Oesophageal cancer

Oesophageal cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Oesophageal cancer Oesophageal cancer About oesophageal cancer Symptoms of oesophageal cancer Causes of oesophageal cancer Diagnosing oesophageal cancer Treating oesophageal cancer Living with 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 doesnt usually cause any symptoms in the early stages when the tumour is small. Its only when it gets bigger that symptoms tend to develop. Symptoms of oesophageal cancer can include: difficulty swallowing persistent indigestion orheartburn bringing up food soon after eating loss of appetite andweight loss pain or discomfort inyour 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 byseveral conditions and in many cases wont be caused by cancer but its 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 thats 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, acure 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 doesnt 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 persistentvomiting pain or discomfort inyour upper tummy, chest or back a persistent cough hoarseness tiredness, shortness of breath and pale skin vomiting bloodorcoughing 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 byseveral conditions and in many cases wont be caused by cancer but its 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 Barretts 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 Barretts oesophagus. These abnormal cells are at an increased risk of becoming cancerous in the future, although the risk is still small.Its estimated that 1 in every 10to 20 people with Barretts oesophagus will develop cancer within 10 to 20 years. Alcohol Drinking too much alcoholcauses irritation and inflammation in the lining of the oesophagus. If the cells in the lining of your gullet become inflamed,theyre 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 youre overweight or obese , your risk of developing cancer of the oesophagus is higher thanpeopleof 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 Barretts 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 havinga healthy diet Other medical conditions Certain rare medical conditions can also increase your chances of developing cancer of the oesophagus, including: achalasia wheretheoesophagus 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 youre experiencing carry out a physical examination take a look at your medical history Ifyour GPthinks 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 todiagnose oesophageal cancer are: anendoscopy 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 forcancer. Athin, flexibletube with alight and camera at the end(an endoscope) is passed into your mouth and down towards your stomach. Small samples of tissue are also removed fromyour oesophagus so they can be checked for cancer under a microscope. This is called a biopsy . Youll be awake whilean endoscopy is carried out. It shouldnt be painful, but may be a bit uncomfortable. Youll normally be given local anaesthetic to numb your throatand possibly asedative to help you relax. Barium swallowor 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 theres anything blockingyour oesophagus, which may be a sign of cancer. This test isnt 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 Ifyou have oesophageal cancer, further tests willberecommended 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 probethat 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 alaparoscopy a type of keyhole surgery performed under general anaesthetic (where youre 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 eachcategory 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 yourcare teamwork 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 Youll 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 treatedwith 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 themain 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 oesophagusis thenreconnected to your stomach. To access your oesophagus, your surgeon will either make incisions (cuts) in yourtummy and chest, or in yourtummy and neck. Endoscopic mucosal resection (EMR) A procedure called endoscopic mucosal resection (EMR)may sometimes be an option instead ofan oesophagectomy if oesophageal cancer is diagnosed very early on. It involvescutting outthe 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, eitherwith or without radiotherapy to shrink the cancer and reduce therisk of it coming back instead of surgery incombination with radiotherapy (called chemoradiation) to relieve your symptoms ifcurative treatmentisnt possible The medicines can begiven into a veinor taken as tablets. Youll usually have the treatmentevery 3 weeksover aperiod of6to 18 weeks. Side effects Common side effects of chemotherapy include: feeling sick loss of appetite losing weight diarrhoea feeling very tired increased risk ofinfections bleeding and bruising easily These side effects should improve gradually after treatment stops. Read more about the side effects of chemotherapy Radiotherapy Radiotherapy involves usingradiation to kill cancer cells and shrink tumours. It may be used: in combination with chemotherapy before surgery to shrink the cancer and reduce therisk of it coming back instead of surgery usually in combination with chemotherapy (called chemoradiation) to relieveyour symptoms if curative treatment isnt 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 haveswallowing difficultiesduring 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. Aspeech and language therapist can assess yourability to swallow andsuggest ways to overcome any problems.A dietitian can also help with any changes you need to maketo 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 ithelpful 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 yourcare team or GP if you have any questions about your condition take time out for yourself dont feel shy about telling friends and family if you want sometime to yourself Read further information: Cancer Research UK: coping with oesophageal cancer Macmillan: coping with oesophageal cancer Work Having oesophageal cancer doesnt necessarily mean youll have to give up work, althoughyou 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, youre covered by the Disability Discrimination Act . This means that your employer isnt 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 youll need off and when. Speak toa member of your human resources department, if you have one. If youre having difficulties with your employer youmay be able to get help fromyour 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 cant work because of your illness, youre entitled to Statutory Sick Pay from your employer if you dont have a job and cant work because of your illness, you may be entitled to Employment and Support Allowance if youre caring for someone with cancer, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or you have a low household income Its 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 youre 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 teamshould 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 isnt easy. It can beemotionally andphysically draining, and make it easy for you to forget your own health and mental wellbeing. But putting yourself last doesnt work in the long-term. If youre caring for someone else, its important to look after yourself and get as much help as possible. Its 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. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Dysphagia (swallowing problems) Other health sites Cancer Research UK: Oesophageal cancer Macmillan Cancer Support: Oesophageal cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852