Oesophageal cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs develops in the tissues lining the oesophagus, a hollow, muscular, tube-shaped organ of the digestive systema group of organs and tissues responsible for breaking down food, absorbing nutrients, and eliminating waste, responsible for the movement of food and liquid from the mouth to the stomach.
Oesophageal cancers are generally diagnosed in people over 60, and is more prevalent in men. However, people of any age and any gender can develop this disease.
Types of Oesophageal Cancer
There are several types of oesophageal cancer, which are characterised by the types of cellsthe basic structural and functional unit of all living things that originate from.
Barrett’s Oesophagus
Barrett’s oesophagus is a precancerous condition that occurs when ongoing acid reflux damages the normal lining of the oesophagus, leading to a change in the cells. Over time, cells in the lower portion of the oesophagus change from cells resembling skin cells to cells more like those found in the intestinesportion of the digestive system that digests food (small intestine) and absorbs salts and water (large intestine), also called bowel. While Barrett’s oesophagus can increase the likelihood of developing oesophageal cancer, the riskthe possibility that something bad will happen is small, and most people don’t develop cancer.
Adenocarcinoma
Oesophageal adenocarcinomacancer arising from mucus-producing glands in organs is the most common type of oesophageal cancer, which often originates in the lower portion of the oesophagus near the gastro-oesophageal junctionthe area where the oesophagus and the stomach meet. This type of cancer is often linked to Barrett’s oesophagus, however, people without this condition can develop oesophageal adenocarcinomas. Oesophageal adenocarcinoma is often aggressive, and may not have as good of a prognosisto predict how a disease/condition may progress and what the outcome might be as other types of cancer.
Squamous Cell Carcinoma
Oesophageal squamous cell carcinomacancer arising from tissues that line organs (SCC) is a less common type of oesophageal cancer which often originates from squamous cells in the upper and middle portions of the oesophagus. This type of cancer is often aggressive and may not have as good of a prognosis as other types of cancer.
Gastro-oesophageal Junction Cancer
Gastro-oesophageal junction (GOJ) cancer, also known as oesopho gastric junctional cancer, is a rare type of malignancy developing from the gastro-oesophageal junction, the area where the stomach and the oesophagus (food pipe) meet. This type of cancer is often difficult to diagnose, and may be misdiagnosed as stomach or oesophageal cancer. For more information on GOJ, please refer to the Rare Cancers Australia Gastro-oesophageal Junction Cancer page.
Rare types of Oesophageal Cancer
These types of oesophageal cancer are rare:
- Oesophageal small cell carcinoma.
- Oesophageal sarcomacancer arising from bones and/or soft tissue.
- Oesophageal lymphomacancers of the lymphatic system.
- Oesophageal melanomaa type of cancer that develops from melanocytes, which are the cells that produce pigment generally in the skin (but can develop in other areas of the body).
- Oesophageal choriocarcinoma.
Treatment
If Oesophageal Cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0 – IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and has not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also classified as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade I cancers. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate course of treatment for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for oesophageal cancer may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Oesophagectomycomplete or partial removal of the oesophagus.
- Oesophagogastrectomyremoval of part or all of the oesophagus, as well as the upper portion of the stomach.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
The risk factors for Oesophageal cancer will vary depending on the type you have.
Risk factors for Oesophageal Adenocarcinoma include:
- Being overweight or obese.
- Having pre-existing conditions of the gastrointestinal tract (e.g., Barrett’s oesophagus or gastro-oesophageal reflux disease (GORD)).
- Smoking tobacco.
- Being over 60 years of age.
- Inherited medical conditions such as Peutz-Jeghers syndrome (PJS) or Cowden syndrome.
Risk factors for Oesophageal squamous cell carcinoma include:
- Drinking alcohol.
- Smoking tobacco.
- Being over 60 years of age.
- Prior oesophageal damage.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Early-stage oesophageal cancer may present with little to no symptoms. As the tumour progresses, some of the following symptoms may appear:
- Difficulty swallowing.
- New heartburn or reflux.
- Worsening indigestion.
- Food or liquids ‘catching’ in the throat or choking episodes when swallowing.
- Pain when swallowing.
- Unexplained weight loss.
- Unexplained loss of appetite.
- Discomfort in abdomenstomach, stomach area, belly.
- Fatiguea state of extreme tiredness or exhaustion, can be physical or mental.
- Vomit or stoolwaste product from the bowel sent to the anus for removal; also known as faeces or poo with bloodthe red bodily fluid that transports oxygen and other nutrients around the body.
Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have oesophageal cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- Endoscopic ultrasoundan ultrasound taken during an endoscopy.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- Barium studiesa type of x-ray where barium powder is either swallowed (barium swallow) or introduced via the colon (barium enema) to coat the organs of the digestive tract and provide clearer x-ray images.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Endoscopya procedure that involves inserting a long, flexible tube with a light and small camera (endoscope) into the body to view internal organs, potentially including:
- Oesophagoscopyexamination of the oesophagus with a small, flexible instrument called a oesophagoscope.
- Gastroscopyexamination of the stomach and part of the small bowel with a small, flexible instrument known as a gastroscope.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
