Download The oesophagus

CANCER INFORMATION FACTSHEET
Cancer of the
Oesophagus (Gullet)
The information in this factsheet will help you understand cancer of the
oesophagus. It is an agreed view on this cancer by medical experts. We hope
that it will answer some questions and concerns you might have. The
information in this factsheet is brief but more details are given in a booklet
called Understanding Cancer of the Oesophagus from the Irish Cancer Society. It
is available free of charge by calling the Helpline on 1800 200 700.
What is cancer?
The body is made up of tiny building
blocks called cells which form the
organs and tissues of the body. Cancer
can affect cell growth and cause them to
grow and divide without control or
order. These groups of abnormal cells
can form a tumour. Tumours can be
benign or malignant. A benign tumour
is not cancer and can usually be
removed. Benign tumours do not spread
to other parts of the body. A malignant
tumour is cancer. Cancer cells can
spread by breaking away and entering
the bloodstream or lymphatic system.
The lymphatic system drains away
excess fluids (called lymph) from the
tissues. Cancer cells can then invade
other tissues and organs.
in adults. When you swallow, food is
pushed down the oesophagus to the
stomach by contraction of these
muscles.
The upper part of the oesophagus runs
behind, but is separate from, the trachea
(windpipe) which connects your mouth
and nose to your lungs and allows you
to breathe. The windpipe joins the top
part of the oesophagus. A valve here
prevents food contents in the
oesophagus from coming back up and
entering the windpipe.
Each year, about 300 people in Ireland
learn that they have cancer of the
oesophagus.
What is the oesophagus?
The oesophagus (food pipe) is a long
muscular tube that connects your throat
to your stomach. It is also known as the
gullet. It is about 12 inches (30 cm) long
This picture shows the mouth,
oesophagus and other parts of the
digestive system.
Information factsheet on cancer of the oesophagus
Risk factors for cancer of the
oesophagus
time cells in the bottom part of
the oesophagus may change and
start to look like cells that line
the stomach.
A risk factor is anything that increases a
person’s chance of getting a disease such
as cancer. The exact cause of cancer of
the oesophagus is unknown, but there
are certain factors that can increase your
risk.

Reflux disease or GORD –
Heartburn is one of the main
symptoms of gastroesophageal
reflux disease (GORD). But the
condition can also occur without
symptoms. Long-term GORD
increases the risk of oesophageal
cancer, even if Barrett’s
oesophagus has been diagnosed
or not.

Other conditions such as
achalasia and tylosis are quite
rare, but carry an increased risk
for this cancer.
Age: The risk of getting oesophageal
cancer increases with age. Most people
who develop it are over the age of 60.
Gender: Men have a higher rate of
oesophageal cancer than women.
Tobacco: Cigarettes, cigars, pipes and
other tobacco products are major risk
factors.
Alcohol: Long-term heavy drinkers of
alcohol have an increased risk. People
who use both tobacco and alcohol are at
an even greater risk of oesophageal
cancer.
How can I reduce my risk of
developing cancer of the
oesophagus?
Nobody knows what causes oesophageal
cancer. But there are steps you can take
to reduce your risk of getting it.
Food: Diets that lack fruit and
vegetables and vitamins A, C and
riboflavin may increase the risk of
developing this cancer.
1. If you smoke, set a date to stop.
Do not smoke in the presence of
others. Advice and support on
quitting is widely available. You
can call the National Smokers
Quitline at
Callsave 1850 201 203.
Obesity: Obesity is also a risk factor for
some types of oesophageal cancer.
Very hot liquids: Frequent drinking of
very hot liquids is thought to increase
the risk of oesophageal cancer.
2. Alcohol use is not
recommended but if you do
drink alcohol, cut down on the
amount you take. Men should
not drink any more than 2
standard drinks per day. Women
should not drink any more than
1 standard drink per day. One
standard drink is equal to a ½
pint of beer, or 1 small glass of
wine, or 1 pub measure of
spirits. Aim to have some
alcohol-free days in the week.
Occupational exposures: Exposure to
the chemical perchloroethylene used in
dry cleaning may also increase a person’s
risk of oesophageal cancer.
Medical conditions: Some medical
conditions carry a higher risk of
oesophageal cancer.

Barrett’s oesophagus – In this
condition there is long-term
reflux (backflow) of stomach
acid into the oesophagus. Over
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Information factsheet on cancer of the oesophagus
Avoiding these two risk factors
is the best way to reduce the
risk of oesophageal cancer.
3. Eat a healthy diet rich in fruit
and vegetables. It is
recommended that you eat five
or more portions of fruit and
vegetables every day. Eat foods
that are low in fat and high in
fibre.
4. Keep within a healthy weight
range. Do this by being more
active every day and eating less
fatty foods. Aim for 30 minutes
of physical activity per day. You
can spread the activity over one
or more sessions.
Weight loss or poor appetite

Pain or discomfort behind the
breastbone or between the
shoulder blades

Discomfort in the throat or back

Acid indigestion or heartburn
that does not go away

Frequent hiccoughs or belching
Vomiting.
How is cancer of the
oesophagus diagnosed?
Most people begin by visiting their
family doctor or GP. If your GP has
concerns, you will be sent to a hospital
doctor for tests. After checking your
general health, some special tests are
done in hospital.
Barium swallow is a special X-ray of
your oesophagus. A white drink called
barium is swallowed which helps to
outline your oesophagus. While you are
drinking the barium, X-rays are taken.
This test takes about 15 minutes and is
not painful.
What are the warning
signs/symptoms?


There are no early detection methods to
screen (test) the general population for
oesophageal cancer. People who are at
high risk, e.g. those with Barrett’s
oesophagus, should be followed closely
so that any abnormal changes can be
treated early.
When cancer occurs, cells in part of the
lining of the oesophagus change to form
a tumour. Tumours can develop
anywhere along the oesophagus. They
can also start from the inner layer and
grow outwards. The tumour may cause
few symptoms at first, but as it grows it
can interfere with the breaking down of
food in the oesophagus. This can give
rise to certain symptoms.
Difficult or painful swallowing
(dysphagia)
Ongoing cough
These signs and symptoms do not
always mean cancer. But if you have any
signs, especially for some weeks and for
no good reason, get your doctor to
check them to be certain.
Cancer of the oesophagus


Other tests include endoscopy, where a
flexible tube is passed down your throat,
along the oesophagus and into your
stomach. Small pieces of the lining of
your oesophagus can be removed for an
examination called a biopsy. The doctor
can look through the tube and check for
anything unusual.
Blood tests and a chest X-ray are also
done.
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Information factsheet on cancer of the oesophagus
Staging and further tests
You may find it hard to think of what
you want to ask the doctor. Sometimes
there is a lot of information to take in,
which might be difficult to remember
later. It helps to make a list of questions
and write down what the doctor says. It
is a good idea to take a family member
or friend along when meeting the
doctor.
Staging means doing tests to find out
the exact size of the tumour and
whether it has spread to other parts of
the body. Sometimes further tests are
needed and can include the following:
Liver ultrasound scan: This test is
carried out in the X-ray department of
the hospital. Once you are lying
comfortably on your back, a gel is
spread onto your abdomen. A small
probe like a flat microphone, which
produces sound waves, is then passed
over the area. Sound waves are then
used to give a picture of your liver.
Treatment for cancer of the
oesophagus
The type of treatment you get will
depend on the size of the tumour, where
it is found and whether it has spread to
the lymph nodes (groups of cells) near
the oesophagus or to other parts of the
body.
Endoscopic ultrasound: This test is
similar to an endoscopy. A small
ultrasound probe is connected to the
scope (tube) while in your oesophagus.
Sound waves are then used to give a
picture of the parts of your body from
inside your oesophagus.
It is important to find out from your
doctor or nurse how the different
treatments work, how long they will last
and what are the side-effects?
Sometimes there may be a choice
between treatments. When talking about
treatments, find out about taking part in
a type of research study called clinical
trials.
CT scan (CAT scan): This is a special
type of X-ray which gives a detailed
picture of the inside of your body. It
lasts about 30 minutes. Sometimes you
are given a drink or an injection to help
show a particular part of your body.
Surgery, radiotherapy and chemotherapy
are all used on their own or in
combination to treat cancer of the
oesophagus. Very often radiotherapy
and chemotherapy are given before
surgery. This is to shrink the tumour
and may make surgery more effective.
MRI scan: This scan uses magnetic
fields and may need to be done before
treatment begins. It is painless and very
noisy. Some people find it
claustrophobic, but it is possible to
bring someone in with you while having
it done. If you have a pacemaker or any
type of metal device placed in your
body, it is important to tell the person
doing the scan.
Surgery is the main treatment for
cancer of the oesophagus. The type of
surgery you have will depend on:
When cancer of the oesophagus
is diagnosed?
After cancer is diagnosed, shock,
disbelief and anxiety are natural
reactions. This can result in confusion.
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
The type of tumour

Its location in the oesophagus

The size of the tumour

If it has spread to other parts of the
body.
Information factsheet on cancer of the oesophagus
If the tumour is only in a small section
of the oesophagus, the whole tumour
can be removed along with part of the
oesophagus. The most common type of
operation is where the tumour section in
the oesophagus is removed and the
stomach is then joined to the remaining
length of oesophagus.
More information on chemotherapy and
its side-effects is available from the Irish
Cancer Society in a booklet called
Chemotherapy. You can also call the
National Cancer Helpline on 1800 200
700.
Radiotherapy is the use of powerful Xrays to treat cancer. It is commonly used
to treat oesophagus cancer. It can also
be used to ease distressing symptoms
like difficult and painful swallowing
caused by the tumour. More
information on radiotherapy and its
side-effects is available from the Irish
Cancer Society in a free booklet called
Radiotherapy. You can also call the
National Cancer Helpline on 1800 200
700.
Depending on where the tumour is,
surgery may also be needed on the
abdomen and the chest. This is so that
the affected part of the oesophagus can
be removed.
During these operations, the top part of
the stomach is usually removed. As it
will now be higher up than before, you
will need to eat smaller meals and more
often. You may find that you feel sick or
very full if you eat too quickly.
Further information
Usually a change in diet is needed. You
may also need a special diet for a few
weeks or months, or permanently. Ask
your doctor or dietitian (a nutrition
specialist) to explain the changes you
should make to your diet. Eating well
means getting enough calories and
protein to prevent weight loss, to build
up strength and rebuild normal tissues.
This is important for people with cancer
of the oesophagus. More information on
diet is available in a free booklet called
Diet and the Cancer Patient from the Irish
Cancer Society.
If you or someone you know is
diagnosed with cancer of the
oesophagus, more detailed information
about the symptoms, diagnosis and
treatment is available in a booklet called
Understanding Cancer of the Oesophagus.
This booklet can help you understand
the feelings and distress that can arise
with a cancer diagnosis. It is available
free of charge from the Irish Cancer
Society by calling the helpline on 1800
200 700.
For more information about
oesophageal cancer or about
cancer in general, call the Irish
Cancer Society’s Helpline on
Freefone
1800 200 700
(Monday-Friday, 9 am-5 pm) or
email [email protected]
for confidential advice from our
cancer nurse specialists.
Chemotherapy is used to treat cancer
of the oesophagus. This type of
treatment involves the use of drugs to
kill cancer cells. It can often be given
after surgery to prevent the cancer
coming back. This is called adjuvant
chemotherapy. Usually this type of
treatment is given in cycles for about six
months. Chemotherapy is also given to
treat cancer of the oesophagus when
surgery is not possible or the cancer has
spread.
Irish Cancer Society
5 Northumberland Road
Dublin 4
5
Tel: (01) 231 0500
Fax: (01) 231 0555
Email: [email protected]
Website: www.cancer.ie