Oesophageal cancer ,also known as esophageal cancer, is a malignant tumor that develops in
the oesophagus, the muscular tube responsible for carrying food and
liquids from the throat to the stomach. This cancer can occur in
two main types: squamous cell carcinoma and adenocarcinoma, with
each having distinct risk factors and locations within the oesophagus.
In 2020, oesophageal cancer was the sixth most common cause of cancer death worldwide, the seventh most common cancer in men and the 13th most common cancer in women. In the same year, Singapore reported 234 new cases of oesophageal cancers, and of these, 220 patients could not have treatment and died of the cancer it had already spread.
However, oesophageal cancer is curable if detected and treated promptly and aggressively at an early stage. Learn more about oesophageal cancer, signs to look out for, treatment and prevention methods.
Oesophageal cancer, like many other cancers, is categorised into stages.
The stages of oesophageal cancer are typically defined by the TNM system,
which takes into account the size and extent of the primary tumor (T),
the involvement of nearby lymph nodes (N), and the presence of distant
spread to different organs - metastasis (M). Here, we outline the stages
and what they mean:
Stage 0 (Carcinoma in Situ): At this early stage, abnormal cells are found only in the innermost layer of the oesophagus lining, without penetrating deeper layers. It is often referred to as "high-grade dysplasia" or "in situ" cancer. Treatment at this stage is highly effective, often involving endoscopic procedures to remove or destroy the abnormal cells.
Stage I: In Stage I, the cancer has invaded the deeper layers of the oesophagus but it has not spread to lymph nodes or distant sites. The tumor is relatively small and confined to the oesophagus. Surgery or endoscopic therapy is a common treatment approach for Stage I oesophageal cancer.
Stage II: In this stage, the tumor has grown deeper into the wall of the oesophagus and it may have spread to the the nearby lymph nodes. Surgical resection is often recommended. Depending on the histology of the cancer that is removed, chemotherapy and/or radiation therapy may also need to be given.
Stage III: Oesophageal cancer in Stage III has spread further into the surrounding tissues, possibly affecting nearby structures, such as the airways or blood vessels. Lymph nodes are often involved. Treatment usually involves a combination of surgery, chemotherapy, and radiation therapy.
Stage IV (Metastatic): At this advanced stage, the cancer has spread to distant organs or lymph nodes, such as the lungs, liver, or distant lymph nodes. Stage IV oesophageal cancer is considered incurable, and the focus is on palliative care to manage symptoms and improve the patient's quality of life. Treatments may include chemotherapy, targeted therapy, immunotherapy, and radiation therapy to alleviate symptoms and slow disease progression.
Recurrent Oesophageal Cancer: Sometimes, oesophageal cancer may come back after initial treatment. The recurrence can occur locally (in the oesophagus or nearby tissues) or distantly (in distant organs or lymph nodes). Treatment for recurrent cancer depends on the location and extent of the recurrence and the patient's overall health.
1. Recurrent acid reflux or heartburn - we all do suffer with occasional
heartburn every few weeks (2-3 times) depending on what we eat and on our stress levels.
However, when this becomes more frequent it may my be the early signs of esophageal cancer
2. Difficulty Swallowing: One of the early signs of oesophageal cancer is difficulty or pain while swallowing (dysphagia).
3. Unintended Weight Loss: Rapid and unintentional weight loss can be indicative of a more advanced stage of the disease.
4. Chronic Heartburn: Long-term and severe acid reflux can lead to Barrett's oesophagus, a precursor to adenocarcinoma.
5. Chest Pain: Oesophageal cancer may cause chest pain or discomfort, especially when swallowing.
6. Coughing or Hoarseness: A persistent cough or hoarseness may be a symptom, as the tumour can affect the nearby airways.
7. Vomiting and Regurgitation: Frequent vomiting and regurgitation may occur, sometimes containing blood.
It is essential to seek medical advice if you experience any of these symptoms, as early diagnosis and treatment can improve outcomes.
- Gastroscopy: A Gastroscopy is a minimally invasive procedure in which a flexible, lighted tube with a camera at the tip (endoscope) is inserted through the mouth and into the oesophagus. This allows the doctor to directly visualise the lining of the oesophagus and obtain tissue samples (biopsies) for further examination. It is a quick and painless procedure undertaken with a light sedation
- Imaging Tests: When you are confirmed with oesophageal cancer, advanced imaging techniques, such as CT scans, PET scans, and MRI scans, are commonly used to determine the extent and stage of oesophageal cancer if needed. These tests provide detailed images of the oesophagus and surrounding structures, helping doctors plan the most appropriate treatment strategy.
- Pathology and Biopsy: Biopsy samples obtained during endoscopy are sent to a pathology laboratory for analysis. Pathologists examine the tissue samples under a microscope to confirm the presence of cancer, determine the cancer type (e.g., squamous cell carcinoma or adenocarcinoma), and assess the cancer's aggressiveness. This information is crucial in tailoring the treatment plan.
Treatment for oesophageal cancer varies depending on the stage and type of cancer, as well as the patient's overall health. Common treatment modalities include:
- Endoscopic Surgery: Endoscopic treatments, such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), are used for early-stage oesophageal cancers, especially in cases of dysplasia or carcinoma in situ. A flexible tube with a camera and specialised tools is inserted through the mouth to remove or destroy cancerous tissue, often avoiding the need for open surgery.
- Open Surgery: Traditional open surgery involves making a large incision in the chest or abdomen to access and removing the oesophagus with the cancer. The stomach is then used to connect the intestines back to the remaining oesophagus. Minimally invasive surgical techniques are increasingly preferred when possible due to faster recovery and reduced post-operative pain.
- Laparoscopic Surgery (Minimally Invasive Surgery): Laparoscopic surgery, also known as minimally invasive surgery, involves making several very small incisions and using a camera with specialised instruments to remove the oesophagus and cancer. This approach typically results in quicker recovery, shorter hospital stays, less complications and faster recovery times compared to open surgery.
- Radiation Therapy: Radiation therapy uses high-energy rays to target and kill cancer cells or shrink tumors. It can be administered externally (external beam radiation) or internally (brachytherapy). In oesophageal cancer, radiation therapy is often used in combination with other treatments, such as chemotherapy, before surgery to shrink the tumor or after surgery to kill any remaining cancer cells. It can also help alleviate symptoms in advanced cases, such as difficulty swallowing.
- Chemotherapy: Chemotherapy involves the use of drugs to kill rapidly dividing cancer cells. It is commonly used in oesophageal cancer, either before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy) to reduce the risk of recurrence depending on the stage of the cancer. It can also be used in combination with radiation therapy (chemoradiation) for locally advanced disease. In advanced or metastatic cases, chemotherapy can help control the cancer and relieve symptoms.
- Targeted Therapy: Targeted therapy drugs are designed to target specific molecules or pathways involved in the growth and spread of cancer cells. They are often used in cases of advanced oesophageal adenocarcinoma that may not respond well to traditional chemotherapy. Targeted therapy can use drugs that inhibit proteins like HER2 or VEGF, which are often overexpressed in certain oesophageal cancers and so helps destroy the cancer cell.
- Immunotherapy: Immunotherapy is an innovative approach that stimulates the patient's immune system to recognize and attack cancer cells. Immune checkpoint inhibitors, such as pembrolizumab and nivolumab, have shown promise in the treatment of advanced oesophageal cancer, particularly in patients whose cancer has progressed despite other treatments. It has help to increase the remain life span in these patients
- Palliative Care: Palliative care is an essential component of oesophageal cancer treatment, particularly in advanced cases. It focuses on managing symptoms, providing pain relief, and improving the patient's quality of life. Palliative care specialists work in conjunction with oncologists to address the physical, emotional, and psychosocial aspects of cancer care.
The choice of treatment depends on the specific circumstances of the patient, the type and stage of cancer, and the patient's overall health.
Oesophageal cancer risk factors can vary based on the type of oesophageal cancer
(squamous cell carcinoma or adenocarcinoma) and geographic region, as certain risk
factors are more prevalent in specific areas. Here are some common risk factors associated with oesophageal cancer:
1. Age: Oesophageal cancer is more common in older adults, with the risk increasing significantly after the age of 55.
2. Gender: Men are more likely to develop oesophageal cancer than women.
3. Tobacco and Alcohol Use: Smoking and heavy alcohol consumption are among the most significant risk factors. The combination of smoking and drinking alcohol increases the risk even further.
4. Gastroesophageal Reflux Disease (GERD): Persistent and severe acid reflux can lead to Barrett's oesophagus, a condition that increases the risk of oesophageal adenocarcinoma.
6. Obesity: Excess body weight, especially when it accumulates around the abdomen, is a risk factor for oesophageal adenocarcinoma.
7. Diet: Diets low in fruits and vegetables and high in processed or red meats have been associated with an increased risk of oesophageal cancer.
8. Family History: A family history of oesophageal cancer may raise an individual's risk, although the genetic factors involved are not yet well understood. Certain regions of the world have a high rate of esophageal cancer.
It's important to note that having one or more risk factors does not guarantee the development of oesophageal cancer. Many people with risk factors never develop the disease, while others with no known risk factors can still develop oesophageal cancer. Additionally, the presence of risk factors may influence the type of oesophageal cancer that is more likely to develop.
While some risk factors for oesophageal cancer, such as age and gender, cannot be changed, there are several ways to reduce your
1. Quit Smoking: Smoking is a significant risk factor for oesophageal cancer. Quitting can lower your risk.
2. Limit Alcohol Consumption: Excessive alcohol consumption is linked to an increased risk of oesophageal cancer. Drinking in moderation or abstinence is advisable.
3. Manage Acid Reflux: If you have chronic heartburn, seek medical treatment and assesment to prevent the development of Barrett's oesophagus.
4. Maintain a Healthy Diet: A diet rich in fresh fruits and vegetables may help lower your risk. Avoiding excessive consumption of processed foods and red meat is also recommended.
5. Regular Exercise: Staying physically active can contribute to overall health and may lower cancer risk.
6. Screening: If you have risk factors such as a family history of oesophageal cancer, consult with a healthcare provider about screening and surveillance options.
Oesophageal cancer is a serious condition, but with early detection and appropriate treatment, it can be managed effectively. Understanding the symptoms, treatment options, and preventive measures is essential in reducing the impact of this disease on individuals and their families. Regular check-ups and a healthy lifestyle are your best defenses against oesophageal cancer. If you suspect any symptoms or have concerns, don't hesitate to seek medical advice from a healthcare professional.