Cancer of the oesophagus

Cancer of the Oesophagus  showing on an upper GI body map

Facts and figures about oesophagus cancer

Cancer of the oesophagus is the 13th most common cancer in the UK. Higher incidence in men, male to female ratio is approximately 2:1. Age related with approximately 83% of cases arising in the 60+ years age group.

Risk factors include tobacco use, a diet lacking in fruit and vegetables, being overweight, obesity and alcohol. Also, a pre-existing condition of Barrett’s oesophagus increases risk.

Tumours arise in the interior layer of the oesophagus and spread by growing beyond the oesophageal wall. Those arising in the upper third and middle third are mainly squamous cell carcinomas and those in the lower third mainly adenocarcinomas.

Cancer of the oesophagus is often detected late as symptoms can be vague.

Oesophagus cancer symptoms

  • Pain and/or difficulty when swallowing (sometimes patients refer to a feeling of food being stuck).
  • Weight loss.
  • Tiredness.

Diagnosis of oesophagus cancer

Investigations may include:

  • Physical examination.
  • Endoscopy- tissue samples may be taken to biopsy any abnormal looking cells.
  • CT scan.
  • PET-CT scan.
  • MRI scan.
  • Barium swallow (not often used now).
  • Laparoscopy.

Oesophagus cancer treatment

Depends on several factors:

  • The type of tumour.
  • The position of the tumour (upper third, middle or lower third).
  • The stage of disease.
  • General health.
  • Treatment aim may be to cure the disease or control it and relieve symptoms.

Surgery

In early stage, surgery will normally be used to remove the affected part of the oesophagus (oesophagectomy). However, surgery may also be used in more advanced disease to place self-expanding stents in the oesophagus to hold the oesophagus open and improve swallowing.

Chemotherapy

Chemotherapy is frequently given before surgery to shrink the tumour but may be given on its own.

In tumours of the lower third, chemotherapy is often prescribed before and after surgery. If the tumour is difficult to remove or the patient is not fit or refuses surgery, chemoradiation may be offered.

Radiotherapy

External beam radiotherapy is usually given in combination with chemotherapy (chemoradiation). This is sometimes given before surgery to shrink the tumour or radiotherapy may be prescribed after surgery to reduce the risk of recurrence.

In advanced cases, radiotherapy and/or chemotherapy may be used to help control and improve symptoms. Brachytherapy is not used very often. This involves a radioactive source being placed in the oesophagus for a set time to enable a very high dose of radiation to be delivered directly to the tumour.

Targeted therapy

Research is being conducted in the use of drugs that block the effects of the proteins that encourage the growth of cancer cells in oesophageal cancers.

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