Oesophageal cancer
Oesophageal cancer
The oesophagus, also called the gullet, is part of your digestive system, which doctors sometimes refer to as the gastro-intestinal or GI tract. It is a muscular tube that runs from your mouth, down through your chest, and into your stomach.
In the UK, doctors diagnose around 9,000 people with oesophageal cancer every year.
Types of oesophageal cancer
Knowing exactly which type of oesophageal cancer you have makes it easier for your cancer doctor to plan the right treatment for you. There are 2 main types.
The first is squamous cell carcinoma. This develops in the thin, flat cells of the mucosa, the lining of the oesophagus.
The second is adenocarcinoma. This develops from glandular cells and is often linked with a condition called Barrett's oesophagus.
Cancer can start anywhere along the oesophagus. When it develops in the upper or middle part, it is usually squamous cell cancer. When it develops in the lower part, it is usually adenocarcinoma, and this includes cancers that form at the gastro-oesophageal junction, often shortened to GOJ, which is the point where the oesophagus meets the stomach.
If you would like to understand more about what cancer is in general, Macmillan Cancer Support has helpful information on this.
Rarer types of oesophageal cancer
A small number of people are diagnosed with rarer forms of oesophageal cancer. These include neuroendocrine cancer, which covers small cell cancer, soft tissue sarcomas such as gastro-intestinal stromal tumours (GISTs), and oesophageal melanoma.
Because these rarer types behave differently, the tests and treatments used for them are not the same as those described in this information. Each one is managed according to its own specific type.
If you would like to know more, you can call the Macmillan Support Line free on 0808 808 00 00 to speak with a cancer information specialist, or chat with Macmillan's specialists online.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
What causes oesophageal cancer?
Certain things are known to raise a person's chances of developing oesophageal cancer. These are called risk factors.
Having a risk factor doesn't mean you'll definitely develop oesophageal cancer, and if you don't have any of these risk factors, you could still be diagnosed with it. Doctors don't fully understand why some people with these risk factors go on to develop the disease while others don't.
It's also important to know that oesophageal cancer isn't infectious. It cannot spread from one person to another.
For more detail on the causes and risk factors of oesophageal cancer, Macmillan Cancer Support offers further information.
Diagnosis
Diagnosing of oesophageal cancer
You usually start by meeting your GP. They’ll ask about your symptoms and examine you. You may have blood tests to check your general health.
If your GP isn’t sure what the problem is, or thinks you may have cancer, they’ll refer you to hospital for a test called an endoscopy.
If your GP thinks you may have cancer, they’ll make an urgent referral for an appointment. This means your GP is asking for a specialist appointment for you within 2 weeks or as soon as the clinic can arrange it.
Tests for oesophageal cancer
The main test used to diagnose oesophageal cancer is an endoscopy. An endoscopy is a test to look at the lining of the oesophagus, stomach and the first part of the small bowel (the duodenum).
Endoscopies can also be used to give treatment.
If the biopsy results from the endoscopy show there are cancer cells, your specialist doctor will arrange more tests. These are to find out:
- which layers of the oesophageal wall the cancer is in
- whether the cancer has spread outside the oesophagus
You may have some of the following tests.
CT scan
A CT scan makes a detailed picture of the inside of the body. The picture is built up using X-rays taken by the CT scanner. The scan uses radiation, but this is very unlikely to harm you. It will not harm anyone you come into contact with.
PET-CT scan
A PET scan uses a low dose of radiation to check the activity of cells in different parts of the body. You may have a PET scan and a CT scan together. This is called a PET-CT scan. It can give more detailed information about cancer or abnormal areas seen on other scans.
Endoscopic ultrasound (EUS)
An endoscopic ultrasound is like an endoscopy, but the end of the endoscope has an ultrasound probe on it. The probe uses sound waves to produce an image of the wall of the oesophagus and surrounding area.
Laparoscopy
A laparoscopy is a small operation used to look at organs inside your tummy (abdomen). The surgeon uses a thin tube with a camera on the end, called a laparoscope. They may also take biopsies.
Waiting for test results can be a difficult time. Macmillan Cancer Support have more information that can help.
Macmillan Cancer Support has more advice if you’ve just been diagnosed with cancer.
Staging and grading of oesophageal cancer
Your cancer doctor needs information about the cancer to advise you on the best treatment for you. This includes the cancer’s:
- stage – describes the cancer and whether it has spread
- grade – gives an idea of how quickly the cancer might grow and spread
Your cancer doctor can use the results of your tests to try to identify the stage of the cancer. They’ll do this before your treatment is planned to help decide the best treatment for you. But they may not know the exact stage of the cancer until it’s been removed with surgery.
Treatment
A team of doctors from different specialties will sit together and work out the best possible treatment plan for you. This is called a multidisciplinary team, or MDT.
Sometimes treatment can cure the cancer. When a cure isn't possible, the goal shifts to controlling the cancer and easing the symptoms as much as possible.
The treatment you're offered for oesophageal cancer depends on a few things:
- the type of oesophageal cancer you have
- where the cancer sits in the oesophagus, whether that's the upper, middle or lower part
- the stage and grade of the cancer
- your general health and fitness
- your own wishes and preferences
Your cancer doctor or specialist nurse will walk you through the different treatment options and their side effects, and talk with you about what to weigh up when deciding.
Macmillan Cancer Support has more information on treating oesophageal cancer.
The treatments below may be used for oesophageal cancer.
Surgery
Surgery can remove the cancer or relieve symptoms.
Chemotherapy
Chemotherapy uses anti-cancer drugs to destroy cancer cells. It can be given before and after surgery, on its own, alongside radiotherapy (chemoradiation), or together with targeted therapy. It may also be used for people who cannot have surgery.
Radiotherapy
Radiotherapy uses high-energy rays to treat cancer. It may be combined with chemotherapy (chemoradiation). If the cancer is more advanced, you may have radiotherapy alone to shrink the tumour and help control symptoms.
Chemoradiation
Chemoradiation means having chemotherapy and radiotherapy together. Chemotherapy can make the cancer cells more sensitive to the effects of radiotherapy.
Targeted therapy
Targeted therapy drugs work by acting on something in or around the cancer cell that helps it grow and survive. A targeted therapy drug called trastuzumab is sometimes used.
Immunotherapy
Immunotherapy is used to treat some people with oesophageal cancer. You may be given it to lower the chance of the cancer coming back after treatment. Nivolumab or pembrolizumab are sometimes used.
You may be offered immunotherapy as part of a clinical trial.
More about treatments
These treatments can be used alone or combined with each other. Your cancer doctor and specialist nurse will explain which ones they think are best suited to you, and help you think through your treatment decisions.
You may also be treated as part of a clinical trial.
Macmillan Cancer Support has more advice on preparing for treatment.
Treatment for advanced oesophageal cancer
Cancer that started in the oesophagus and has spread to other parts of the body is called advanced oesophageal cancer. It may already be advanced when it's first diagnosed, or it may return after treatment, which is called recurrent cancer.
The main difficulty for people with advanced oesophageal cancer is trouble swallowing.
If you have advanced oesophageal cancer, you may be offered chemotherapy, radiotherapy or targeted therapies. These won't cure the cancer, but they may shrink it, which can keep it under control for a while and ease symptoms such as difficulty swallowing.
After oesophageal cancer treatment
Once your treatment is finished, you'll have regular follow-up appointments.
Depending on the treatment you had, you may need an endoscopy or a scan as part of your follow-up care. At each appointment, you'll usually speak with someone from your care team, such as your surgeon, cancer doctor, specialist nurse or another member of the team.
Feeling anxious between appointments is natural. It can help to lean on support from family, friends or a support organisation.
Macmillan Cancer Support has further help available. You can:
- phone the Macmillan Support Line on 0808 808 00 00
- chat to Macmillan specialists online
- use the Macmillan oesophageal cancer forum to talk with others affected by oesophageal cancer, ask questions and share your experience
Eating after treatment for oesophageal cancer
Recovering from oesophageal cancer treatment can take a few months, and adjusting fully to the changes in your digestive system may take up to a year.
Macmillan Cancer Support has more information and advice on eating after treatment for oesophageal cancer, including details on dumping syndrome, a condition that affects how food moves from the stomach into the bowel.
Complications
After treatment, you may want to make a few positive lifestyle changes, even if you're already living healthily. Small steps like staying active can boost your health and wellbeing and help your body recover. For more advice on finishing cancer treatment, see Macmillan Cancer Support. Don't include personal information such as your name, location or any personal health conditions.