Carcinoma (cancer) of Oesophagus (food pipe)

 

Carcinoma of the oesophagus is diagnosed late, after symptomatic oesophageal obstruction (dysphagia) has developed and the tumour has transgressed the anatomical limits of the organ. The tumour occurs more commonly in men over 50 years of age. Prognosis is dismal: with standard methods of therapy (surgical resection and/or irradiation), 70% of the patients die within one year of diagnosis. Five year survival rate is 5-10%.

 

Causes:

 

Although exact causes of carcinoma of the oesophagus is not known, a number of conditions and factors have been implicated as under:

 

1. Diet and personal habits:

 

i) Heavy smoking

ii) Alcohol consumption

iii) Intake of foods contaminated with fungus

iv) Nutritional deficiency of vitamins and trace elements.

 

2. Oesophageal disorders:

 

i) Oesophagitis (especially Barrett’s oesophagus in adenocarcinoma)

ii) Achalasia

iii) Hiatus hernia

iv) Diverticula

v) Plummer-Vinson syndrome.

 

3. Other factors:

 

i) Race—more common in the Chinese and Japanese than in Western races; more frequent in blacks than whites.

ii) Family history—association with tylosis (keratosis palmaris et plantaris).

iii) Genetic factors—predisposition with coeliac disease, epidermolysis bullosa, tylosis.

iv) HPV infection—is the recent addition in etiologic factors.

 

Symptoms:

Difficulty in swallowing

This is the most common symptom of oesophageal cancer. There may be some pain in the form of a burning sensation when swallowing food. Or you may feel that your food is sticking in your throat or chest and you can't swallow it. A harmless narrowing of the oesophagus (called a stricture) may cause difficulty in swallowing. But these problems can be due to a tumour or swelling blocking the oesophagus. Either way, it is very important to see your doctor and get them to check out what is causing the symptoms.

Food coming back up

If you are having difficulty getting your food down, it may just come back up again soon after swallowing. This is really more like regurgitating food than being sick. With oesophageal cancer, it is usually hard food that sticks and comes back up at first. But if left untreated, you may start to regurgitate soft foods, drinks and even saliva.

Weight loss

Losing weight is also a common symptom of oesophageal cancer. It may happen because you are having difficulty swallowing or discomfort when eating and this is putting you off your food. In some cases, extreme weight loss can be a sign of an advanced cancer. If you are losing weight and are worried, see your doctor.

Pain or discomfort in the throat or back

Pain or soreness behind the breastbone, or between the shoulder blades, could be caused by cancer of the oesophagus.

Acid indigestion

If you get a lot of acid indigestion, it could be due to a tumour in the oesophagus. A tumour by the valve between the stomach and oesophagus (cardiac sphincter) can stop it from working. This allows acid to track back up into the oesophagus. Some people with cancer of the oesophagus have back or shoulder pain. Or you may have pain in the centre of your chest, which may be worse when you try to swallow or during attacks of indigestion.

Remember -acid indigestion is extremely common and is not usually caused by a cancer in the oesophagus. It can be very painful, even when there is nothing seriously wrong. But it is also a risk factor for getting cancer. So if you have it, see your doctor to get it checked and treated.

Hoarseness, or chronic cough

If you have a hoarse voice all the time, or a cough that won’t go away, it may be a warning sign of oesophageal cancer.

Coughing up blood

Cancers sometimes bleed. If you are coughing up blood, or if there is blood in your vomit (or food that you bring back up), see your doctor.

 

 

How it Spreads:

 

The oesophageal cancer spreads locally as well as to distant sites.

 

i) Local spread. This is the most important mode of spread and is of great importance for surgical treatment. The local spread may occur in the transverse as well as longitudinal direction. The tumour may invade below into the stomach, above into the hypopharynx, into the trachea resulting in tracheo-oesophageal fistula, and may involve larynx causing hoarseness. The tumour may invade the muscular wall of the oesophagus and involve the mediastinum, lungs, bronchi, pleura and aorta.

 

ii) Lymphatic spread. Submucosal lymphatic permeation may lead to multiple satellite nodules away from the main tumour. Besides, the lymphatic spread may result in metastases to the cervical, para-oesophageal, tracheobronchial and subdiaphragmatic lymph nodes.

 

iii) Haematogenous spread. Blood-borne metastases from the oesophageal cancer are rare, probably because the death occurs early due to invasion of important structures by other modes of spread. However, metastatic deposits by haematogenous route can occur in the lungs, liver and adrenals.

 

 

More information

The earlier a cancer is picked up, the easier it is to treat it and the more likely the treatment is to be successful. So it is important that you go to your doctor as soon as possible if you notice worrying symptoms.