Oesophageal Cancer - The Facts

Oesophageal Cancer - The Facts

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Originally published in May-June 2004 icon

 

Open quotesThe incidence of tumours found close to the junction of the oesophagus and stomach is
increasingClose quotes

 

Cancer of the oesophagus or gullet is rare in the UK, accounting for only one in 50 of new cancer cases. But for reasons yet unknown, the incidence of tumours found close to the junction of the oesophagus and stomach is increasing - now at a faster rate than any other cancer in the western world. Cancer that occurs at this lower end of the oesophagus is usually the type termed adenocarcinoma, while squamous carcinoma is more common at the upper end of the gullet. Wherever it occurs, the overall prognosis for oesopheagal cancer is poor: most patients are still diagnosed late and at present less than 10 per cent survive five years. The picture is brighter for those fit enough for radical treatment, of whom 30 per cent may be cured. The vexed problem with this cancer is the fact that symptoms can be masked for a considerable time with patent medecines and indigestion tablets.

 

Who is at risk?

The over-60’s are most prone to oesopheagal cancer, historically three times more prevalent in men than in women. But this condition can no longer be defined as a disease of the elderly, as it is now emerging even in thirtysomethings and increasingly in women. Smoking and drinking are contributory factors. Diet may also up the risk: in southern China where heavily smoked and salted fish feature large on the menu, this cancer is 10 times more common than in the UK. Iron deficiency was once a common cause of cancers in the upper gullet, especially in pregnant women. But thanks to improved diet and ante-natal care, the problem has virtually disappeared. Barrett’s oesophagus (a condition caused by acid reflux and defined by changes in the gullet lining) also puts patients at up to 50 times the normal risk and requires regular monitoring.

 

Symptoms

Symptoms of early stage cancer are minor and therefore often overlooked for months, until swallowing becomes difficult. Patients report a feeling of solid food being "stuck" behind the lower end of the breastbone. Later it may even be hard to swallow liquids. Discomfort between the shoulder blades after a meal may be a telltale sign along with regurgitating food, unaltered, a few minutes after swallowing. Rather than see a doctor, people often adjust by eating less, so that they become tired and lose weight. Later onset symptoms include heartburn, sickness and vomiting of blood.

 

Diagnosis and Treatment

The barium swallow involves drinking a beaker of whitish liquid which is tracked by x-ray as it travels down the gullet into the stomach. This painless procedure shows up any abnormality or narrowing of the gullet. Endoscopy accompanied by biopsy provides a definitive diagnosis and is usually carried out whilst the patient is sedated. CT scans can determine any spread of the cancer - an important consideration when surgery is being considered. Surgery - the treatment of choice for this cancer - may cure about 30 per cent of those undergoing it, but an operation is only recommended for patients in good general health and with small tumours.

 

Open quotesThis painless procedure shows up any abnormality or narrowing of the gulletClose quotes

 

Chemo given before surgery is now shown to be advantageous, and sometimes radiotherapy is also given before surgery, though the benefits have yet to be proven. Although Sheena Howarth’s operation took 10 hours, four hours is more common and not all surgeons remove a rib. Fit patients with more advanced disease have combined chemo and radiotherapy, offering a 20 per cent chance of a cure. Where intensive treatment is not possible, a stent or tube inserted in the gullet helps keep it open for the passage of food and drink, so relieving symptoms. It’s hoped that Potodynamic Therapy (PDT) will, in time, play a very useful curative part in treating early-stage cancer of the oesophagus. Pioneered many years ago in Leeds, this treatment involves giving the patient an oral, light-sensitive drug which homes into the rogue cells. Then, usually within a few days, a low-powered laser is fed down the gullet. activating and killing the light-sensitive cancer cells.

 

Support

Patients like Sheena gain great help from the Oesophageal Patients Association (OPA):

 

16 Whitfield Crescent
Solihull
West Midlands
B91 3NU

Telephone: 0121 704 9860

The OPA keeps in close touch with medical specialists and centres of excellence such as Birmingham Heartlands, St Thomas, London, and the Royal Victoria, Newcastle. Few in number, oesophageal patients can feel very isolated: "We receive so many letters saying ’if only we’d known that you were there when I was having surgery" says David Kirby.

Some oesophageal patients also develop nodules on the skin. A very early trial is now testing a type of gene therapy - OncoVexGM-CSF - using an altered strain of the common cold sore virus that scientists hope will target and kill cancer cells. A Cambridge trial continuing until 2005 is researching why Barrett’s oesophagus only develops into cancer in some people and whether or not there is a faulty gene association. Another London trial is currently assessing the long term effects of PDT given to patients with mild cell changes in Barrett’s oesophagus. From May 2004 patients with Barrett’s are also being recruited for a trial where a combined-dose aspirin and esomeprazole (an acid inhibitor) will be given to see if this prevents the condition progressing into cancer.

Thanks to Cancer Research UK and Oesophageal Patients Association.

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