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The type of treatment you’re offered depends on the type and stage of your oesophageal cancer.
The oesophagus is the medical name for the food pipe (sometimes called the gullet), which is the long, muscular tube that carries food down your throat to the stomach. It’s part of your digestive system, and about 25cm long in adults (about 10 inches)[i].
The upper part of the oesophagus sits behind your windpipe (called the trachea), while the lower part passes down through your chest between the spine and the heart.
When you swallow food, the muscles of the oesophagus wall contract to push the food down and into your stomach.
[i] Macmillan Cancer Support, The oesophagus (gullet) https://www.macmillan.org.uk/Cancerinformation/Cancertypes/
[ii] Cancer research UK, Cancer statistics key facts https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/oesophageal-cancer
[iii] Cancer research UK, Cancer statistics key facts
[iv] Cancer research UK, Cancer statistics key facts
A cancer can occur anywhere along the length of the oesophagus, and there are two main types of oesophageal cancer:
Squamous cell cancers occur more frequently in the upper and middle regions of the oesophagus. Hot liquids and sharp foods don’t easily damage squamous cells, and they can repair themselves. Adenocarcinomas are more common at the lower end of the food pipe, including where the oesophagus joins the stomach.
Over 95% of oesophageal cancers are either squamous cell carcinomas or adenocarcinomas[v].
There are other more rare types of cancer of the oesophagus, and these include soft tissue sarcomas such as gastrointestinal stromal tumours (GISTs), which need different kinds of tests and treatments.
[v] Macmillan Cancer Support, Types of oesophageal cancer (cancer of the gullet) https://www.macmillan.org.uk/Cancerinformation/
The exact causes of oesophageal cancer aren’t understood, but a number of factors can put you at risk for each of the two main types of cancer described above[vi]:
[vi] Cancer Research UK, Causes and risk factors https://www.nhs.uk/Conditions/Cancer-of-the-liver/Pages/Causes.aspx
[vii] Cancer research UK, Cancer statistics key facts https://publications.cancerresearchuk.org/downloads
If you experience any of these symptoms you should visit your GP as soon as possible:
These symptoms can also be caused by conditions other than oesophageal cancer, but if they don’t go away after a couple of weeks, you should always tell your GP about them so you can treat any problems early.
Diagnosing oesophageal cancer
If you’re experiencing any of the symptoms of oesophageal cancer, you should see your GP first, who will examine you. If your GP isn’t sure of the problem, or suspects a cancer, they will refer you to hospital for specialist advice and treatment.
Before the consultant specialist examines you, they will ask about your general health and any medical problems.
At CircleI Health, you will have blood tests and a chest x-ray to check your general health, and the following tests may be used to diagnose cancer of the oesophagus:
Your consultant specialist may also do further tests to confirm the diagnosis, particularly to see if the cancer has spread to any other parts of the body. The tests might include:
The results of the tests will also help to determine the appropriate treatment for you.
Stages of oesophageal cancer
After your tests, your consultant will tell you what stage your oesophageal cancer is at by looking at a sample of your cells under a microscope.
This describes how big your tumour is and how far it’s spread, and will influence the type of treatment you’re offered. There are several ways of staging cancers but the two main ones used for oesophageal cancer are the TNM system and the number system.
The number system
[viii] Cancer Research UK, the stages of oesophageal cancer https://www.cancerresearchuk.org/about-cancer/type/oesophageal-cancer/
The type of treatment you’re offered depends on the type and stage of your oesophageal cancer. If your cancer is in the early stage and hasn’t spread to other parts of your body, your consultant may recommend surgery to remove part of or your entire oesophagus. You may also be offered chemotherapy and radiotherapy.
But if the oesophageal cancer is more advanced, or there are specific conditions involved (such as Barrett's oesophagus) surgery may not be recommended for you and other options will be discussed with you.
If the oesophageal cancer is caught early and hasn’t spread to any other organs, surgery may be an option. Surgery for oesophageal cancer is a major operation that will remove some or all of your oesophagus, so it’s important that your consultant makes sure you are fit enough to make a good recovery.
Endoscopic mucosal resection (EMR)
If you have high grade Barrett's oesophagus, or a very early stage cancer that only affects the inside lining of the oesophagus (the mucosal layer), it may be possible to remove the cancer using endoscopic mucosal resection (EMR), where a tube called an endoscope is pushed gently down your throat to see inside your oesophagus and remove the cancer.
Your consultant specialist may suggest chemotherapy on its own or given before your surgery to treat oesophageal cancer. When chemotherapy is given before surgery it is called neo adjuvant chemotherapy, and is commonly used to treat oesophageal cancer. You may be offered chemotherapy following surgery and this can help to reduce the risk of cancer returning.
If the oesophageal cancer has spread to other parts of your body (this is advanced oesophageal cancer), you might be given chemotherapy on its own, which will help to control or reduce the cancer and it effects.
Combined chemotherapy and radiotherapy
In certain cases, you might be offered chemotherapy and radiotherapy together, which is also called chemoradiation. This may be given to you before surgery to help shrink the cancer, which then makes it easier to cut out.
If you are can’t have surgery, or you simply don’t want surgery, you might be able to have chemoradiation on its own, especially is you have squamous cell cancer that is near the top of your oesophagus, as chemoradiation is often effective for this type of cancer.
In some cases, you may be given radiotherapy on its own if you are unable to have chemotherapy or surgery – this is common for advanced oesophageal cancer.
Biological therapies, sometimes known as targeted therapies, are treatments that act on processes in the cells. They can interfere with the growth of some types of cancer cells. They can also slow the growth of new blood vessels to the tumour.
Laser treatment and stents
If the cancer is blocking your and making it difficult for you to swallow, it’s likely you will need treatment to clear the blockage. To treat this, sometimes laser treatment is used to burn away the tumour, or a tube called a stent is inserted that allows food and drink to pass through the oesophagus.
Radiofrequency ablation (RFA)
This treatment uses heat to destroy the cancer cells and is occasionally used to treat very early oesophageal cancers.
Photodynamic therapy (PDT)
This is also called a light sensitising treatment, and involves the use of lasers with a light sensitive drug to destroy cancer cells. PDT may be given to try to prevent high-grade Barrett's oesophagus developing into cancer, or if you can’t have an endoscopic mucosal resection (EMR) or surgery.
Paying for your treatment
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself. Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy. If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.
Ask the hospital for a quote beforehand, and ensure that this includes the consultant fees and the hospital charge for your procedure.
Want to know more?
If you’d like to read more about oesophageal cancer, treatment or living with oesophageal cancer, please visit cancerresearchuk.org.uk.