Oesophageal Cancer

There is a decreasing trend for oesophageal cancer. However the incidence of adenocarcinoma has increased and  is now more prevalent than squamous cell carcinoma.

Long-standing gastroesophageal reflux will lead to a condition called Barrett metaplasia, and increases the risk of developing adenocarcinoma of the oesophagus.

Nitrosamines and alcohol have been implicated in the high incidence of oesophageal cancer in certain countries. Nitrosamines are found as food preservatives.

Certain benign oesophageal diseases have been known to predispose to oesophageal cancer. Patients with achalasia, an oesophageal disease due to uncoordinated contractions of the oesophagus leading to difficulty swallowing, have a seven times higher incidence of oesophageal cancer. Previous injury to the oesophagus due to caustic soda also predisposes to cancer. Conditions such as Plummer-Vinson syndrome where a web forms over the opening of the oesophagus into the stomach, all predispose to oesophageal cancer.

Tylosis, an inherited condition characterised by thickening of the palms and soles, has a high association with oesophageal cancer.

Patients with oesophageal cancer confined to the oesophagus but who are not fit for surgery may receive combined chemotherapy and radiotherapy. Using both methods of therapy may cure a small group of these patients. Radiotherapy is usually given daily over a period of 5 to 6 weeks. Side effects include difficulty eating because of pain, redness of the skin, and loss of appetite. Chemotherapy may be combined with the first and fifth week of radiotherapy to make radiotherapy more effective. Treatment is associated with nausea and vomiting, mouth ulcers, hair loss, and loss of appetite. Recent studies suggest that the use of surgery combined with chemotherapy and radiotherapy may be beneficial. Proper patient selection is important.

Patients with advanced incurable oesophageal cancer involving organs other than the oesophagus are sometimes given chemotherapy alone to slow the course of the cancer. However, if the main symptom is difficulty swallowing, radiotherapy is sometimes given to enable the person to eat.

 

Patients with oesophageal cancer who have difficulty eating and who are not fit for surgery or radiotherapy may have a feeding device inserted directly from the skin into their stomach. Another way of bypassing the blockage caused by the cancer is to pass a metal stent into the oesophagus through the cancer. Liquids can pass through this stent into the stomach and nourish the patient.

Prognosis of Oesophageal Cancer

Clinical examinations, x-rays and pathology reports all help the medical team decide what the progress of an individual case of oesophageal cancer may be. Then, the appropriate course of treatment will be put into action. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with oesophageal cancer is fair.