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Understanding Oesophageal Cancer: Causes, symptoms and treatment

Dr. Ajay KohliJun 23, 2024

The oesophagus helps in the transportation of food and beverages from the mouth to the stomach. At the top of your oesophagus lies the upper oesophageal sphincter, which waits for the food or liquid to enter the oesophagus. Its major function is to open when a food or liquid enters the oesophagus. It remains closed when nothing is present.

Muscle contractions propel food downward within the oesophagus. The lower oesophageal sphincter senses food and liquid at the bottom of your oesophagus. It relaxes to let them pass into the stomach. When nothing is present, it stays closed.

Since the oesophagus performs crucial functions in the human body, the growth of malignant cells prevents the oesophagus from performing its role in the digestive system. As a result, oesophageal cancer has emerged as one of the critical health menaces now. Even though it is not as common as other forms of cancer, oesophageal cancer remains the sixth leading cause of death worldwide. However, early detection and treatment can contribute to a good prognosis.

However, the symptoms of oesophageal cancer often remain hidden until it reaches an advanced stage. In this article, delve deeper to get an overview of oesophageal cancer and its symptoms. You can also learn about the diagnosis and treatment of this life-threatening condition, as we have discussed in this article.

Oesophageal

Contents

What is Oesophageal Cancer?
Signs and symptoms of Oesophageal Cancer
What causes Oesophageal Cancer?
Types of Oesophageal Cancer
Stages of Oesophageal Cancer
Treatment for Oesophagus Cancer
Diagnosis of Oesophageal Cancer
How to prevent Oesophageal Cancer
Risk factors of Oesophageal Cancer
Frequently Asked Questions (FAQs)

What is Oesophageal Cancer?

Oesophageal Cancer begins when cells lining the inside of the food pipe grow and divide nonstop, spreading throughout the other layers and body areas. Our food pipe is a hollow tube that connects the throat to the stomach, comprising several layers of connective tissue supporting the body's framework.

As part of normal biological function, damaged or dying cells within these layers are replaced with newer ones in a regulated manner. But, when this process is disrupted, the damaged cells, particularly those from the inner lining of the oesophagus, multiply and spiral out of control. This results in a tissue mass known as a tumour. In some cases, these tumours are benign; in others, they become cancerous, invade surrounding tissues, or spread to other parts of the body (metastasis).

Signs and symptoms of Oesophageal Cancer

Symptoms of Oesophageal Cancer usually do not appear until the disease progresses. However, one may frequently notice the following.

Chest pain with heartburn
Unexplained weight loss
Trouble swallowing (dysphagia)
Persistent coughing and hoarseness of voice
Vomiting or regurgitation of food
Bleeding into the oesophagus

Some other less common symptoms include the following.

Hiccups
Pneumonia
Lump on your neck or collarbone or under your arm
Bone pain

Speak to your doctor if you think you have any of the signs or symptoms listed above, as many other medical conditions of the oesophagus can mimic these symptoms. Remember, becoming aware of the potential symptoms of this disease can help you get evaluated sooner rather than later.

What causes Oesophageal Cancer?

The exact cause of Oesophageal Cancer is still unknown to the medical fraternity. However, experts believe that certain lifestyle factors, such as smoking, and drinking alcohol, as well as various digestive tract diseases, cause irreversible damage to the DNA within the cells lining the oesophagus, thus increasing your odds of this rare and rapidly spreading cancer.

Types of Oesophageal Cancer

Adenocarcinoma and Squamous Cell Carcinoma are two subtypes of Oesophageal Cancer with distinct risk factors. Squamous Cell Carcinoma develops from the squamous or flat cells that line the upper or middle oesophagus and is more common worldwide due to its link with smoking and alcohol intake. In contrast, Adenocarcinoma begins in mucus-producing glandular tissue when sustained acid reflux affects the lining of the lower one-third of the oesophagus. Adenocarcinoma is a common cancer of white men in the United States and other Western nations.

Stages of Oesophageal Cancer

Usually, the stages of oesophagus cancer include the following:

Stage 0 Oesophageal Cancer	Malignant cells are in the inner layer of the oesophageal lining.
Stage 1 Oesophageal Cancer	Cancer has spread to the deeper layers of the oesophagus.
Stage 2 Oesophageal Cancer	Cancer has spread deeper into the oesophageal wall and surrounding tissues.
Stage 3 Oesophageal Cancer	Cancer has reached nearby tissues and organs, including lymph nodes.
Stage 4 Oesophageal Cancer	Cancer has spread to distant organs, like the liver and lungs.

Treatment for Oesophagus Cancer

Treatment decisions for Oesophageal Cancer depend on how far the cancer has spread, the location of the tumour, and the patient's general health and preferences. Most early-stage cancers are resected using a localised approach that combines chemotherapy, radiation, and surgery. However, in some cases, photodynamic therapy (PDT) or other laser-based treatments may be necessary.

Treatment of most advanced Oesophageal Cancers usually involves systemic use of chemotherapy, targeted therapy, or immunotherapy, often in combination. But again, doctors may use laser ablation, cryoablation, or oesophageal stenting in specific situations to keep the oesophagus open. For patients with Barrett's oesophagus, radiofrequency ablation is recommended to stop the condition from progressing into cancer.

Check out an overview of the commonly used treatments for oesophagal cancer:

Surgery: Oesophageal cancer is commonly treated with a procedure known as oesophagectomy. This surgery typically involves the removal of a portion or the entire organ along with adjacent tissue. Surgeons reconstruct a new oesophagus by bringing up a portion of the stomach into the chest and neck area.
Radiation Therapy: Radiation damages malignant cells by directing a beam of radiation towards the tumour. Medical professionals might utilize radiation as a supplementary treatment prior to or following a surgical procedure.
Endoscopic mucosal resection: This treatment option is suitable when tumours are present in the mucous lining of the oesophagus.
Endoscopic submucosal dissection: It is highly common for early-stage oesophageal cancer.
Chemotherapy: This treatment option helps in killing the malignant cells or prevents them from growing.
Targeted therapy: Certain oesophagal cancer cells have abnormally high levels of the HER2 protein, which promotes rapid growth. To address this, targeted therapy involves using drugs that block HER2 proteins, preventing their ability to stimulate cancer cell growth.
Immunotherapy: This treatment uses medications known as immune checkpoint inhibitors. They work by boosting your body's own immune system to recognise and attack oesophagal cancer cells.
Photodynamic therapy: This method uses medications known as photosensitisers. Light activates them and initiates a biochemical response to kill the cancer cells.
Endoscopic laser therapy: If tumours block the oesophagus, it becomes difficult for the patient to swallow. In this case, endoscopic laser therapy remains an appropriate treatment option.

Diagnosis of Oesophageal Cancer

Since Oesophageal Cancer is not diagnosed until it advances, accuracy in detecting the cancer stage is especially pivotal to minimise the risk of futile treatment. And to achieve this, your doctor will ask about your medical history and the ongoing symptoms.

They may also order other types of tests to diagnose the condition, such as:

Barium swallow: Also called an oesophagram, a barium swallow is an X-ray procedure in which you drink a barium-based solution to find signs of cancer in your oesophagus.

Biopsy: This is the most common test performed for Oesophageal Cancer diagnosis. In this test, your doctor will use a camera-equipped tube (endoscope) to take a piece of tissue from an abnormal area and examine it under a microscope for cancer cells.

Endoscopic ultrasonography: Your doctor may order an endoscopic ultrasound (EUS) if your biopsy results reveal cancer. The process involves two sub-procedures to see within your oesophagus.

Endoscopy, wherein a thin, lighted tube into your body is inserted to aid diagnosis.

Ultrasound, where your doctor uses high-frequency sound waves to obtain detailed images.

Positron emission tomography (PET) scan: A PET scan is used when your doctor suspects cancer spreading is in areas beyond the oesophagus. During the process, your doctor would use radioactive dye to highlight areas of your body that may have cancerous growths.

Computed tomography (CT) scan: Though less common, a CT scan is typically performed to rule out the distant spreading of cancer beyond the oesophagus.

How to prevent Oesophageal Cancer

The most effective way to prevent Oesophageal Cancer is to reduce your risk factors while improving the factors that protect and benefit your overall health. Some typical examples of these measures include the following.

Avoiding tobacco and alcohol consumption
Eating a healthy, well-balanced diet
Maintaining a healthy weight
Using medication to stop gastric reflux and heartburn
Radiofrequency ablation for treating Barrett's oesophagus
Receiving the human papillomavirus (HPV) vaccine

Risk factors of Oesophageal Cancer

Oesophageal Cancer is linked to a wide range of risk factors. Some factors increase one's risk for Oesophageal Adenocarcinoma, while others snowball the possibility of Squamous Cell Carcinoma. Yet, the presence of any of the risk factors listed below does not necessarily mean you will develop this disease.

Excessive alcohol consumption and tobacco smoking
Age (55 years and up)
Gender with men being more susceptible to Oesophageal Cancer
Gastroesophageal reflux disease (GERD)
Barrett's oesophagus
Overweight and obesity
Low levels of intake of fruits and vegetables
Occupational exposure to cleaning solvents
Other rare Oesophageal Diseases like achalasia, tylosis, and Plummer-Vinson syndrome
History of head and neck cancer
Human Papillomavirus infection

Frequently Asked Questions (FAQs)

Here’s a list of common questions and answers about Oesophageal Cancer.

Is there a cure for Oesophageal Cancer?

While surgery is the recommended treatment to remove small tumours, less than a quarter of patients with Oesophageal Cancer typically receive a diagnosis before the cancer spreads. So, technically there is not any cure for this fast-spreading cancer.

What are the potential side effects of Oesophageal Cancer treatment?

Like any other treatment, Oesophageal Cancer treatment also has several side effects. For example, an endoscopic resection procedure can cause bleeding or narrowing of the oesophagus. Again, the patients who have undergone surgery with chemotherapy and radiotherapy might experience the following.

Nausea and vomiting

Pain

Heartburn

Mouth sores

Loss of appetite

Diarrhoea and constipation

What if my Oesophageal Cancer comes back?

In the event of cancer recurrence, it may return to the same site or develop somewhere else in your body. Generally, Oesophageal Cancer patients have a higher risk of developing cancers of the throat, oral, lung, thyroid, and small intestine. However, men are more prone to stomach cancer. For this reason, seeking medical attention when warning signs appear is crucial in Oesophageal Cancer management and getting the best possible outcome.

What is the prognosis for Oesophageal Cancer patients?

The prognosis, which is an estimate of how an illness will affect a patient overall, varies and is dependent on several factors, including the following.

Where the tumour is located in the body?

In which places of your body has the cancer spread?

What percentage of the tumour is removed during surgery?

The general five-year survival rate for Oesophageal Cancer is closer to 20%, though it can range from 5% to 47%, depending on when the disease is diagnosed. For instance, the five-year survival rate is higher if Oesophageal Cancer is found early when small. But the rate drops when the tumour is large or has spread to other parts of the body, making treatment more difficult.

Is family history a risk factor for Oesophageal Cancer?

In most cases of Oesophageal Cancer, DNA damage rather than inheritance is the root cause of the condition. However, Oesophageal Cancer can sometimes run in families due to mutations or alterations in multiple genes linked with the disease. For example, mutations in the gene RHBDF2 induce tylosis with Oesophageal Cancer, which increases the likelihood of developing Squamous Cell Carcinoma. Similarly, Bloom syndrome is caused by detrimental mutations in the BLM gene, which can raise a person's possibility of getting squamous cell Oesophageal Cancer.

Where does oesophagal cancer spread to first?

First, oesophagal cancer spreads to the surrounding tissues and organs. In the last stage, it reaches the distant organs.

Where does oesophageal cancer spread?

The primary site for the spread of oesophageal cancer is often the liver. Additionally, it may metastasise to the lungs and lymph glands.

How common is oesophageal cancer?

Oesophageal cancer ranks as the eighth most prevalent type of cancer globally. Among men, it is the seventh most common, while among women, it falls to the thirteenth most common.

How long can you have oesophagal cancer and not know?

Oesophageal cancer cells grow at an extremely slow pace. It might take years for the signs of oesophageal cancer to show up. But the cancer usually progresses rapidly after the symptoms become prominent.

Is it natural to lose weight after oesophageal cancer surgery?

Esophageal cancer causes weight loss due to difficulty or pain when swallowing food. Even after successful treatment, swallowing issues may persist. Adjusting meal portions or incorporating nutritional supplements into your diet might help with weight issues.

What is metastatic oesophageal cancer?

Metastatic oesophageal cancer starts in the oesophagus and spreads to other distant parts of the body. For instance, oesophagal cancer cells might spread to the lungs. In that case, an individual has metastatic oesophageal cancer and not lung cancer.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.