Ooesophageal Cancer

Key Points for This Section

  • Oesophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the oesophagus.
  • Smoking, heavy alcohol use, and Barrett’s oesophagus can affect the risk of developing oesophageal cancer.
  • The most common signs of oesophageal cancer are painful or difficult swallowing and weight loss.
  • Tests that examine the oesophagus are used to detect (find) and diagnose oesophageal cancer.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Oesophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the oesophagus.

The oesophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the oesophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Oesophageal cancer starts at the inside lining of the oesophagus and spreads outward through the other layers as it grows.

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Gastrointestinal (digestive) system anatomy; shows oesophagus, liver, stomach, large intestine, and small intestine.
The stomach and oesophagus are part of the upper digestive system.

The two most common forms of oesophageal cancer are named for the type of cells that become malignant (cancerous):

  • Squamous cell carcinoma: Cancer that forms in squamous cells, the thin, flat cells lining the oesophagus. This cancer is most often found in the upper and middle part of the oesophagus, but can occur anywhere along the oesophagus. This is also called epidermoid carcinoma.
  • Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the oesophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the oesophagus, near the stomach.

Smoking, heavy alcohol use, and Barrett’s oesophagus can affect the risk of developing oesophageal cancer.

Risk factors include the following:

  • Tobacco use.
  • Heavy alcohol use.
  • Barrett’s oesophagus: A condition in which the cells lining the lower part of the oesophagus have changed or been replaced with abnormal cells that could lead to cancer of the oesophagus. Gastric reflux (the backing up of stomach contents into the lower section of the oesophagus) may irritate the oesophagus and, over time, cause Barrett’s oesophagus.
  • Older age.
  • Being male.
  • Being African-American.

The most common signs of oesophageal cancer are painful or difficult swallowing and weight loss.

These and other symptoms may be caused by oesophageal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  • Painful or difficult swallowing.
  • Weight loss.
  • Pain behind the breastbone.
  • Hoarseness and cough.
  • Indigestion and heartburn.

Tests that examine the oesophagus are used to detect (find) and diagnose oesophageal cancer.

The following tests and procedures may be used:

  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Barium swallow: A series of x-rays of the oesophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the oesophagus and x-rays are taken. This procedure is also called an upper GI series.

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Barium swallow; shows barium liquid flowing through the oesophagus and into the stomach.
Barium swallow. The patient swallows barium liquid and it flows through the oesophagus and into the stomach. X-rays are taken to look for abnormal areas.

  • Oesophagoscopy: A procedure to look inside the oesophagus to check for abnormal areas. An oesophagoscope (a thin, lighted tube) is inserted through the mouth or nose and down the throat into the oesophagus. Tissue samples may be taken for biopsy.

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    Oesophagoscopy; shows endoscope inserted through the mouth and into the oesophagus. Inset shows patient on table having an oesophagoscopy.
    Oesophagoscopy. A thin, lighted tube is inserted through the mouth and into the oesophagus to look for abnormal areas.

  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The biopsy is usually done during an oesophagoscopy. Sometimes a biopsy shows changes in the oesophagus that are not cancer but may lead to cancer.

    • Certain factors affect prognosis (chance of recovery) and treatment options.

    The prognosis (chance of recovery) and treatment options depend on the following:

    • The stage of the cancer (whether it affects part of the oesophagus, involves the whole oesophagus, or has spread to other places in the body).
    • The size of the tumour.
    • The patient’s general health.

    When oesophageal cancer is found very early, there is a better chance of recovery. Oesophageal cancer is often in an advanced stage when it is diagnosed. At later stages, oesophageal cancer can be treated but rarely can be cured. Taking part in one of the clinical trials being done to improve treatment should be considered. Information about ongoing clinical trials is available from the NCI Web site.

    Stages of Oesophageal Cancer

    Key Points for This Section

    • After oesophageal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the oesophagus or to other parts of the body.
    • The following stages are used for oesophageal cancer:
      • o Stage 0 (Carcinoma in Situ)
      o Stage I
      o Stage II
      o Stage III
      o Stage IV

      After oesophageal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the oesophagus or to other parts of the body.

      The process used to find out if cancer cells have spread within the oesophagus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

      • Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.
      • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
      • Laryngoscopy: A procedure in which the doctor examines the larynx (voice box) with a mirror or with a laryngoscope (a thin, lighted tube).
      • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This test is also called computed tomography, computerised tomography, or computerised axial tomography.
      • Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, lighted tube) is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
      • Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope (a thin, lighted tube) is inserted into the chest. Tissue samples and lymph nodes may be removed for biopsy. In some cases, this procedure may be used to remove portions of the oesophagus or lung.
      • Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen, and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
      • PET scan (positron emission tomography scan): A procedure to find malignant tumour cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumour cells show up brighter in the picture because they are more active and take up more glucose than normal cells. The use of PET for staging oesophageal cancer is being studied in clinical trials.

      The following stages are used for oesophageal cancer:

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      Oesophageal cancer staging; shows tumours growing through layers of the oesophagus wall for Stage 0, Stage I, Stage II, Stage III, and Stage IV oesophageal cancer. Inset shows muscle, submucosa, and mucosa layers of the oesophagus wall, and lymph nodes.
      As oesophageal cancer progresses from Stage 0 to Stage IV, the cancer cells grow through the layers of the oesophagus wall and spread to lymph nodes and other organs.

      Stage 0 (Carcinoma in Situ)

      In stage 0, cancer is found only in the innermost layer of cells lining the oesophagus. Stage 0 is also called carcinoma in situ.

      Stage I

      In stage I, cancer has spread beyond the innermost layer of cells to the next layer of tissue in the wall of the oesophagus.

      Stage II

      Stage II oesophageal cancer is divided into stage IIA and stage IIB, depending on where the cancer has spread.

      • Stage IIA: Cancer has spread to the layer of oesophageal muscle or to the outer wall of the oesophagus.
      • Stage IIB: Cancer may have spread to any of the first three layers of the oesophagus and to nearby lymph nodes.

      Stage III

      In stage III, cancer has spread to the outer wall of the oesophagus and may have spread to tissues or lymph nodes near the oesophagus.

      Stage IV

      Stage IV oesophageal cancer is divided into stage IVA and stage IVB, depending on where the cancer has spread.

      • Stage IVA: Cancer has spread to nearby or distant lymph nodes.
      • Stage IVB: Cancer has spread to distant lymph nodes and/or organs in other parts of the body.

      Recurrent Oesophageal Cancer

      Recurrent oesophageal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the oesophagus or in other parts of the body.

      Treatment Option Overview

      Key Points for This Section

      • There are different types of treatment for patients with oesophageal cancer.
      • Five types of standard treatment are used:
        • o Surgery
        o Radiation therapy
        o Chemotherapy
        o Laser therapy
        o Electrocoagulation
      • Other types of treatment are being tested in clinical trials.
      • Patients have special nutritional needs during treatment for oesophageal cancer.

      There are different types of treatment for patients with oesophageal cancer.

      Different types of treatment are available for patients with oesophageal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

      Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

      Five types of standard treatment are used:

      Surgery

      Surgery is the most common treatment for cancer of the oesophagus. Part of the oesophagus may be removed in an operation called an oesophagectomy.

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      Three panel drawing showing oesophageal cancer surgery; first panel shows area of oesophagus with cancer, middle panel shows cancer and nearby tissue removed, last panel shows the stomach pulled up and joined to the remaining oesophagus.
      Oesophagectomy. A portion of the oesophagus is removed and the stomach is pulled up and joined to the remaining oesophagus.
      The doctor will connect the remaining healthy part of the oesophagus to the stomach so the patient can still swallow. A plastic tube or part of the intestine may be used to make the connection. Lymph nodes near the oesophagus may also be removed and viewed under a microscope to see if they contain cancer. If the oesophagus is partly blocked by the tumour, an expandable metal stent (tube) may be placed inside the oesophagus to help keep it open.

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      Oesophageal stent. Shows cancer blocking oesophagus. Insets show enlarged area of cancer and a stent placed in the oesophagus to keep it open.
      Oesophageal stent. A device (stent) is placed in the oesophagus to keep it open to allow food and liquids to pass through into the stomach.

      Radiation therapy

      Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

      A plastic tube may be inserted into the oesophagus to keep it open during radiation therapy. This is called intraluminal intubation and dilation.

      Chemotherapy

      Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

      Laser therapy

      Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.

      Electrocoagulation

      Electrocoagulation is the use of an electric current to kill cancer cells.

      Other types of treatment are being tested in clinical trials.

      Information about ongoing clinical trials is available from the NCI Web site.

      Patients have special nutritional needs during treatment for oesophageal cancer.

      Many people with oesophageal cancer find it hard to eat because they have difficulty swallowing. The oesophagus may be narrowed by the tumour or as a side effect of treatment. Some patients may receive nutrients directly into a vein. Others may need a feeding tube (a flexible plastic tube that is passed through the nose or mouth into the stomach) until they are able to eat on their own.

      Treatment Options By Stage

      Stage 0 Oesophageal Cancer (Carcinoma in Situ)

      Treatment of stage 0 oesophageal cancer (carcinoma in situ) is usually surgery.
      Stage I Oesophageal Cancer

      Treatment of stage I oesophageal cancer may include the following:

      • Surgery.
      • Clinical trials of chemotherapy plus radiation therapy, with or without surgery.
      • Clinical trials of new therapies used before or after surgery.

      Stage II Oesophageal Cancer

      Treatment of stage II oesophageal cancer may include the following:

      • Surgery.
      • Clinical trials of chemotherapy plus radiation therapy, with or without surgery.
      • Clinical trials of new therapies used before or after surgery.

      Stage III Oesophageal Cancer

      Treatment of stage III oesophageal cancer may include the following:

      • Surgery.
      • Clinical trials of chemotherapy plus radiation therapy, with or without surgery.
      • Clinical trials of new therapies used before or after surgery.

      Stage IV Oesophageal Cancer

      Treatment of stage IV oesophageal cancer may include the following:

      • External or internal radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
      • Laser surgery or electrocoagulation as palliative therapy to relieve symptoms and improve quality of life.
      • Chemotherapy.
      • Clinical trials of chemotherapy.

      Treatment Options for Recurrent Oesophageal Cancer

      Treatment of recurrent oesophageal cancer may include the following:

      • Use of any standard treatments as palliative therapy to relieve symptoms and improve quality of life.
      • Clinical trials of new therapies used before or after surgery.

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