Esophageal cancer

Are there different types of oesophageal cancer?

The most common histological types of oesophageal cancer are two: adenocarcinoma and squamous cell carcinoma, which are usually found in different parts of the oesophagus. Adenocarcinoma usually occurs in the lower 1/3 of the oesophagus and behaves like stomach cancer. The incidence of oesophageal adenocarcinoma is increasing dramatically worldwide, which has been epidemiologically linked to modern lifestyles and diets and to the scourge of obesity. Squamous cell carcinoma is associated with smoking and excessive alcohol consumption, and is usually found in the upper 2/3 of the organ.

Who are more likely to get oesophageal cancer?

It usually affects people over the age of 60 and is more prevalent in men, who are at least three times more likely to be affected than women. Interestingly, in recent years there has been a change in the histological type of oesophageal cancer, with a dramatic increase in adenocarcinomas compared to squamous cell carcinomas, which used to predominate. Responsible for this change seems to be the higher incidence of gastroesophageal reflux disease, leading to a disorder called Barrett’s esophagus, characterized by replacement of the normal mucosa of the lower esophagus by another histological cell type and considered a precancerous condition. In addition to patients with gastroesophageal reflux, an increased risk of cancer is also seen in esophageal achalasia sufferers, smokers and those who abuse alcohol.

Are there any symptoms indicative of oesophageal cancer?

The most common symptom is dysphagia (difficulty and pain in passing food through the oesophagus), which is usually more severe with solid foods than with liquid foods and is accompanied by weight loss. Coughing is caused by aspiration (entry of food or liquids into the lung) and if the palindromic laryngeal nerve is affected, hoarse voice may occur.

What tests does a patient with suspected oesophageal cancer undergo?

Patients with dysphagia should undergo a barium meal, i.e. an X-ray of the oesophagus-stomach after ingestion of a radiopaque substance (barium). On malignancy of the oesophagus a prominent area of stenosis is visualised. Among patients with severe dysphagia the examination may be dangerous because of the possibility of aspiration of the radiopaque substance into the lung. In this case it is more appropriate to perform a chest CT scan which may detect pathological findings from the oesophagus, infiltration of adjacent structures or highlight other causes of dysphagia, such as oesophageal pressure from swollen mediastinal lymph nodes.

How is oesophageal cancer diagnosed?

An endoscopic esophageal examination can pinpoint the exact location and characteristics of the stenosis and, more importantly, take a biopsy of the lesion to confirm the diagnosis.

What are the treatments available today?

In the treatment of adenocarcinoma of the oesophagus, surgery is the treatment of choice for early cancer (stage I), the chemotherapy and radiotherapy being able to help complementary treatment after surgery in selected cases. In cases where cancer has spread to the oesophageal wall (stage II) or local lymph nodes (stage III), chemotherapy before and after surgery appears to improve survival.
In patients with early-stage squamous cell cancer, options are between surgical cancellation or endoscopic removal. Intermediate-stage patients require radical treatment with a combination of chemotherapy and radiotherapy. Patients with metastatic cancer should be treated with chemotherapy, leaving radiotherapy only for the control of persistent symptoms, especially pain, significant dysphagia or bleeding.

Do all oesophageal cancer patients receive the same treatment?

The therapeutic approach of each patient is individualized and determined by the location of the tumor, its extent, the infiltration of adjacent structures and the existence of distant metastases as well as the general condition of the patient.

What is the prognosis for patients with oesophageal cancer?

A better prognosis is ensured by surgical treatment of the disease if this is possible. For the remaining patients, a combination of chemotherapy and radiotherapy is usually chosen, with the aim of shrinking the tumour and relieving dysphagia.

What options are available if the disease cannot be treated surgically?

If surgery cannot provide a cure and cancer is advanced, palliative chemotherapy may improve symptoms, quality of life and prolong survival. For more urgent cases where the patient cannot be fed, an attempt is made to open-dilate the oesophagus through endoscopy and locate stents to ensure the oesophagus is passable. However, this intervention often has no lasting effect and needs to be repeated.