bit
  • chemotherapy, with or without radiotherapy, to kill the cancerous cells and shrink the tumour

If oesophageal cancer is diagnosed at a later stage, a cure may not be achievable.

But in these cases, surgery, chemotherapy and radiotherapy can be used to help keep the cancer under control and relieve any symptoms you have.

Read more about how oesophageal cancer is treated and living with oesophageal cancer.

Outlook for oesophageal cancer

The outlook for oesophageal cancer varies depending on things like how far it's spread, your age and your general health.

If it's detected while it's still quite small, it may be possible to get rid of it completely.

But as oesophageal cancer does not usually cause any symptoms until a late stage, it's often spread quite far by the time it's diagnosed.

Cancer Research UK has more information about oesophageal cancer survival statistics.

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Symptoms

Oesophageal cancer does not usually have any symptoms at first. But as the cancer grows, it can cause swallowing problems and other symptoms.

Difficulty swallowing

Difficulty swallowing is the most common symptom of oesophageal cancer.

The cancer can narrow the oesophagus, making it difficult for food to pass down.

It may feel as though food is getting stuck, and sometimes swallowing may be uncomfortable or painful.

You may have to chew your food more thoroughly, or only be able to eat soft foods.

If the tumour continues to grow, even liquids may become difficult to swallow.

Other symptoms

Other symptoms of oesophageal cancer can include:

  • persistent indigestion or heartburn
  • bringing up food soon after eating
  • loss of appetite and weight loss
  • persistent vomiting
  • pain or discomfort in your upper tummy, chest or back
  • a persistent cough
  • hoarseness
  • tiredness, shortness of breath and pale skin
  • vomiting blood or coughing up blood (although this is uncommon)

When to get medical advice

See a GP if you have:

  • swallowing difficulties
  • heartburn on most days for 3 weeks or more
  • any other unusual or persistent symptoms

The symptoms can be caused by several conditions and in many cases will not be caused by cancer, but it's a good idea to get them checked out.

Read about how oesophageal cancer is diagnosed.

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Who can get it

The exact cause of oesophageal cancer is unknown, but certain things can increase the risk of it developing.

Acid reflux

Gastro-oesophageal reflux disease (GORD) is where a weakness in the muscles above the stomach means stomach acid can travel up into the oesophagus.

In around 1 in 10 people with GORD, repeated damage from stomach acid over many years can eventually cause changes in the cells lining the oesophagus. This is called Barrett's oesophagus.

These abnormal cells are at an increased risk of becoming cancerous in the future, although the risk is still small. 

Between 1 and 5 people out of 100 (1 to 5%) with Barrett's oesophagus will go on to get oesophageal cancer.

Alcohol

Drinking too much alcohol irritates and inflames the lining of the oesophagus.

If the cells in the lining of your gullet become inflamed, they're more likely to become cancerous.

Read more about alcohol and drinking, including tips on cutting down.

Smoking

Tobacco smoke contains many harmful toxins and chemicals.

These substances irritate the cells that make up the lining of the oesophagus, which increases the likelihood that they'll become cancerous.

The longer you smoke, the greater your risk of developing oesophageal cancer.

Read more about getting help to stop smoking.

Obesity

If you're overweight, your risk of developing cancer of the oesophagus is higher than people of a healthy weight. 

The more overweight you are, the higher the risk.

This may be partly because overweight people are more at risk of long-term acid reflux.

Read more information and advice about losing weight.

Diet

Not eating enough fruit and vegetables may increase your risk of getting oesophageal cancer.

Aim to eat at least 5 portions of fresh fruit and vegetables every day.

Read more about having a healthy diet.

Other medical conditions

Certain rare medical conditions can also increase your chances of getting cancer of the oesophagus.

These include:

  • achalasia – where the oesophagus loses the ability to move food along, causing vomiting and acid reflux
  • Paterson-Brown Kelly syndrome (also called Plummer Vinson syndrome) – a condition that can cause iron deficiency anaemia and small growths in the throat 
  • tylosis – an inherited skin condition
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Diagnosis

See a GP if you experience symptoms of oesophageal cancer. They'll carry out an initial assessment and decide whether you need to have any further tests.

Seeing a GP

A GP may:

  • ask about your symptoms
  • carry out a physical examination
  • take a look at your medical history

If they think you need to have some tests, they can refer you to a hospital specialist.

This will usually be a gastroenterologist, a specialist in the digestive system.

Tests to diagnose oesophageal cancer

The 2 main tests used to diagnose oesophageal cancer are:

  • an endoscopy – this is the most common test
  • a barium swallow or barium meal

Endoscopy

An endoscopy is a procedure that allows your doctor to see inside your oesophagus so they can check for cancer.

A thin, flexible tube with a light and camera at the end is passed into your mouth and down towards your stomach.

Small samples of tissue are also removed from your oesophagus so they can be checked for cancer under a microscope. This is called a biopsy.

You'll be awake while an endoscopy is carried out. It should not be painful, but may be a bit uncomfortable.

You'll normally be given local anaesthetic to numb your throat and possibly a sedative to help you relax.

Barium swallow or barium meal

A barium swallow or barium meal involves drinking a harmless white liquid called barium before several X-rays are taken.

The barium coats the lining of your oesophagus so it shows up on the X-ray.

This can show whether there's anything blocking your oesophagus, which may be a sign of cancer.

This test is not used to diagnose oesophageal cancer very often nowadays because the best way to confirm a diagnosis is to use tissue samples taken during an endoscopy.

Further tests

If you have oesophageal cancer, further tests can show how far the cancer has spread, called the "stage".

These tests may include:

  • a CT scan – where a series of X-rays are taken and put together by a computer to create a detailed picture of the inside of your body
  • an endoscopic ultrasound scan – where a small probe that produces sound waves is passed down your throat to create an image of your oesophagus and the surrounding area
  • a PET scan – a scan that can help show how far the cancer has spread
  • a laparoscopy – a type of keyhole surgery performed under general anaesthetic (where you're asleep), in which a thin tube with a camera at the end is inserted through a cut in your skin to examine the area around your oesophagus

Stages of oesophageal cancer

The most widely used system for staging oesophageal cancer is the TNM system.

This involves scoring the cancer in 3 categories:

  • T (tumour) – the location and size of the tumour
  • N (node) – whether the cancer has spread to the lymph nodes (a network of glands throughout the body)
  • M (metastasis) – whether the cancer has spread to other parts of the body, such as the lungs, liver or bones

Scores for each category are then often used in a simpler number system, ranging from stage 1 (early cancer) to stage 4 (advanced cancer).

Knowing the stage of your cancer will help your care team work out the best treatment for you.

Read more about treatments for oesophageal cancer.

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Treatment

The main treatments for oesophageal cancer are surgery, chemotherapy and radiotherapy.

Your treatment plan

You'll be cared for by a group of different healthcare professionals.

Your team will recommend a treatment plan they feel is most suitable for you, although final treatment decisions will be yours.

Your plan will largely depend on how far your cancer has spread, known as the stage.

Stage 1 to 3

Stage 1 to 3 oesophageal cancer is usually treated with surgery to remove the affected section of oesophagus (oesophagectomy).

Chemotherapy and sometimes radiotherapy may be given before surgery to make it more effective or is sometimes used instead of surgery.

Stage 4

Stage 4 oesophageal cancer has usually spread too far for a cure to be possible, but chemotherapy, radiotherapy and other treatments can slow the spread of the cancer and relieve symptoms.

Surgery

There are 3 main types of surgery for oesophageal cancer.

Oesophagectomy

An oesophagectomy is the main treatment for early-stage oesophageal cancer.

During the procedure, your surgeon will remove the section of your oesophagus that contains the tumour and, if necessary, the nearby lymph nodes. 

A small portion of your stomach may also need to be removed.

The remaining section of your oesophagus is then reconnected to your stomach.

To access your oesophagus, your surgeon will either make cuts in your tummy and chest, or in your tummy and neck.

Endoscopic mucosal resection (EMR)

A procedure called endoscopic mucosal resection (EMR) may sometimes be an option instead of an oesophagectomy if oesophageal cancer is diagnosed very early on.

It involves cutting out the tumour using a loop of wire at the end of a thin flexible tube.

The tube is passed down your throat, so no cuts are made in your skin.

Sometimes radio waves may also be used to destroy the cancerous tissue. This is called radiofrequency ablation (RFA).

Stents

For more advanced oesophageal cancer that's causing swallowing difficulties, a procedure to insert a hollow tube called a stent into the oesophagus may be recommended.

The stent expands once in place and holds the oesophagus open.

Chemotherapy

Chemotherapy involves taking medicines that kill the cancer cells or stop them multiplying.

It may be used:

  • before and sometimes after surgery, either with or without radiotherapy – to shrink the cancer and reduce the risk of it coming back
  • instead of surgery – in combination with radiotherapy (chemoradiation)
  • to relieve your symptoms if curative treatment is not possible

Chemotherapy can be given into a vein or taken as tablets.

You'll usually have the treatment every 3 weeks over 6 to 18 weeks.

Side effects

Common side effects of chemotherapy include:

  • feeling sick
  • loss of appetite
  • losing weight
  • diarrhoea
  • feeling very tired
  • increased risk of infections
  • bleeding and bruising easily

These side effects should improve gradually after treatment stops.

Radiotherapy

Radiotherapy involves using radiation to kill cancer cells and shrink tumours.

It may be used:

  • in combination with chemotherapy before surgery – to shrink the cancer and reduce the risk of it coming back
  • instead of surgery – usually in combination with chemotherapy
  • to relieve your symptoms if it's not possible to cure your cancer

Radiotherapy is most often given using an external machine that directs beams of radiation at your oesophagus, or sometimes by temporarily placing a small piece of radioactive material in your oesophagus (brachytherapy).

Side effects

Common side effects of radiotherapy include:

  • tiredness
  • temporary soreness when swallowing
  • temporary worsening of swallowing difficulties
  • a dry throat
  • feeling or being sick
  • reddening of the skin and loss of body hair in the treatment area

These side effects should improve gradually after treatment stops. 

These side effects should improve gradually after treatment stops. Read more about the side effects of radiotherapy.

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Living with

Having oesophageal cancer can have a big impact on your life, but support is available to help you cope.

Eating and swallowing

You may have swallowing difficulties during and after treatment for oesophageal cancer.

There are treatments that can help, including surgery to place a hollow tube (stent) in your oesophagus, or a combination of chemotherapy and radiotherapy, although they may not work immediately.

You might need to have a temporary feeding tube or fluids given through a drip, before moving on to fluids by mouth and soft foods. You may eventually be able to eat solid food.

A speech and language therapist can assess your ability to swallow and suggest ways to overcome any problems.

A dietitian can also help with any changes you need to make to your diet.

Want to know more?

Support and advice

Coping with a diagnosis of cancer can be very difficult. 

You may find it helpful to:

  • Talk to your friends and family – be open about how you feel and what your family and friends can do to help may put you and them at ease.
  • Communicate with others in the same situation – you may want to contact a local support group or join a forum such as the HealthUnlocked forum for oesophageal patients or Cancer Chat.
  • Find out more about your condition – check websites such as Cancer Research UK or Macmillan, or speak to your care team or GP if you have any questions about your condition.
  • Take time out for yourself – don't feel shy about telling friends and family if you want some time to yourself.

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Work

Having oesophageal cancer does not necessarily mean you'll have to give up work, although you may need quite a lot of time off.

During treatment, you may not be able to carry on as you did before.

If you have cancer, you're covered by the Disability Discrimination Act.

This means that your employer is not allowed to discriminate against you because of your illness.

They have a duty to make "reasonable adjustments" to help you cope, such as:

  • allowing you time off for treatment and medical appointments
  • allowing flexibility with working hours, the tasks you have to perform, or your working environment

Give your employer as much information as possible about how much time you'll need off and when.

Speak to a member of your HR department, if you have one.

If you're having difficulties with your employer you may be able to get help from your union, association representative or local Citizens Advice Bureau.

Want to know more?

Money and benefits

If you have to reduce or stop work because of your cancer, you may find it difficult to cope financially. 

You may be entitled to financial support:

  • if you have a job but can't work because of your illness, you're entitled to Statutory Sick Pay from your employer
  • if you don't have a job and can't work because of your illness, you may be entitled to Employment and Support Allowance
  • if you're caring for someone with cancer, you may be entitled to Carer's Allowance
  • you may be eligible for other benefits if you have children living at home or you have a low household income

It's a good idea to find out what help is available as soon as possible.

You could ask to speak to the social worker at your hospital, who can give you the information you need.

Palliative care

If you're told there's nothing more that can be done to treat your oesophageal cancer or you decide to decline treatment, a GP or your care team will provide you with support and pain relief.

This is called palliative care. You can choose to receive palliative care:

  • at home
  • in a care home
  • in hospital 
  • in a hospice

Your doctor or care team should work with you to establish a clear plan based on your wishes.

Want to know more?

Caring for someone with cancer

Being a carer is not easy. It can be emotionally and physically draining, and make it easy for you to forget your own health and mental wellbeing.

But putting yourself last does not work in the long-term.

If you're caring for someone else, it's important to look after yourself and get as much help as possible.

It's in your best interests, as well as those of the person you're caring for.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 18/10/2019 10:43:16