Q. What is the esophagus?

A. The esophagus is the proper name for your gullet, the tube running from your mouth down to your stomach. It lies between your windpipe and your spine.

Q. What is cancer of the esophagus?

A. There are two main types of esophageal cancer. Cancers found in the upper two-thirds of the esophagus are usually squamous carcinomas. Cancers of the lower third are usually adenocarcinomas. These two types of cancers have different types of cells, almost certainly have different causes and need to be treated differently

Q. How common is esophageal cancer?

A. Each year there are nearly 15,000 new cases of esophageal cancer in the USA, nearly 1500 in Canada, nearly 1200 in Australia and 6,000 in the UK. Some countries, such as Turkey, China, India and South Africa have very high rates of this type of cancer. Even within Europe there is a wide variation. The rate in the UK and Ireland is ten times higher than in Greece and Spain. The incidence of adenocarcinoma of the esophagus has been increasing over the last 20 years, particularly amongst males in Europe and North America.

Q. Who is more likely to get adenocarcinoma of the esophagus ?

A. The main risk of adenocarcinoma of the esophagus comes from a condition called Barrett's esophagus. This is a type of heartburn, caused by long-term gastric reflux - the stomach contents splashing up into the lower part of the gullet. About one person in a hundred suffers from Barrett's esophagus. They are up to 50 times more likely to get esophageal cancer then normal. The more severe the case of Barrett's esophagus, the greater the risk of cancer. Barrett's esophagus is about three times more common in men than women and cancer of the esophagus is twice as common in men as women. Like most cancers, esophageal adenocarcinoma is more common in older people: the majority of cases are diagnosed in people over 65. Whites are more likely to get this type of cancer then blacks. Higher risk of this cancer has also been associated with smoking, obesity and a diet low in fruit and vegetables.

Q. Who is more likely to get squamous carcinoma of the esophagus?

A. Smoking and excessive alcohol consumption substantially increase the risk of this type of esophageal cancer. Indeed, smoking is thought to be responsible for four in every ten cases. Blacks are more likely to get this cancer than whites. Eating certain preserved and pickled foods, common in China and Iran, have also been linked to a higher risk.

Q. What are the symptoms of esophageal cancer?

A. Early esophageal cancer does not cause any symptoms, which means that most cases are quite advanced when diagnosed. By far the most common symptom of esophageal cancer is difficulty swallowing, often with the feeling that the food is getting stuck in the throat. Other, less common symptoms include persistent hiccups or coughing, weight loss, indigestion and vomiting.

Q. Is there screening for esophageal cancer?

A. There is no routine screening for esophageal cancer, but people who have a high risk (e.g. people with Barrett's esophagus) should have an endoscopic examination every year (see below).

Q. How is esophageal cancer diagnosed?

A. The main technique used for diagnosis is called endoscopy. Under sedation, a thin fibre-optic tube (the endoscope) is passed down the throat. The inside of the esophagus is lit up and photographed. Any growths can be spotted relatively easily by this method. A type of endoscope which can take a small sample of the esophageal lining (a biopsy) is often used. Sometimes, a barium meal is used instead of endoscopy. The patient is given a white liquid to drink, containing the element barium, then the throat is observed through an X-ray screen. The way that the barium flows through the esophagus will reveal any growths. If the endoscopy or barium meal reveals a tumour, a CT or ultrasound scan will normally be done to find out if the cancer has spread. 

 

Q. How is esophageal cancer treated?

A. Surgery is the main form of treatment for esophageal cancer. For early cancers that have not spread, the surgeon removes the section of the esophagus with the cancer. Usually the remaining part of the esophagus is reconnected to the stomach. However, if the cancer has spread, part of the stomach may have to be removed as well, so the shortened esophagus is connected to a smaller stomach. Sometimes, patients will be given drug treatment (chemotherapy) to shrink the tumor before the operation. In other cases, where the cancer is so advanced that it cannot be cured, chemotherapy or radiation treatment may be used to reduce the symptoms.

Q. How successful are the treatments?

A. If the cancer is diagnosed early, the treatments have a reasonable chance of success. In the USA, nearly one third of patients live for five years after they have been diagnosed and treated. However, most cases are not diagnosed early and, overall, only one in seven of esophageal cancer patients survive for five years. In some countries, including the United Kingdom, that figure is as low as one in fourteen.