Oesophageal cancer: what is it?
Oesophageal cancer (also called cancer of the oesophagus) is a malignant tumour that grows in the lining of the oesophagus. The oesophagus (the gullet) is the tube that carries food from the mouth down into the stomach using a series of muscular movements. Oesophageal cancer is far more common in men than women, and usually affects people older than 50.
Types of oesophageal cancer
Two types of cancer, squamous cell carcinoma and adenocarcinoma, make up 90 per cent of all oesophageal cancers. Oesophageal cancer can occur in any section of the oesophagus. Most cancers in the top part of the oesophagus are squamous cell cancers. They are called this because the cells lining the top part of the oesophagus are squamous cells. Squamous means scaly.
Most cancers at the end of the oesophagus that joins the stomach are adenocarcinomas. Adenocarcinomas are often found in people who have a condition called Barrett’s oesophagus. In Barrett’s oesophagus, long term gastro-oesophageal reflux damages the normal squamous cells that line the oesophagus by repeatedly bathing them in acidic stomach contents. Over time the squamous cells are replaced by cells more like the ones in the stomach and small intestine. It is in these new cells, the so-called Barrett’s metaplasia, that adenocarcinomas can develop. Because some people with Barrett’s oesophagus will go on to develop cancer of the oesophagus, regular screening may be required to detect any pre-cancerous cells that may develop.
Who gets oesophageal cancer?
Oesophageal cancer is relatively uncommon in Australia but in some parts of Asia it is very common. In many Western countries adenocarcinoma is becoming much more common.
What causes oesophageal cancer?
What causes this type of cancer is not fully understood, but it is thought that there are a number of risk factors and conditions that, if present for any length of time, may lead to oesophageal cancer. These include the following.
- Barrett’s oesophagus (a condition caused by repeated episodes of reflux that results in changes to the usual cell lining of the oesophagus).
- Smoking.
- Drinking large quantities of alcohol on a regular basis.
- Regularly consuming very hot drinks or foods.
- Obesity.
- Vitamin and other nutritional deficiencies.
- Being exposed to certain chemicals, such as nitrosamines.
- Achalasia — a condition where the muscles of the lower oesophageal sphincter (the ‘valve’ that controls food passing from the oesophagus to the stomach) can’t relax properly and so food builds up in the oesophagus and doesn’t pass to the stomach. Also, the normal waves of muscle contractions that propel food down the oesophagus don’t work properly, also adding to the build-up of food.
- Plummer-Vinson syndrome — a rare condition that causes anaemia, tongue abnormalities and oesophageal webs (abnormal protrusions of tissue into the oesophagus that interfere with swallowing).
You should always check with your doctor if you have any difficulty swallowing or have constant episodes of reflux, or if you develop any of the symptoms that may indicate oesophageal cancer, such as:
- difficulty swallowing that worsens over time;
- pain on swallowing;
- regurgitation of food or blood-stained vomit;
- unexplained weight loss;
- coughing after swallowing;
- chest or back pain; and
- a hoarse voice.
Early detection of this cancer is extremely important as it does improve the chance of successful treatment. Unfortunately, this type of cancer, even if successfully treated, can often recur even after surgery, chemotherapy and/or radiation treatment.
Last Reviewed: 08 July 2009
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