Oesophageal cancer

About oesophageal cancer

Oesophageal cancer is a type of cancer affecting the oesophagus (gullet) – the long tube that carries food from the throat to the stomach.

It mainly affects people in their 60s and 70s and is more common in men than women.

Symptoms of oesophageal cancer

Oesophageal cancer doesn’t usually cause any symptoms in the early stages when the tumour is small. It’s only when it gets bigger that symptoms tend to develop.

Symptoms of oesophageal cancer can include:

• difficulty swallowing
• persistent indigestion or heartburn
• bringing up food soon after eating
• loss of appetite and weight loss
• pain or discomfort in your upper tummy, chest or back

Read more about the symptoms of oesophageal cancer

When to get medical advice

Speak to your GP if you experience:

• swallowing difficulties
• heartburn on most days for three weeks or more
• any other unusual or persistent symptoms

The symptoms can be caused by several conditions and in many cases won’t be caused by cancer – but it’s a good idea to get them checked out.

If your GP thinks you need to have some tests, they can refer you to a hospital specialist.

Read about how oesophageal cancer is diagnosed

Causes of oesophageal cancer

The exact cause of oesophageal cancer is unknown, but the following things can increase your risk:

• persistent gastro-oesophageal reflux disease (GORD)
• smoking
• drinking too much alcohol over a long period of time
• being overweight or obese
• having an unhealthy diet that’s low in fruit and vegetables

Stopping smoking, cutting down on alcohol, losing weight and having a healthy diet may help reduce your risk of developing oesophageal cancer.

Read more about the causes of oesophageal cancer

Treatments for oesophageal cancer

If oesophageal cancer is diagnosed at an early stage, it may be possible to cure it with:

• surgery to remove the affected section of oesophagus
• chemotherapy, with or without radiotherapy (chemoradiation), to kill the cancerous cells and shrink the tumour

If oesophageal cancer is diagnosed at a later stage, a cure may not be achievable.

But in these cases, surgery, chemotherapy and radiotherapy can be used to help keep the cancer under control and relieve any symptoms you have.

Read more about how oesophageal cancer is treated and living with oesophageal cancer

Symptoms of oesophageal cancer

Oesophageal cancer doesn’t usually have any symptoms at first. But as the cancer grows, it can cause swallowing problems and other symptoms.

Difficulty swallowing

Difficulty swallowing is the most common symptom of oesophageal cancer.

The cancer can narrow the oesophagus, making it difficult for food to pass down. It may feel as though food is getting stuck and sometimes swallowing may be uncomfortable or painful.

You may have to chew your food more thoroughly, or you can only eat soft foods. If the tumour continues to grow, even liquids may become difficult to swallow.

Other symptoms

Other symptoms of oesophageal cancer can include:

• persistent indigestion or heartburn
• bringing up food soon after eating
• loss of appetite and weight loss
• persistent vomiting
• pain or discomfort in your upper tummy, chest or back
• a persistent cough
• hoarseness
• tiredness, shortness of breath and pale skin
• vomiting blood or coughing up blood – although this is uncommon

When to get medical advice

Speak to your GP if you experience:

• swallowing difficulties
• heartburn on most days for three weeks or more
• any other unusual or persistent symptoms

The symptoms can be caused by several conditions and in many cases won’t be caused by cancer – but it’s a good idea to get them checked out.

Read about how oesophageal cancer is diagnosed

Causes of oesophageal cancer

The exact cause of oesophageal cancer is unknown, but certain things can increase the risk of it developing.

GORD and Barrett’s oesophagus

Gastro-oesophageal reflux disease (GORD) is a condition in which a weakness in the muscles above the stomach means stomach acid can travel up into the oesophagus.

In around 1 in 10 people with GORD, repeated damage from stomach acid over many years can eventually cause changes in the cells lining the oesophagus. This is called Barrett’s oesophagus.

These abnormal cells are at an increased risk of becoming cancerous in the future, although the risk is still small. It’s estimated that 1 in every 10 to 20 people with Barrett’s oesophagus will develop cancer within 10 to 20 years.

Alcohol

Drinking too much alcohol causes irritation and inflammation in the lining of the oesophagus.

If the cells in the lining of your gullet become inflamed, they’re more likely to become cancerous.

Read more about alcohol and drinking, including tips on cutting down

Smoking

Tobacco smoke contains many harmful toxins and chemicals. These substances irritate the cells that make up the lining of the oesophagus, which increases the likelihood that they will become cancerous.

The longer you smoke, the greater your risk of developing oesophageal cancer.

Read more about getting help to stop smoking

Obesity

If you’re overweight or obese, your risk of developing cancer of the oesophagus is higher than people of a healthy weight. The more overweight you are, the higher the risk.

This may be partly because obese people are more at risk of developing GORD and Barrett’s oesophagus (see above).

Read more information and advice about losing weight

Diet

Not eating enough fruit and vegetables may increase your risk of getting oesophageal cancer.

You should aim to eat at least 5 portions of fresh fruit and vegetables every day.

Read more about having a healthy diet

Other medical conditions

Certain rare medical conditions can also increase your chances of developing cancer of the oesophagus, including:

• achalasia – where the oesophagus loses the ability to move food along, causing vomiting and acid reflux
• Paterson-Brown Kelly syndrome (also called Plummer Vinson syndrome) – a condition that can cause iron deficiency anaemia and small growths in the throat 
• tylosis – an inherited skin condition

Diagnosing oesophageal cancer

Speak to your GP if you experience symptoms of oesophageal cancer. They will carry out an initial assessment and decide whether you need to have any further tests.

Seeing your GP

Your GP may:

• ask about the symptoms you’re experiencing
• carry out a physical examination
• take a look at your medical history

If your GP thinks you need to have some tests, they can refer you to a hospital specialist. This will usually be a gastroenterologist (specialist in conditions affecting the digestive system).

Tests to diagnose oesophageal cancer

The 2 main tests used to diagnose oesophageal cancer are:

• an endoscopy – this is the most common test
• a barium swallow or barium meal

Endoscopy

An endoscopy is a procedure that allows your doctor to see inside your oesophagus so they can check for cancer.

A thin, flexible tube with a light and camera at the end (an endoscope) is passed into your mouth and down towards your stomach.

Small samples of tissue are also removed from your oesophagus so they can be checked for cancer under a microscope. This is called a biopsy.

You’ll be awake while an endoscopy is carried out. It shouldn’t be painful, but may be a bit uncomfortable.

You’ll normally be given local anaesthetic to numb your throat and possibly a sedative to help you relax.

Barium swallow or barium meal

A barium swallow or barium meal involves drinking a harmless white liquid called barium before several X-rays are taken.

The barium coats the lining of your oesophagus so it shows up on the X-ray. This can show whether there’s anything blocking your oesophagus, which may be a sign of cancer.

This test isn’t used to diagnose oesophageal cancer very often nowadays because the best way to confirm a diagnosis is to use tissue samples taken during an endoscopy.

Further tests

If you have oesophageal cancer, further tests will be recommended to determine how far the cancer has spread – known as called the ‘stage’. 

These tests may include:

• a computerised tomography (CT) scan – where a series of X-rays are taken and put together by a computer to create a detailed picture of the inside of your body
• an endoscopic ultrasound scan – where a small probe that produces sound waves is passed down your throat to create an image of your oesophagus and the surrounding area
• a positron emission tomography (PET) scan – a scan that can help show how far the cancer has spread
• a laparoscopy – a type of keyhole surgery performed under general anaesthetic (where you’re asleep), in which a thin tube with a camera at the end is inserted through a cut in your skin to examine the area around your oesophagus

Stages of oesophageal cancer

The most widely used system for staging oesophageal cancer is the TNM system. This involves scoring the cancer in 3 categories:

• T (tumour) – the location and size of the tumour
• N (node) – whether the cancer has spread to the lymph nodes (a network of glands throughout the body)
• M (metastasis) – whether the cancer has spread to other parts of the body, such as the lungs, liver or bones

Scores for each category are then often used in a simpler number system, ranging from stage 1 (early cancer) to stage 4 (advanced cancer).

Knowing the stage of your cancer will help your care team work out the best treatment for you.

Read more about treatments for oesophageal cancer

Read further information:

• Cancer Research UK: diagnosing oesophageal cancer
• Cancer Research UK: stages and grades of oesophageal cancer
• Macmillan: how oesophageal cancer is diagnosed
• Macmillan: staging oesophageal cancer

Treating oesophageal cancer

The main treatments for oesophageal cancer are surgery, chemotherapy and radiotherapy.

Your treatment plan

You’ll be cared for by a group of different healthcare professionals and your team will recommend a treatment plan they feel is most suitable for you, although final treatment decisions will be yours.

Your plan will largely depend on how far your cancer has spread – known as the ‘stage’.

• stage 1 to 3 oesophageal cancer is usually treated with surgery to remove the affected section of oesophagus (oesophagectomy) – chemotherapy and sometimes radiotherapy may be given before surgery to make it more effective or is sometimes used instead of surgery
• stage 4 oesophageal cancer has usually spread too far for a cure to be possible, but chemotherapy, radiotherapy and other treatments can slow the spread of the cancer and relieve symptoms

Surgery

There are 3 main types of surgery for oesophageal cancer.

Oesophagectomy

An oesophagectomy is the main treatment for early-stage oesophageal cancer.

During the procedure, your surgeon will remove the section of your oesophagus that contains the tumour and, if necessary, the nearby lymph nodes. A small portion of your stomach may also need to be removed.

The remaining section of your oesophagus is then reconnected to your stomach.

To access your oesophagus, your surgeon will either make incisions (cuts) in your tummy and chest, or in your tummy and neck.

Endoscopic mucosal resection (EMR)

A procedure called endoscopic mucosal resection (EMR) may sometimes be an option instead of an oesophagectomy if oesophageal cancer is diagnosed very early on.

It involves cutting out the tumour using a loop of wire at the end of a thin flexible tube (endoscope). The endoscope is passed down your throat so no incisions are made in your skin.

Sometimes radiowaves may also be used to destroy the cancerous tissue (called radiofrequency ablation or RFA).

Stents

For more advanced cases of oesophageal cancer that are causing swallowing difficulties, a procedure to insert a hollow tube called a stent into the oesophagus may be recommended.

The stent expands once in place and holds the oesophagus open.

Chemotherapy

Chemotherapy involves taking medicines that kill the cancer cells or stop them multiplying.

It may be used:

• before and sometimes after surgery, either with or without radiotherapy – to shrink the cancer and reduce the risk of it coming back
• instead of surgery – in combination with radiotherapy (called chemoradiation)
• to relieve your symptoms if curative treatment isn’t possible

The medicines can be given into a vein or taken as tablets. You’ll usually have the treatment every 3 weeks over a period of 6 to 18 weeks.

Side effects

Common side effects of chemotherapy include:

• feeling sick
• loss of appetite
• losing weight
• diarrhoea
• feeling very tired
• increased risk of infections
• bleeding and bruising easily

These side effects should improve gradually after treatment stops. 

Read more about the side effects of chemotherapy

Radiotherapy

Radiotherapy involves using radiation to kill cancer cells and shrink tumours.

It may be used:

• in combination with chemotherapy before surgery – to shrink the cancer and reduce the risk of it coming back
• instead of surgery – usually in combination with chemotherapy (called chemoradiation)
• to relieve your symptoms if curative treatment isn’t possible

Radiotherapy is most often given using an external machine that directs beams of radiation at your oesophagus, or sometimes by temporarily placing a small piece of radioactive material in your oesophagus (brachytherapy).

Side effects

Common side effects of radiotherapy include:

• tiredness
• temporary soreness when swallowing
• temporary worsening of swallowing difficulties
• a dry throat
• feeling or being sick
• reddening of the skin and loss of body hair in the treatment area

These side effects should improve gradually after treatment stops. 

Read more about the side effects of radiotherapy

Read further information:

• Cancer Research UK: treatments for oesophageal cancer
• Macmillan: treatments for oesophageal cancer

Living with oesophageal cancer

Having oesophageal cancer can have a big impact on your life, but support is available to help you cope.

Eating and swallowing

You may have swallowing difficulties during and after treatment for oesophageal cancer.

There are treatments that can help – including surgery to place a hollow tube (stent) in your oesophagus, or a combination of chemotherapy and radiotherapy – although they may not work immediately.

You might need to have a temporary feeding tube placed or fluids given through a drip inserted in a vein to begin with, before moving onto fluids by mouth and soft foods. You may eventually be able to eat solid food.

A speech and language therapist can assess your ability to swallow and suggest ways to overcome any problems. A dietitian can also help with any changes you need to make to your diet.

Read further information:

• Cancer Research UK: eating and oesophageal cancer
• Macmillan: swallowing problems

Support and advice

Coping with a diagnosis of cancer can be very difficult. You may find it helpful to:

• talk to your friends and family – be open about how you feel and what your family and friends can do to help may put you and them at ease
• communicate with others in the same situation – you may want to contact a local support group or join a forum such as the HealthUnlocked forum for oesophageal patients or Cancer Chat
• find out more about your condition – check websites such as Cancer Research UK or Macmillan, or speak to your care team or GP if you have any questions about your condition
• take time out for yourself – don’t feel shy about telling friends and family if you want some time to yourself

Read further information:

• Cancer Research UK: coping with oesophageal cancer
• Macmillan: coping with oesophageal cancer

Work

Having oesophageal cancer doesn’t necessarily mean you’ll have to give up work, although you may need quite a lot of time off. During treatment, you may not be able to carry on as you did before.

If you have cancer, you’re covered by the Disability Discrimination Act. This means that your employer isn’t allowed to discriminate against you because of your illness.

They have a duty to make ‘reasonable adjustments’ to help you cope, such as:

• allowing you time off for treatment and medical appointments
• allowing flexibility with working hours, the tasks you have to perform, or your working environment

You should give your employer as much information as possible about how much time you’ll need off and when. Speak to a member of your human resources department, if you have one.

If you’re having difficulties with your employer you may be able to get help from your union, association representative or local Citizens Advice Bureau.

Read further information:

• Macmillan: work and cancer

Money and benefits

If you have to reduce or stop work because of your cancer, you may find it difficult to cope financially. You may be entitled to financial support:

• if you have a job but can’t work because of your illness, you’re entitled to Statutory Sick Pay from your employer
• if you don’t have a job and can’t work because of your illness, you may be entitled to Employment and Support Allowance
• if you’re caring for someone with cancer, you may be entitled to Carer’s Allowance
• you may be eligible for other benefits if you have children living at home or you have a low household income

It’s a good idea to find out what help is available as soon as possible. You could ask to speak to the social worker at your hospital, who can give you the information you need.

Read further information:

• GOV.UK: benefits information
• Macmillan: benefits and financial support

Palliative care

If you’re told there is nothing more that can be done to treat your oesophageal cancer or you decide to decline treatment, your GP or care team will provide you with support and pain relief. This is called palliative care.

You can choose to receive palliative care:

• at home
• in a care home
• in hospital 
• in a hospice

Your doctor or care team should work with you to establish a clear plan based on your wishes.

Read further information:

• End of life care
• Cancer Research UK: coping with advanced cancer

Caring for someone with cancer

Being a carer isn’t easy. It can be emotionally and physically draining, and make it easy for you to forget your own health and mental wellbeing.

But putting yourself last doesn’t work in the long-term. If you’re caring for someone else, it’s important to look after yourself and get as much help as possible.

It’s in your best interests, as well as those of the person you are caring for.

Read more about getting care and support on the Care Information Scotland website.