Oesophageal Cancer

Understanding Oesophageal Cancer

Oesophageal (also spelled esophageal) cancer starts in the oesophagus, or food pipe, the muscular tube that connects your throat to your stomach.

Your oesophagus moves food from your mouth to your stomach for digestion. Cancer in the oesophagus can make swallowing difficult and may affect your ability to eat enough food, which can lead to weight loss, muscle loss, and other nutrition-related problems.

Here’s an overview of oesophageal cancer, including information on the causes, symptoms, diagnosis, and treatments, as well as ways to support your nutrition and overall health when cancer affects your food pipe.

What Is Oesophageal Cancer?

Oesophageal cancer can start anywhere in your food pipe, the tube that lies behind your windpipe and in front of your spine. It develops when abnormal cells in the inner layer of the oesophagus grow out of control.

There are two main types, named for the cells the cancer starts in [1]:

• Adenocarcinoma starts in gland cells known as adenomatous cells, which make mucus to help you swallow. It’s the most common type of oesophageal cancer in many Western countries, and typically affects the lower part of the oesophagus, near your stomach.
• Squamous cell oesophageal cancer starts in thin, flat cells lining the oesophagus. It usually starts in the upper oesophagus, near your throat, or in the middle section. It remains more common in parts of Asia and Africa.

A few other, rare types of oesophageal cancer also exist. Each type can grow and spread differently and may require different treatments.

What Causes Oesophageal Cancer?

Doctors aren’t sure exactly what causes oesophageal cancer, but several things can raise your risk [1]:

• Being older than 60
• Being male. Men are more likely to develop it than women.
• A history of gastroesophageal reflux disease (GORD)
• Having Barrett’s oesophagus, a condition that causes damage to cells in the oesophageal lining
• Long-term heavy alcohol use
• Smoking or chewing tobacco
• Being overweight
• A history of head and neck cancer or radiotherapy to the chest or abdomen

Common Signs and Symptoms of Oesophageal Cancer

Oesophageal cancer symptoms can vary from person to person, but they might include [1]:

• Pain when swallowing
• Loss of appetite or feeling full quickly
• Frequent heartburn or indigestion
• Regurgitation of undigested food
• A persistent cough or hoarse voice
• Chest discomfort
• Unintentional weight loss
• Black stools (if tumour bleeding occurs)
• Hiccups (in advanced cases)

Other health conditions besides cancer can cause these symptoms. Still, tell your doctor if you notice them, especially if they don’t go away.

How Oesophageal Cancer Is Diagnosed and Staged

Your doctor will examine you and may order tests or send you to a specialist to check for oesophageal cancer. Tests might include:

• Endoscopy - A thin tube with a camera that looks at the lining of your oesophagus. If any parts look abnormal, they can also collect a biopsy or tissue sample to test for cancer.
• Imaging tests - An endoscopic ultrasound, MRI, or a CT scan can take pictures inside your oesophagus and check for tumours that may have spread. A PET-CT is often used for distant staging.

If tests confirm cancer in your food pipe, your doctors will identify its type and grade, which helps determine how fast it’s likely to grow. They’ll also stage it, a measure of how much, if any, the cancer has spread [2]. This information will guide your treatment options.

• Stage 0 (high-grade dysplasia) - Abnormal cells are only in the top layer of the oesophageal lining.
• Stage I - The tumour has grown deeper into the oesophagus lining, but has not spread to any lymph nodes.
• Stage II - The tumour has grown into the muscle layer of the oesophagus, or it has spread to one or two nearby lymph nodes.
• Stage III - The main tumour has grown larger and deeper through the muscle layer of the oesophagus and into the outer layer (adventitia). It may have also spread to up to six nearby lymph nodes.
• Stage IV - The cancer has spread to distant lymph nodes or other organs.

Modern staging is more detailed and uses the AJCC TNM system (Tumour, T1-T4, Nodes, N0-3, and Metastases, M0-1).

How Oesophageal Cancer Is Treated

Oesophageal cancer treatments vary depending on your cancer type and whether it has spread. You and your medical team will decide on the best treatment approach, which might include one or more of the following:

• Surgery (oesophagectomy) to remove some or all of the oesophagus, usually when cancer hasn’t spread beyond the food pipe. Minimally invasive approaches (laparoscopic or thoracoscopic) are increasingly used in modern surgery. Many patients also receive pre-surgical interventions such as chemoradiotherapy to shrink the tumour prior to surgery.
• Chemotherapy uses strong medicines to kill cancer cells and shrink tumours.
• Radiotherapy uses high-energy rays to shrink tumours.
• Chemoradiotherapy combines chemotherapy and radiotherapy to make cancer cells more sensitive to radiotherapy.
• Targeted therapy uses drugs that block specific proteins that help your cancer cells grow and spread, targeting only your cancer cells.
• Immunotherapy helps your immune system fight the cancer.

Recovery, Survival, and Long‑Term Outlook

Each person’s cancer and treatment are different, so it’s hard to predict how you’ll recover or what may happen in the future. In general, early diagnosis leads to better, more effective treatment options, sometimes with fewer side effects.

Treatments for cancer in your food pipe can affect your appetite, ability to eat, and your digestion. It may take several months to recover from your treatment, and even longer to adjust to any changes in your digestive system. There may also be potential long-term issues such as strictures, which require dilation or a need for long-term dietary adjustments with oesophagectomy.

Early diagnosis and treatment typically lead to better outcomes. After treatment, some early-stage oesophageal cancers can be cured. The cancer may also go into remission, which means that signs and symptoms are gone and the cancer is under control but not cured.

Regular follow-up appointments are an important part of your care because they help your healthcare team monitor your recovery and identify any concerns as early as possible.

Nutrition Support in Oesophageal Cancer

Treatments for oesophageal cancer can make eating difficult, which affects your nutrition, weight, and overall health at a time when it’s vital to eat well so you can stay strong.

An oncology dietitian can create a personalised nutrition plan to help you meet your calorie, protein, and other nutritional needs and troubleshoot swallowing problems, loss of appetite, or early fullness. They may recommend:

• Soft foods like oatmeal, puddings, or pureed fruits and vegetables
• Smaller, more frequent meals and snacks, especially if you experience early fullness
• Easy-to-swallow proteins such as scrambled eggs, fish, and Greek yoghurt
• Oral nutrition supplements like shakes, powders, or puddings that provide extra protein and calories in a small volume
• If you cannot meet your nutritional needs by mouth, your healthcare team may recommend tube feeding. Nutrition can be provided through different types of feeding tubes, depending on your treatment plan and nutritional needs. Some tubes pass through the nose into the stomach, while others are placed directly into the stomach or small intestine.

Your dietitian may also work with a speech/language pathologist if swallowing is affected.

Your medical team will support you throughout every step, from diagnosis through recovery. Stay in close contact, ask questions, and alert them to any problems or challenges you may encounter.