OESOPHAGEAL CANCER

What is oesophageal cancer?

Your oesophagus (gullet) is a tube that connects your mouth to your stomach. When you swallow food, your oesophagus transports this food down to your stomach. Oesophageal cancer is more common in the elderly, where around 8 in 10 cases happen in people aged 60 and above.

Cancers can occur in any part of your oesophagus. Cancers in the upper and middle part are usually squamous cell carcinomas. These cancers grow from cells that are found in the inner lining of your oesophagus.

Cancer in the lower part of your oesophagus are usually adenocarcinomas. These cancers develop from gland cells.

The lower portion of your oesophagus is joined to your stomach. Where they join is the gastro-oesophageal junction. Cancers that occur here are called gastro-oesophageal junction cancers.

What causes oesophageal cancer?

Oesophageal cancer happens when cells in your oesophagus undergo mutations (changes) in their DNA. These mutations make cells undergo uncontrolled cell division. The accumulating mass of abnormal cells form a tumour in your oesophagus that can grow to spread to other parts of your body.

You may be at risk for developing oesophageal cancer if you

  • Have persistent Gastroesophageal Reflux Disease (GERD)
  • Are overweight or obese
  • Consume a diet that is low in fruits and vegetables
  • Drink a lot of alcohol long-term
  • Smoke
  • As you age

How do I know if I have oesophageal cancer?

In its early stages, oesophageal cancer may not present any symptoms.

In later stages, common symptoms of oesophageal cancer include:

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  • Persistent heartburn or indigestion
  • Difficulty swallowing
  • Food coming back up soon after you swallow
  • Loss of appetite and unintentional weight loss
  • Hoarse voice
  • Coughing blood
  • Chest or back pain

If you experience any of the above symptoms, do consult your doctor immediately.

How is oesophageal cancer diagnosed?

Through an endoscopy, the doctor uses a long flexible tube called an endoscope with a tiny camera and light on the end to look inside your oesophagus. The oesophagus is checked for growths or abnormal looking areas. Tissue samples (biopsies) of any abnormal looking structures may be taken and sent them to the laboratory for examination using a microscope.

A barium swallow is test that shows the inside of your oesophagus. Doctors can use this test to diagnose oesophageal cancer and the stage of the cancer. During this test, you will drink a white barium liquid. While you swallow the liquid, a radiographer takes many X-rays of your oesophagus.This test is used to show any tumours or abnormal-looking areas in your oesophagus.

What does each stage of oesophageal cancer mean?

  • Pre-cancerous stage: Cancerous cells are visible through a microscope on the lining of your oesophagus. However, it has not invaded the deeper parts of the inner lining.
  • Stage I: The cancer is present in the outer layers and has also started to invade the first layers of the inner lining of your oesophagus. The cancer may also have spread to nearby lymph nodes.
  • Stage II: The cancer has invaded deeper muscular layers of your oesophagus. It may also have spread to nearby lymph nodes.
  • Stage III: The cancer has spread to the deepest layers of the lining of your oesophagus and through the muscular layers, to nearby tissues or lymph nodes.
  • Stage IV: The cancer has spread to other parts of your body besides your oesophagus.

Why surgery for oesophageal cancer?

Should you be diagnosed with oesophageal cancer, it is very important that you undergo surgery to remove the affected area of your oesophagus to prevent the cancer from progressing to later stages and spreading to other parts of your body. If oesophageal cancer is only diagnosed at a later stage, a cure may not be possible. Surgery, when combined with chemotherapy and radiotherapy, can help keep the cancer under control and relieve symptoms you may have. Surgery also prevents the tumour from recurring or spreading.