What is oesophageal cancer?

Oesophageal cancer occurs when abnormal cells grow uncontrollably in the oesophagus. The oesophagus is part of the digestive system and is the muscular tube that connects the mouth to the stomach. 

It is a rare cancer that affects about 1450 people in Australia each year, [1]  however, it is usually detected at an advanced stage when outcomes are less positive. 

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Digestive system

The series of organs within the body that contribute to the digestion of food. It begins at the mouth and ends at the anus, and includes the stomach, small and large intestines as well as the pancreas, gallbladder and liver.

1. Stomach and oesophageal cancer. Cancer Council Victoria. Accessed 10 June 2015 from

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Causes

The cause of oesophageal cancer, as with other cancers, is damage to cellular DNA. This results in uncontrolled growth of damaged cells, which leads to the formation of a cancer. The cancer can invade nearby tissues, or spread via the bloodstream or lymphatic system to other ares of the body.

The exact cause of oesophageal cancers is not well known. However, certain risk factors are known to increase the risk of developing this condition.

Tumour in the oesophagus.A cancer in the oesophagus. 

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

DNA

The genetic material of all living cells and some viruses. The full name is deoxyribonucleic acid.

Lymphatic system

A network of vessels, lymph nodes, the spleen and other organs that transport lymph fluid between tissues and bloodstream.

1. Stomach and oesophageal cancer. Cancer Council Victoria. Accessed 10 June 2015 from

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Risk factors

Risk factors for oesophageal cancer include:

  • Tobacco and alcohol consumption - smoking and alcohol consumption both significantly increase your risk of developing oesophageal cancer. Consumed together, the risk is magnified many times over;
  • Barrett's oesophagus - Barrett's oesophagus occurs when recurring acid reflux from the stomach (heartburn) causes cells in the oesophagus to change from squamous cells to columnar cells. This change of cell type is called metaplasia. This condition can be a precursor of a cancer originating in glandular cells (adenocarcinoma);
  • Obesity - obesity, particularly when fat is mainly in the abdominal area, increases your risk of developing adenocarcinoma, and;
  • Nitrosamines - nitrosamines are carcinogens present in foods such as salted vegetables and preserved fish that have been linked to squamous cell carcinoma of the oesophagus.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Glandular cells

Specialised cells that secrete materials such as lubricants and hormones.

Reflux

An abnormal, backwards flow of fluid within the body.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

1. Stomach and oesophageal cancer. Cancer Council Victoria. Accessed 10 June 2015 from

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Types

Oesophageal cancer can occur in different types of cells in the oesophagus.

Squamous cell carcinoma

Squamous cell carcinoma of the oesophagus originates in the squamous cells in the lining of the oesophagus (mucosa). It tends to occur in the upper oesophagus. Smoking and alcohol are common risk factors for squamous cell carcinomas. 

Adenocarcinoma

Adenocarcinoma of the oesophagus originates in the glandular cells of the submucosa (the supportive layer of tissue) of the oesophagus. It tends to occur in the lower oesophagus. Barrett's oesophagus is a known risk factor for adenocarcinomas. 

Globally, squamous cell carcinoma is the most common type of oesophageal cancer, whereas in developed countries adenocarcinoma is more common.

Less common cancers

Other less common cancers of the oesophagus include lymphomas, gastrointestinal stromal tumours (GIST), sarcomas, and carcinoid tumours.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Glandular cells

Specialised cells that secrete materials such as lubricants and hormones.

Lymphomas

A tumour of lymph tissue, which is rich in lymphocytes, small white blood cells that have specific immune responses.

Sarcomas

A cancer that arises from connective tissues such as fat, bones, muscles and blood vessels.

Tumours

A growth caused by an abnormal and uncontrolled reproduction of cells.

Carcinoid tumours

A rare tumour that begins in hormone-producing cells of various organs. About 80% of carcinoid tumours grow in the appendix and small bowel, but they can also develop in the pancreas, lungs, stomach, ovaries, kidneys or testicles.

Gastrointestinal stromal tumours

A rare type of tumour, which can be benign or cancerous, arising from specific smooth muscle cells of the digestive tract, known as interstitial cells of Cajal. They mainly arise in the stomach but can occur in other areas of the digestive tract.

1. Stomach and oesophageal cancer. Cancer Council Victoria. Accessed 10 June 2015 from

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Stages of oesophageal cancer

Treatment outcomes can vary greatly depending on the stage of cancer. Cancer is staged according to the size and location of the primary tumour and whether it has spread to lymph nodes or other organs in the body.

Stage 0

Carcinoma in situ (Tis) is when the cancer is only in the upper layer lining the oesophagus, known as the mucosa.

Stage I

Stage IA - The cancer hasn't grown beyond the supportive layer of tissue called the submucosa of the oesophageal wall (T1).

Stage IB - The cancer has spread into, but not beyond, the muscular layer of oesophageal wall, called the muscularis propria (T2).

Stage II

Stage IIA - The cancer has spread into the membrane that covers the outside of the oesophagus, but not to nearby lymph nodes (T3).

Stage IIB - The cancer has spread to 1-2 nearby lymph nodes, but hasn't grown beyond the muscle layer (T2, N1).

Stage III

Stage IIIA - The cancer has grown into adjacent structures like the diaphragm, lining of thelungs or heart, but not elsewhere (T4); or the cancer has grown into the membrane covering the oesophagus and has also spread to 1-2 nearby lymph nodes (T3, N1); or the cancer has not grown further than the muscle layer, but has spread to 3-6 nearby lymph nodes (T2, N2).

Stage IIIB - The cancer has grown into the membrane that covers the oesophagus and has also spread to 3-6 lymph nodes, but not elsewhere (T3, N2).

Stage IIIC - The cancer has grown into adjacent structures like the diaphragm, lining of lung or heart, windpipe, spine, or major blood vessels, and has spread to any nearby lymph nodes (T4); or the cancer has spread to 7 (or more) nearby lymph nodes, but hasn't spread elsewhere (N3).

Stage IV

The cancer has spread throughout the body to distant organs, such as the lungs and liver (T4).  

Stages of oesophageal cancer. 

Liver

A large, internal organ of the body, located on the upper right-hand side of the abdomen. The liver has hundreds of distinct functions, including producing bile, regulating the body's metabolism and detoxifying the blood.

Lymph nodes

A small organ of the lymphatic system containing many immune cells. Lymph nodes, also known as lymph glands, are the sites where many interactions between immune cells and foreign materials occur.

Tumour

A growth caused by an abnormal and uncontrolled reproduction of cells.

Diaphragm

1. A dome-shaped muscular membrane that separates the chest from the abdomen and is important for breathing. 2. A thin, dome-shaped cap that covers a woman's cervix and acts as a contraceptive device by preventing the male's sperm from accessing the egg.

1. Stomach and oesophageal cancer. Cancer Council Victoria. Accessed 10 June 2015 from

External link

Signs and symptoms

Signs and symptoms of oesophageal cancer may include:

  • Difficulty swallowing;
  • A hoarse voice;
  • Nausea and vomiting, which may contain blood;
  • Pain in the chest, throat or between the shoulders;
  • Weight loss, which may occur because you're having difficulty swallowing and are put off eating, but it can also be a sign of advanced cancer, and;
  • Acid reflux - it is important to know, however, that reflux is a common condition even in the absence of cancer.

Reflux

An abnormal, backwards flow of fluid within the body.

1. Stomach and oesophageal cancer. Cancer Council Victoria. Accessed 10 June 2015 from

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Methods for diagnosis

If you have signs and symptoms that might indicate oesophageal cancer, a gastroscopy will generally be the first method of investigation (see below). A biopsy of any suspicious area of the oesophagus can also be taken. The tissue from the biopsy can then be examined by a pathologist to see if there are any features of a cancer. If a cancer is confirmed, a variety of further investigations may be performed to assess the extent of the cancer, including imaging or other procedures.

Imaging

Computerised tomography scan

A computerised tomography (CT) scan uses X-rays to develop a 3D image of the body. This can detect smaller tumours more effectively than a simple X-ray can. The scan may be used to assess the size or spread of a tumour and may show enlarged lymph nodes or an effect on other organs such as the liver.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) is similar to a CT scan, but it uses magnetism instead of X-rays for imaging.

Positron emission tomography

Positron emission tomography (PET) requires that an injection with a radioactive label, or tracer, first be administered. When combined with a CT scan, it produces images that can provide the doctor with additional characteristics about the tumour. 

Procedures

Gastroscopy

A gastroscopy is performed by inserting a thin tube with an attached camera through your mouth into the oesophagus. Sometimes an ultrasound can be performed at the same time to produce images of the wall of the oesophagus and internal organs near it. Cells or a tissue biopsy can be obtained from the area using the gastroscopy procedure to then be analysed. 

Laparoscopy

During a laparoscopy, your internal abdominal and pelvic cavities will be checked for abnormalities using a slender camera inserted through a small incision in your abdomen. A biopsy can be taken during the procedure.

Biopsy

A biopsy is a removal of a tissue sample for examination under a microscope. The biopsy is the only definite way of making a cancer diagnosis, as it provides the most accurate analysis of the abnormal-looking cells. 

Biopsy

The removal of a tissue sample for microscopic laboratory examination. It is used to determine the presence, cause and type of the disease.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Liver

A large, internal organ of the body, located on the upper right-hand side of the abdomen. The liver has hundreds of distinct functions, including producing bile, regulating the body's metabolism and detoxifying the blood.

Lymph nodes

A small organ of the lymphatic system containing many immune cells. Lymph nodes, also known as lymph glands, are the sites where many interactions between immune cells and foreign materials occur.

Pathologist

A doctor specialising in the microcopic study of disease, such as examining a tissue sample taken in a biopsy.

Tumours

A growth caused by an abnormal and uncontrolled reproduction of cells.

Ultrasound

A scan that uses high-frequency soundwaves to produce images of the body’s internal structures.

X-rays

A scan that uses ionising radiation beams to create an image of the body’s internal structures.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

1. Stomach and oesophageal cancer. Cancer Council Victoria. Accessed 10 June 2015 from

External link

Types of treatment

Surgery

Depending on the size and location of the cancer, surgery can be performed in a number of ways. Surgical options are often complex and extensive, however, they can offer the possibility of a cure. Your surgeon can help discuss these options with you.

Adjuvant therapy

Adjuvant therapy is given after surgery, with the aim of preventing the cancer from returning. It can take the form of radiotherapy and/or chemotherapy (see below).

Neoadjuvant therapy

Like adjuvant therapy, neoadjuvant therapy also uses radiotherapy and/or chemotherapy, but is provided before surgery.

Chemotherapy

Chemotherapy works by attacking cancer cells and stopping their reproduction. Various medications are used, which are generally administered intravenously. They are often given in cycles, followed by rest periods, which help to reduce the toxic side effects of chemotherapy. Your doctor will monitor your dosage and treatment schedule to ensure optimal therapeutic dosage is administered, with minimum side effects.

Radiotherapy

In this type of therapy, focused X-rays from an external beam radiation source are applied to the area where the cancer was located. Radiotherapy helps to reduce the recurrence of cancers at their original site. 

Immunotherapy

Immunotherapy, also known as biologic therapy, is used for some types of cancer. It involves the use of medications that trigger the immune system to help fight the cancer. In the case of oesophageal cancer a monoclonal antibody drug, called trastuzumab, can be used for particular types of adenocarcinoma, specifically the HER2-positive tumours. However, trastuzumab cannot be combined with a chemotherapy drug called antracycline, as the combination increases the risk of heart problems.

Other therapies

Some people diagnosed with cancer seek out complementary and alternative therapies. None of these alternative therapies are known to cure cancer, but some can help people feel better when used together with conventional medical treatment. It is important to discuss any treatments with your doctor before starting them.

Antibody

A protein molecule produced by the immune system. Antibodies bind specifically to foreign substances to neutralise them or target them for destruction.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Immune system

The organs and cells involved in protecting the body against infection.

Radiotherapy

A treatment that uses ionising radiation to kill or control growth of malignant cancer cells.

Tumours

A growth caused by an abnormal and uncontrolled reproduction of cells.

X-rays

A scan that uses ionising radiation beams to create an image of the body’s internal structures.

1. Stomach and oesophageal cancer. Cancer Council Victoria. Accessed 10 June 2015 from

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Potential complications

Treatment side effects

Side effects from cancer treatment can include the following:

  • Nausea, vomiting and fatigue - these can result from chemotherapy and radiotherapy. Whether or not the treatment makes you feel sick is not an indication of how well the treatment is working;
  • Altered bowel habits - constipation frequently occurs during chemotherapy, probably as a result of anti-nausea and some pain-relief medication. Radiotherapy may cause diarrhoea;
  • Difficulty swallowing - radiotherapy can cause a sore throat and difficulty swallowing. Occasionally ulcers can develop and you need to have a liquid or soft diet for some time;
  • Heart problems - chemotherapy, radiotherapy and immunotherapy can potentially cause heart failure and other heart conditions;
  • Respiratory failure - reduced respiratory function and abnormal function of the diaphragm can result from tissue damage in the chest (thoracic) cavity following surgery. Other lung complications, especially in the immediate days following surgery, include pneumonia and pneumothorax (collapsed lung).
  • Joint and muscle pain - this can occur after a treatment session and can last a few days;
  • Temporary hair loss from the head and body due to some types of chemotherapy. It will grow back after treatment has ended, and;
  • Tingling in the hands and feet - some chemotherapeutic agents can affect the nerves. It is important to tell your doctor if you develop these symptoms. 

Advanced oesophageal cancer

Advanced oesophageal cancer can metastasise. This is when the cancer spreads to other parts of the body through the bloodstream and lymphatic system. This can interfere with the vital function of the affected organ or body part.

Fatigue

A state of exhaustion and weakness.

Lymphatic system

A network of vessels, lymph nodes, the spleen and other organs that transport lymph fluid between tissues and bloodstream.

Nerves

One or more fibres that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.

Radiotherapy

A treatment that uses ionising radiation to kill or control growth of malignant cancer cells.

Ulcers

An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.

Diaphragm

1. A dome-shaped muscular membrane that separates the chest from the abdomen and is important for breathing. 2. A thin, dome-shaped cap that covers a woman's cervix and acts as a contraceptive device by preventing the male's sperm from accessing the egg.

1. Stomach and oesophageal cancer. Cancer Council Victoria. Accessed 10 June 2015 from

External link

Prognosis

The prognosis for oesophageal cancer depends on the type and stage of the disease, but the overall five-year survival rate from the point of diagnosis is 16%. For those who survive the first year, this increases to 35% and for those who survive the first five years, the forward five-year survival rate further increases to 78%. [2]

It is important to remember survival rates are only an indication and are based upon the averages of previously treated patients. It is not an absolute prognosis for an individual. It is often difficult to accurately predict an individual's cure or survival rate. Constant advances in treatment are continually improving these statistics. 

2. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Australian Government – Australian Institute of Health and Welfare. Accessed 22 September 2014 from

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Prevention

Oesophageal cancer cannot be prevented, but you can reduce your risk by not drinking excessively, quitting smoking and by maintaining a healthy weight.

2. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Australian Government – Australian Institute of Health and Welfare. Accessed 22 September 2014 from

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