Oesophagus Cancer

What is the oesophagus?

The oesophagus (sometimes also spelt as oesophagus) is a muscular tube that connects the back of the mouth to the stomach. It runs down at the back of the neck, down the chest where it lies to the back of the heart, and then enters the abdomen through a hole in the diaphragm. Its main role is to propel food from the mouth into the stomach.

 

What is oesophageal cancer?

 

Oesophageal cancer is the cancer of the cells of the inner lining of the oesophagus. It is interesting to note that the oesophagus has 2 types of lining. Most of the oesophagus is lined by squamous cells – this is similar to the cells of our skin. Just when the oesophagus joins the stomach, it is lined by columnar cells. This is similar to the cells lining the rest of the digestive tract.

 

If the cancer arises from the squamous lining part of the oesophagus, the medical scientific term is called Squamous Cell Carcinoma. If the cancer arises from the columnar lining part, it is called Adenocarcinoma.

What are the risk factors of developing oesophageal cancer?

  • Chronic smoking
  • Alcohol drinking, especially heavy drinking
  • Not eating enough fruits and vegetables
  • Taking of foods high in nitrosamines, a chemical found in processed food and barbecued food
  • Achalasia – a disease where the oesophageal sphincter cannot relax resulting in chronic prolong of food in the oesophagus
  • Regular drinking of very hot drinks which results in thermal injury of the oesophagus

 

For adenocarcinoma of the oesophagus, there is an association with chronic gastric reflux (or GERD for short). For patients with gastric reflux, the repeated exposure to gastric acid will cause the lower end of the oesophagus to develop chronic inflammation, sometimes even with ulcer formations. Over time, there will be genetic mutations of the lining, a condition called Barrett’s oesophagus. This is a pre-cancerous condition.

What are the symptoms?

Esophageal cancer may not present with any symptoms in the early stages. Common symptoms include:

 

  • Difficulty swallowing
  • Pain during swallowing
  • Weight loss
  • Heartburn
  • Regurgitation
  • Vomiting blood
  • Black, tarry bowel movements
  • Hoarse voice
  • Persistent cough

What will the doctor do to diagnose the cancer?

The ideal test is to perform a gastroscopy (a type of endoscopy). This allows the doctor to visualise the cancer, accurately locate the part of the oesophagus where the cancer is, and obtain tissue biopsy to confirm the diagnosis. An alternative to the gastroscopy is to do a Barium Swallow.

 

Following the diagnosis of the cancer, the doctor may organise scans like CT scan to check if the cancer has spread.

What is the treatment of esophagus cancer?

Treatment depends on the location and stage of the disease as well as the patient’s general condition. Surgical treatment ranges from minimally invasive resection to open radical resection.

 

Chemotherapy and radiotherapy may be necessary as additional or alternative treatments.

How to prevent esophagus cancer?

  • Stop smoking
  • Drink in moderation if at all
  • Eat a well-balanced diet, rich in vegetables and fresh fruits
  • Avoid eating too much salty and smoked or processed food
  • Reduce weight, as obesity predisposes to gastric reflux, which in turn can lead to esophagus cancer
  • If you have been diagnosed with Barrett’s esophagus, consider going for regular gastroscopy for surveillance and detection of early cancer

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