What is oesophageal cancer?

Oesophageal cancer (sometimes spelled 'esophageal' cancer) occurs when cells grow out of control in the oesophagus. Usually, the tumour grows in the lower part of the tube, near the stomach.

It’s a serious condition and the chance of surviving past 5 years after diagnosis is less than 1 in 5. This is because the cancer can spread to nearby lymph nodes (glands), or to other parts of the body.

More than 1300 people are diagnosed with oesophageal cancer in Australia every year. Most of them are aged over 60 years.

What are the types of oesophageal cancer?

There are different types of oesophageal cancer. The most common type is called ‘adenocarcinoma’, which grows in the lower part of the oesophagus. This can happen if you have reflux and the oesophagus is constantly exposed to acid from your stomach.

Another common type is ‘squamous cell carcinoma’, which begins in the squamous cells that line the middle and upper part of the oesophagus.

What are the symptoms of oesophageal cancer?

Oesophageal cancers are often not detected until they are quite advanced, because there may not be any symptoms in the early stages of the disease. Symptoms of oesophageal cancer include:

• difficulty or pain when swallowing
• pain in the top part of the abdomen when eating
• acid reflux or heartburn
• food coming back up
• weight loss
• feeling very tired
• a hoarse voice or a cough that doesn’t go away
• coughing or vomiting up blood
• black or bloody bowel motions

All of these symptoms can be explained by something else. But if you are worried, tell your doctor.

What causes oesophageal cancer?

The exact causes of oesophageal cancer are not known, but there are some things that may increase your risk:

• smoking or excessive alcohol consumption
• having a condition called Barrett’s oesophagus or gastro-oesophageal reflux disease (GORD)
• being older than 60 years
• low intake of fresh fruit and vegetables
• eating a lot of smoked, salted or pickled food
• drinking a lot of very hot liquids (above 65°C) frequently
• being overweight or obese
• being infected with the human papillomavirus (HPV)
• having a close relative who has had oesophageal cancer

How is oesophageal cancer diagnosed?

If your doctor suspects you have oesophageal cancer, they may refer you to a specialist who may order tests such as an endoscopy (where a flexible tube is used to look down your throat and into your stomach), a biopsy (where a small sample of tissue is removed to be examined in the lab), and scans including CT or PET.

You may also have a 'barium swallow', where you swallow a liquid that lights up your digestive system on an X-ray. You may also have scans of nearby organs to see if the cancer has spread.

How is oesophageal cancer treated?

The type of treatment will depend on the type of oesophageal cancer and how far it has spread (its 'stage').

Surgery is often performed to remove part of, or all of, the oesophagus. Small tumours can be removed during the endoscopy.

For larger, more advanced tumours, the affected part of the oesophagus is removed in an operation call an ‘oesophagectomy’. Sometimes the lower part of the oesophagus and the top part of your stomach is removed (called an ‘oesophago-gastrectomy’). The surgeon will create a new oesophagus for you, either using what is left of your own oesophagus, or sometimes using part of your bowel.

Treatment might involve inserting an oesophageal stent. The stent is a small tube placed in the oesophagus to keep it open so that food and liquids can be swallowed.

You might also have chemotherapy or radiotherapy.

Living with oesophageal cancer

Surgery for oesophageal cancer can make it hard to swallow and eat for a while. It’s important to have enough to eat and drink so you stay healthy and don’t lose weight. You may need to eat soft foods. It’s often better to eat small, regular meals, and avoid eating late in the day.

After treatment has finished, you will still need ongoing tests and regular checks with your specialists. After you have been treated for cancer, it's normal to feel afraid that the cancer will return. If you are struggling, it is important to seek support from your doctor, a therapist or other people who have been through cancer.

Resources and support

For more information and support, try these resources:

• Cancer Council Australia provides services and support to all people affected by cancer. Call 13 11 20.
• The Pancare Foundation provides information and support for people affected by pancreatic and other upper gastrointestinal cancers. Call 1300 881 698.
• Beyond Blue provides support to people with depression and anxiety. Call 1300 22 4636.