Oesophagus Cancer

What is Oesophageal Cancer?

Oesophageal cancer is a cancerous growth in the cells lining the oesophagus. This disease is a type of gastrointestinal cancer and is relatively uncommon in Australia.

How Does Oesophageal Cancer Impact Your Anatomy and Health?

The oesophagus is a vital organ that plays a critical role in digestion. Damage to this organ can lead to severe health complications.

Cancer cells in the oesophagus can interfere with the organ's ability to function correctly. This can lead to problems with swallowing and digestion and other symptoms such as chest pain, weight loss, and coughing.

Types of Oesophageal Cancer

There are two main types of oesophageal cancer: squamous cell carcinoma and adenocarcinoma.

• Squamous cell carcinoma is a type of cancer that begins in the thin, flat cells lining the oesophagus. This type of cancer is more common in people who smoke or drink alcohol heavily.
• Adenocarcinoma: A type of cancer that begins in the cells that produce and release mucus in the oesophagus. This type of cancer is more common in people who have Barrett's oesophagus, a condition in which the cells in the lower part of the oesophagus change due to repeated exposure to stomach acid.

Who is Most at Risk for Oesophageal Cancer?

Oesophageal cancer can affect anyone, but some people are at a higher risk than others. Some of the factors that can increase the risk of developing oesophageal cancer include:

• Age: 80% of people living with oesophageal cancer are over 60.
• Gender: Men are more likely than women to develop oesophageal cancer.
• Tobacco and heavy alcohol use
• Obesity
• Gastrointestinal disorders: Certain gastrointestinal disorders, such as gastroesophageal reflux disease (GORD) and achalasia
• Family history
• Chronic ingestion of hot liquids
• Radiation exposure
• Patients with previous head and neck cancer

Causes of Oesophageal Cancer

The exact causes of oesophageal cancer are still unknown. Most are linked to lifestyle and environmental factors. Some factors that are associated with an increased risk of Oesophageal Cancer are:

• Genetic mutations: Changes in the DNA of the cells in the oesophagus can cause cancerous growths to form.
• Environmental factors: Exposure to certain chemicals and toxins, such as those found in tobacco smoke, can increase the risk of developing oesophageal cancer.
• Lifestyle factors: Certain lifestyle factors, such as heavy alcohol consumption and a high-fat diet, can increase the risk of developing oesophageal cancer.
• Medical conditions: Certain medical conditions, such as gastro-oesophageal reflux disease (GORD) and Barrett's oesophagus, can increase the risk of developing oesophageal cancer.

Symptoms of Oesophageal Cancer

The symptoms of oesophageal cancer can vary depending on the stage of the disease. In the early stages, the symptoms may be minimal or non-existent, making it difficult to detect the cancer. As the cancer progresses, however, the symptoms become more noticeable and may include the following:

• Difficulty swallowing (dysphagia): discomfort and inability for food or liquids to pass through the oesophagus. Food may feel stuck in your throat.
• Acid indigestion or heartburn: when acid from the stomach goes back up (refluxes) that is persistent or lasts more than three days or if the stomach becomes inflamed or irritated
• Weight loss
• Regurgitation or vomiting: when food comes back up soon after you swallow it 
• Pain in your throat or behind your breastbone: pain in the centre of your chest or, more rarely, in your back or shoulder
• Hoarseness: voice can become raspy or croaky
• Chronic cough: cough that won't go away or that happens when you try to eat.
• Coughing up blood or blood in your vomit 
• Dark faeces: due to blood loss from cancer

Oesophageal Cancer Diagnosis

Oesophageal cancer is typically diagnosed through a combination of tests and procedures. Some of the most common diagnostic tools include:

• Endoscopy: A thin, flexible tube with a camera is inserted through the mouth into the oesophagus to examine abnormal areas.
• Endoscopic ultrasound: A thin tube with an ultrasound attached that produces sound waves to visualise cancer and invasion into layers of the oesophagus.
• Biopsy: A tissue sample is taken from the oesophagus during endoscopy and examined under a microscope for cancer cells.
• Imaging tests: CT scans and PET scans can help determine the stage and location of the cancer.
• Blood tests: Blood tests can detect certain markers that may indicate the presence of oesophageal cancer.

Tests After Diagnosis

Once a diagnosis of oesophageal cancer is made, further tests will be required. These tests are necessary to define cancer’s size, position, stage, and spread. They do not always answer with certainty what stage the cancer is. Only after surgery can further answers be found. These tests may include the following:

• CT scan
• Endoscopic ultrasound (EUS)
• PET-CT
• Laparoscopy
• MRI

Stages of Oesophageal Cancer

The cancer stage tells you how big it is and how far it’s spread. Staging is an important part of oesophageal cancer diagnosis, as it helps doctors determine the best course of treatment. The stages of oesophageal cancer are:

• Stage 1 - within the oesophageal tissue
• Stage 2 - grown into the wall of the oesophagus 
• Stage 3 - moved to the outer oesophageal wall
• Stage 4 - expanded to one or more organs or structures near the oesophagus
• metastasised to the lungs, heart or rib cage tissue
• metastasised to the windpipe, spine or major blood vessel

Other important measurements used to determine the progression of the cancer are:

• the spread to lymph nodes
• the extent of metastasis
• the grade or cell patterns under a microscope.

How can Oesophageal Cancer be Treated?

A patient’s treatment and survival rate for oesophageal cancer mainly depends on the cancer's stage and location. The doctor can advise after diagnosis and surgery. There are several treatment options available for oesophageal cancer, including:

• Endoscopy: Early oesophageal cancer can be potentially cured with endoscopic resection (EMR or ESD).
• Surgery: Involves removing part or all of the oesophagus and nearby lymph nodes. This is typically the preferred treatment for early-stage oesophageal cancer.
• Chemotherapy: Involves using powerful drugs to kill cancer cells. This treatment is typically used in combination with surgery or radiation therapy.
• Radiation therapy: Uses high-energy radiation to kill cancer cells. This treatment may be used before or after surgery or with chemotherapy.

Oesophageal Cancer Surgery

A cure for oesophageal cancer is sometimes possible through surgery. Surgery removes cancer, sometimes along with part of the oesophagus and other affected tissue. Your surgeon can offer various operations depending on

• where your cancer is
• the stage
• the type of oesophageal cancer
• the grade
• patient's general health and fitness

Some surgical approaches include:

• Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection: Very early-stage cancer is removed through an endoscope. This can be a day procedure with fast recovery.
• Oesophagectomy: The affected oesophageal sections are removed, and where necessary, parts of the upper stomach, lymph nodes and other tissue. The oesophagus is then reconnected to the gastrointestinal tract.

Oesophageal Cancer Prognosis

The prognosis for esophageal cancer in Australia is similar to other developed countries. The five-year survival rate for esophageal cancer in Australia varies depending on the cancer stage at diagnosis. According to the latest data from the Australian Institute of Health and Welfare (AIHW), the five-year relative survival rate for esophageal cancer is as follows:

• Localised cancer (cancer that has not spread beyond the oesophagus): 39%
• Regional cancer (cancer that has spread to nearby lymph nodes): 19%
• Distant cancer (cancer that has spread to distant organs or tissues): 7%

Note that survival rates are based on population statistics and do not reflect an individual's chances of survival. Many factors can affect an individual's prognosis, including age, overall health, and response to treatment. Working closely with your doctor to determine the best treatment plan and monitor the disease's progress is essential.

What if Oesophageal Cancer is Untreated?

If oesophageal cancer is left untreated, it can continue to spread and cause significant damage to the body. This can lead to a range of health complications, including:

• Difficulty breathing
• Difficulty swallowing
• Malnutrition and dehydration
• Chronic pain
• Oesophageal bleeding
• Increased risk of infections

Untreated oesophageal cancer can also be life-threatening, as the cancer can spread to other parts of the body and cause organ failure.