Oesophageal Cancer: Types, Symptoms, Diagnosis, Treatment

Oesophageal cancer occurs when cancerous cells start to develop in the oesophagus lining. Cancer initially begins in the inner layers, which will eventually spread out, affecting the muscles and tissues of the oesophagus.

In Malaysia, oesophageal cancer attributed to around 1 in 100 of all new cancer cases in 2020.

Types of oesophageal cancer

The two main types of oesophageal cancer are:

• Adenocarcinoma which occurs in the lower regions of the oesophagus, affecting the epithelial cells responsible for mucus production.
• Squamous cell carcinoma occurs when cancer develops in the flat thin cells that line the oesophagus, usually in the middle and upper regions of the oesophagus.

Other rare forms of oesophageal cancer also include melanoma, small cell carcinoma, sarcoma, lymphoma and choriocarcinoma.

Risk factors of oesophageal cancer

The following are some of the risk factors of oesophageal cancer:

• Older age, especially those above 60 years
• Male gender, as men are three times more likely to develop the disease than women
• Being overweight or obese
• Having a poor diet
• Frequently smoking or consuming tobacco products
• Consuming large amounts of alcohol regularly
• Drinking very hot liquids on a regular basis
• Occupational exposure (prolonged) to dry cleaning solvents

Conditions that also increase the risk of oesophageal cancer are:

• Human papillomavirus
• Gastroesophageal reflux disease (GERD)
• Barrett’s oesophagus, precancerous changes of the oesophageal cells

Signs and symptoms of oesophageal cancer

Important symptoms of oesophageal cancer include:

• Pain or difficulty when swallowing
• Pain in the throat or back, behind the breastbone, or between the shoulder blades
• Sudden weight loss
• Heartburn and indigestion
• Hoarseness and coughing
• Vomiting or coughing up blood

Diagnosis of oesophageal cancer

Tests to diagnose oesophageal cancer:

• Barium swallow study involves swallowing liquid barium to coat the inside of the oesophagus for x-ray examination of the oesophageal tissue
• Endoscopy passes a flexible tube equipped with a video lens down the throat and into the oesophagus to examine the oesophagus, and to find cancer or areas of irritation
• Biopsy where a sample of suspicious tissue was collected and analysed to detect cancer cell

Tests to determine if cancer has spread:

• Bronchoscopy
• Endoscopic ultrasound
• Computerised tomography (CT)
• Positron emission tomography (PET)

Learn more about the different types of screening and diagnostic procedures performed to diagnose oesophageal cancer.

Treatment options for oesophageal cancer

Doctors determine the best-suited treatment after considering:

• Stage and type of cancer
• General health condition of the patient
• Whether the tumour can be completely removed by surgery

The following are the standard treatments for oesophageal cancer:

• Surgery is the most common treatment. An operation called oesophagectomy removes a portion of the oesophagus and pull the stomach up and join to the remaining oesophagus.
• Chemotherapy utilises medications to kill cancer cells or by stopping them from dividing.
• Radiation therapy uses X-ray beams to eradicate the cancer cells or limit their growth.
• Electrocoagulation destroys cancer cells using electric current.
• Targeted therapy uses drugs to identify and attack specific cancer cells.
• Immunotherapy boosts, directs, or restores the body’s natural defences against cancer.
• Photodynamic (laser) therapy eliminates cancer cells using a laser beam.

Learn more about the different types of treatment technologies to treat oesophageal cancer.

Prevention of oesophageal cancer

A healthy lifestyle can minimise the risk of developing this cancer, which includes:

• Quit smoking
• Consume alcohol in moderation
• Eat more fruits and vegetables
• Maintain a healthy body weight
• Get treated for GERD or Barrett's oesophagus

Detect to Protect!

No standard or routine screening tests is currently available to find oesophageal cancer in people who are at average risk. However, close follow-up is recommended for certain groups of individuals at high risk of developing oesophageal cancer.

If you have any of the following conditions, speak to your doctor to determine a monitoring plan to detect oesophageal early.

• Barrett's oesophagus: Experts recommend that individuals with Barrett’s oesophagus should have upper endoscopy regularly. Biopsies may also be conducted during endoscopy to extract tissues from abnormal area to find dysplasia (pre-cancer cells) or cancer cells.
• Inherited syndromes: Frequent endoscopies are recommended to find cancer or pre-cancer. An upper endoscopy is advised for individuals who have family members with familial (inherited) Barrett’s oesophagus after 40 years old.

Make an appointment at Gleneagles Hospitals

If you are experiencing any of the symptoms of oesophageal cancer, get in touch with us to find out more about our Oncology Services at your nearest Gleneagles Hospital.

Gleneagles Hospital works with oncologists to assist patients through cancer treatment. The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care.