The oesophagus is the tube that carries food from your mouth to your stomach. Cancer can effect any part of this tube and the risk increases with age. It is important to see a specialist gastrointestinal consultant, if you are experiencing problems swallowing or have new heartburn or changes to pre-existing heartburn symptoms . In most cases these symptoms won’t be due to oesophageul cancer but it is important to get them checked.
- persistent heartburn (gastro-oesophageal reflux disease (GORD))
- eating a diet low in fruit and vegetables
- drinking too much alcohol
- being overweight or obese
Consequently, eating a healthy balanced diet, maintaining a healthy body weight and avoiding smoking can all help to reduce your chances of developing the disease.
- Difficulty swallowing or feeling as though the food is getting stuck
- Persistent indigestion or heartburn
- Being sick after eating
- Persistent cough or hoarseness
- Loss of appetite and unexplained weight loss
- Shortness of breath and tiredness
- Vomiting or coughing up blood
These symptoms require specialist medical attention and full investigation to accurately determine the stage of the disease and offer the appropriate treatment. As with most cancers, treatment is most successful when it is diagnosed at an early stage.
After taking a medical history and asking you to describe your symptoms, the doctor may refer you for diagnostic testing. The tests used to diagnose oesophageal cancer include:
- Endoscopy– this is most commonly used. It allows the doctor to look inside your oesophagus using a thin, flexible tube with a light and a camera (an endoscope).
The endoscope is passed carefully down your throat towards your stomach. You will normally be given a local anaesthetic to numb your throat and you may also be given a sedative to help you relax. The procedure shouldn’t hurt but it may feel a bit uncomfortable. As well as looking inside your oesophagus, the doctor may also take small samples of tissue for analysis in the laboratory. This is called a biopsy.
- Barium swallow – this involves drinking a harmless liquid called barium, which coats the lining of your oesophagus so that it shows up on an X-ray.
X-rays are taken after you have swallowed the barium and these will show whether anything is blocking your oesophagus, which may indicate that you have a cancerous tumour. Barium swallows are less commonly used than endoscopies. If oesophageal cancer is diagnosed, you will be offered further tests to ascertain how far the cancer has spread. Your doctor will assess the location and size of the tumour, whether it has spread to the lymph nodes, and whether it has spread to other organs in the body such as the lungs and liver. These tests might include:
- A CT scan – this type of scan takes a series of X-rays and puts them together to create a detailed 3D picture of the inside of your body.
- A PET scan – a position emission tomography scan shows how far the cancer has spread.
- An endoscopic ultrasound scan – this uses sound waves to create an image of your oesophagus and surrounding organs.
- Laparoscopy – this is performed under general anaesthetic. It involves making a small incision in your skin and inserting a thin, flexible tube with a camera at one end to see inside your oesophagus.
Among the treatments for oesophageal cancer are:
- Surgery – you might be offered surgery to remove the section of oesophagus that contains the tumour (this is the main treatment for early stage oesophageal cancer).
- EMR (endoscopic mucosal resection) may also be offered for very early cancers. This involves cutting out the tumour during endoscopy. Stents may be used for more advanced oesophageal cancers. This involves inserting a hollow tube called a stent into the oesophagus. The stent expands and keeps the oesophagus open.
- Chemotherapy – this involves taking medicines that kill cancer cells or prevent them from multiplying. The medicines are given into the vein or taken as tablets.
- Radiotherapy – this uses radiation to kill cancer cells and shrink tumours. It may be used in combination with chemotherapy. Beams of radiation are directed at your oesophagus or by placing small pieces of radioactive material into your oesophagus.
Natalie has been a consultant gastroenterologist since 2016 and in addition to her private practice she currently holds a post at Imperial College Healthcare NHS Trust, with a specialist interest in gastroenterology and…
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Consultant Gastroenterologist & HPB Physician