Oesophageal cancer

The oesophagus (gullet) is part of the digestive system, which is sometimes called the gastro-intestinal or GI tract. It's a muscular tube that goes from the mouth down through the chest to the stomach.

In the UK, around 9,000 people are diagnosed with oesophageal cancer each year.

There are other, rarer types of oesophageal cancer. These include:

• neuroendocrine cancer, including small cell cancer
• soft tissue sarcomas, like gastro-intestinal stromal tumours (GISTs)
• oesophageal melanoma

The tests and treatments for these rarer types are different from the ones described here. They depend on the type of oesophageal cancer you have.

If you would like more information about this, you can:

• phone the Macmillan Support Line for free on 0808 808 00 00 to talk to a cancer information specialist
• chat to Macmillan's specialists online

You'll usually begin with your doctor. They'll ask about your symptoms and examine you, and they may arrange blood tests to check your general health.

If your doctor isn't sure what the problem is, or thinks you may have oesophageal cancer, they'll refer you to hospital for a test called an endoscopy.

If your doctor thinks you may have cancer, they'll ask for an urgent appointment for you. This means they're asking for you to see a specialist within 2 weeks, or as soon as the clinic can arrange it.

The main test doctors use to diagnose oesophageal cancer is an endoscopy. It lets the doctor look at the lining of your oesophagus, your stomach and the first part of the small bowel (the duodenum). An endoscopy can also be used to give treatment.

During the endoscopy, a biopsy is taken. If the biopsy results show 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.

A CT scan gives a detailed picture of the inside of your body. The scanner takes X-rays and builds them up into the picture. The scan does use radiation, but it is very unlikely to harm you, and it will not harm anyone you come into contact with.

A PET scan uses a low dose of radiation to check how active the cells are in different parts of your body. You may have a PET scan and a CT scan done together, and this is called a PET-CT scan. In oesophageal cancer, it can give more detailed information about the cancer or about abnormal areas seen on other scans.

An endoscopic ultrasound is much like an endoscopy, except that the tip of the endoscope carries a small ultrasound probe. The probe uses sound waves to make an image of the wall of the oesophagus and the area around it.

A laparoscopy is a small operation to look at the 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 has more information that can help, and more advice if you've just been diagnosed with cancer.

Your cancer doctor needs some information about the oesophageal cancer before advising you on the best treatment. This includes the cancer's:

• stage, which describes the cancer and whether it has spread
• grade, which 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 work out the stage of the cancer. They'll do this before your treatment is planned, so it can help decide what's best for you. But they may not know the exact stage until the cancer has been removed with surgery.

Doctors can use surgery to remove oesophageal cancer, or to ease the symptoms it causes.

Chemotherapy for oesophageal cancer uses anti-cancer drugs to destroy cancer cells. Doctors can give it before and after surgery, or on its own. It can also go together with radiotherapy (this is called chemoradiation) or with targeted therapy. And it may be used for people who can't have surgery.

Radiotherapy for oesophageal cancer uses high-energy rays to treat the cancer. Doctors may give it together with chemotherapy, which is called chemoradiation. If the cancer is more advanced, you may have radiotherapy on its own. In that case it is used to shrink the tumour and help control your symptoms.

Chemoradiation means having chemotherapy and radiotherapy together. The reason is that chemotherapy can make cancer cells more sensitive to the radiotherapy, so the radiotherapy works better against them.

Targeted therapy drugs for oesophageal cancer work by going after something in or around the cancer cell that is helping it grow and survive. Sometimes a targeted therapy drug called trastuzumab.

Doctors use immunotherapy to treat some people with oesophageal cancer. You may be given it to lower the risk of the cancer coming back after treatment. The medicines sometimes used are nivolumab or pembrolizumab.

You may also be offered immunotherapy as part of a clinical trial.

Treatments for oesophageal cancer can be used alone or in combination with each other. Your cancer doctor and specialist nurse will explain the treatments they think are best for you, and they can support you in making decisions about your treatment.

You may also have treatments as part of a clinical trial.

Advanced oesophageal cancer is cancer that started in the oesophagus and has spread to other parts of the body. Sometimes it's already advanced when it's first found. In other cases it comes back after treatment, and this is called recurrent cancer.

The main problem for people with advanced oesophageal cancer is difficulty swallowing.

You may be offered treatment such as chemotherapy, radiotherapy or targeted therapies. These treatments won't cure the cancer, but they may be able to shrink it. That can control the cancer for a time and ease symptoms like difficulty swallowing.

After your treatment has finished, you'll have regular follow-up appointments.

Depending on what treatment you had, you may have an endoscopy or a scan as part of your follow-up care. You'll usually talk with someone from your healthcare team at the appointment. This may be your surgeon, cancer doctor, specialist nurse or another health professional.

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan Cancer Support has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan oesophageal cancer forum, where you can talk to others affected by oesophageal cancer, ask questions and share your experience

It can take a few months to recover from treatment for oesophageal cancer. Adjusting to the changes in your digestive system may take up to a year.

Macmillan Cancer Support has more information and advice about eating after treatment for oesophageal cancer. It also covers dumping syndrome, which affects how food is released from the stomach to the bowel.

Even if you already live a healthy life, you may want to make some positive changes after your oesophageal cancer treatment. Small changes, like keeping active, can improve your health and wellbeing and help your body recover.

Macmillan Cancer Support, a UK charity, has more advice on finishing cancer treatment.

Don't include personal information, such as your name, your location or any personal health conditions.