Conditions:

Oesophageal Cancer

Oesophageal cancers can arise from anywhere in the oesophagus (feeding tube that connects the mouth to the stomach). In Western communities, they are most common at the junction of the oesophagus and stomach.

Oesophageal cancers were previously uncommon in Western countries, being highly prevalent in Asian and Middle Eastern regions. With the vastly increased incidence of gastro-oesophageal reflux disease, oesophageal cancer in Western countries has also dramatically increased.

Most cancers in the oesophagus are either squamous cell carcinomas (arising from the upper part) or adenocarcinomas (arising from the lower part). They occur in five to ten people per 100 000.

What causes oesophageal cancer?

The exact cause of oesophageal cancer is not fully understood, but certain risks are associated with its development.

1. Heavy smoking - increases risk 5 fold
2. Heavy alcohol consumption - increases risk 5 fold
3. Heavy smoking and alcohol consumption - combination of both increases risk 25-100 fold
4. Barrett's Oesophagus - gastro-oesophageal reflux disease can lead to changes to the inner lining of the lower oesophagus known as Barrett's Oesophagus. This is a pre-cancerous condition. Click here to learn more about gastro-oesophageal reflux disease.

What symptoms does oesophageal cancer cause?

Early diagnosis of oesophageal cancer is crucial to successful treatment. Any of the following symptoms are potential symptoms of oesophageal cancer.

1. Difficulty with swallowing (dysphagia) - present in 80-90% of people with oesophageal cancer.
2. Weight Loss - Can be caused by many disorders, but present in 45-50% of people with oesophageal cancer.
3. Vomiting - also can be due to many diseases but present in 30-40% of people with oesophageal cancer.
4. Chest or abdominal pain - present in 20-30% of people with oesophageal cancer.

Oesophageal cancers often cause no symptoms until they are quite advanced.

How is oesophageal cancer diagnosed?

The best test to diagnose oesophageal cancer is gastroscopy. Gastroscopy is a day procedure that involves the passage of a flexible tube down the oesophagus which allows the surgeon to visualise the cancer and also take biopsies to confirm the diagnosis. The procedure is done with sedation and takes approximately fifteen minutes.

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How is oesophageal cancer treated?

The most important question that must be answered prior to developing a treatment plan for oesophageal cancer is whether the cancer is curable. The determining factor for this is whether the cancer has spread away from the oesophagus.

This process of determining if the cancer has spread is known as staging. All of Dr Fenton-Lee's patients undergo the following minimum staging procedures once the diagnosis of oesophageal cancer has been confirmed with gastroscopy.

1. Blood tests - these can give clues to cancer spread to the liver.
2. Chest x-ray
3. CT san of the abdomen and chest - this is performed to ascertain spread to the lungs and liver.
4. Endoscopic Ultrasound - This procedure is similar to a gastroscope and is the best test to determine the depth and local invasion of the tumour. It also allows biopsies to be taken of surrounding lymph nodes to determine if they are involved which may alter the treatment plan.
5. Staging laparoscopy - This is the best test to look for small cancer nodules and lymph node involvement within the abdominal cavity that CT scan can miss. Laparoscopy is a minor procedure that is done when all other staging procedures are clear. It is done to prevent major surgery being performed in patients whose cancer is not curable.

Other tests that are sometimes used to look for cancer spread are PET scans and MRI scans.

Once all these staging procedures are performed and cleared, surgery can be considered. Click here to learn more about surgery for oesophageal cancer.

What are the chances of cure?

The success of curing oesophageal cancer is dependant on early diagnosis. The prognosis is calculated by staging that takes three factors into consideration. These factors are

1. Degree of tumour invasion (T staging)
2. Lymph node involvement (N staging)
3. Presence of distant metastases (M staging)

These factors are subcategorised into groups as follows

T staging
T1 - cancer within inner lining of oesophagus only
T2 - tumour involving muscle of oesophagus only
T3 - tumour past oesophageal wall, but not surrounding structures
T4 - tumour invading surrounding structures.

N staging
N0 - No regional lymph node involvement
N1 - Regional lymph node involvement

M staging
M0 - No distant metastases
M1 - Distant metastases

The stage grouping and the 5 year survival for these groupings are as follows

Stage I
T₁N₀M₀ 50-55% 5 yr survival

Stage IIA
T₂N₀M₀
T₃N₀M₀

Stage IIB
T₁N₁M₀ 15-35 % 5yr survival
T₂N₁M₀

Stage III
T₃N₁M₀
T₄N₁M₀ 5-15 % 5yr survival

Stage IV
T_anyN_anyM₁ <5% 5yr survival

What other treatment options are available?

Although surgery provides the only chance of cure, other treatments are available as adjuvant or palliative treatment. Palliation is treatment that involves prolonging the length of disease free time, as well as improving the quality of life for patients whose cancers cannot be cured.

Other forms of treatment available include

1. Chemotherapy - used both in improving cure rates in potentially curable cancers and also in slowing growth time in incurable cancers
2. Radiotherapy - can often work very well in slowing down the tumour growth.
3. Stents - a palliative procedure to unblock the oesophagus when occluded by a cancer that is inoperable.

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