Cancer of the Oesophagus

The Oesophagus (pronounced e-sof-a-gus) is the hollow tube that carries food and liquids from the throat to the stomach. In the adult it is 10 inches long.

Introduction

Cancer can affect the cells lining the inner aspect of the oesophagus. Normally, cells grow, divide, and produce more cells when they are needed. This process keeps the body healthy and functioning properly. Sometimes however, cells keep dividing when new cells are not needed and this swelling is called a tumour. Tumours can be benign or malignant.

Benign tumours are not cancer and can usually be removed surgically are rarely come back.
Malignant tumours are cancers. The cells are abnormal and grow out of control. These cells may travel around the body and cause severe problems where they implant. They can destroy the tissues they invade. Some cancer cells produce chemicals that cause weight loss, loss of appetite and ultimately death.

Oesophageal Cancer

Cancer that begins in the oesophagus (oesophageal cancer) is divided in to two types,
Squamous Cell cancer and Adeno cancers (or carcinomas the more common medical usage) depending on the type of cells that are malignant.

Squamous cell cancer arises in cells that line the upper and middle part of the oesophagus. Adenocarcinomas usually develop in the glandular tissue in the lower part of the oesophagus. The treatment is similar for both types of cancer

Risk Factors

The exact cause of oesophageal cancer is unknown. However studies have shown that any of the following factors can increase the risk of developing cancer
1. Age: Oesophageal cancer is more likely to develop in people, as they get older. Most people who develop it are over 60.
2. Gender: Oesophageal cancer is more common in males.
3. Tobacco use: Smoking cigarettes increases the risk of ALL forms of cancer.
4. Alcohol use: Chronic or heavy alcohol abuse is another major risk factor- mainly for squamous cancer.
5. Medical History: Patients who have other forms of head and neck cancer have an increased risk of developing a second cancer in the oesophagus.
6. Barrett's Oesophagus: This is a condition that occurs due to chronic heartburn or acid reflux. It is the only known risk factor for Adenocancer.

What is Barrett's Oesophagus?

Long-term regurgitation of acid from the stomach into the oesophagus can increase the risk of oesophageal cancer.

The tissues at the bottom of the oesophagus near the stomach can become irritated if stomach acid frequently regurgitates into the oesophagus. Over time, cells in the irritated part of the oesophagus may change and begin to resemble the cells that line the stomach. This condition, known as Barrett’s Oesophagus, is pre-malignant. In other words in certain people it can become cancer.

Fortunately, endoscopy and biopsy can identify who is at risk and at-risk people can be followed closely to detect it early. It is important to be reassured that 99% of people with chronic heartburn or reflux or Barretts oesophagus are not at risk for cancer.

Treatment of Oesophageal Cancer

Surgery is the main treatment of all solid cancers. This aims to remove the entire tumour. Usually chemotherapy and radiotherapy are given before surgery to shrink the tumour. You may also require chemotherapy after surgery. Sometimes chemotherapy and radiotherapy are the only treatments required.

Radiation therapy may be used alone or in combination with chemotherapy and/or surgery to destroy the cancer. It may be used as the main treatment especially if the size or location of the tumour makes the operation difficult. Doctors may also combine radiotherapy with chemotherapy to shrink the tumour before surgery.

Chemotherapy involves the use of anticancer drugs to kill cancer cells. These drugs travel throughout the body and are given by injection in to vein. It may be used with radiotherapy to shrink the tumour before surgery. As chemotherapy travels throughout the body it can kill cells that have travelled outside of the operation field

What are the Side Effects of the Treatment?

The side effects of cancer treatment depend on the type of treatment and may be different for each person.

Complications of Surgery

Surgery for this cancer is major and is associated with a number of predictable and some unpredictable complications. Predictable complications include pain, infection, bleeding, in the area of the operation but as these are predictable they are now well controlled with medication. Many patients will develop chest inflammation. This may be reduced by breathing exercises before surgery and physiotherapy after surgery.

Because this is a major operation bleeding at the time of operation may occur.
After surgery leakage from the joining of the stomach may require re operation.
Infection, clot in the legs and a clot in the lung are also possible.

Your surgeons will do all that is possible to prevent complication. Like all operations there complications associated with each particular type of surgery and your surgeon will explain these with you.

Less predictable are complications such as lung failure. This may occur after an otherwise uneventful operation and partial recovery. The outcome depends on its severity.

Complications of Radiation Therapy

Radiation Therapy affects normal cells as well as cancerous cells. Side effects of radiation depend mainly on the dose and the part of the body treated. However common side effects are
1. Dry, sore mouth and throat
2. Difficulty Swallowing
3. Fatigue
4. Loss of appetite
5. Skin changes at the site of treatment

Complications of Chemotherapy

Chemotherapy like radiation therapy affects normal as well as cancerous cells. The side effects depend largely on the specific drugs and the amount of drug administered. Common side effects however are
1. Nausea and vomiting
2. Loss of appetite
3. Hair loss
4. Skin rash and itching
5. Mouth and lip sores
6. Fatigue

These side effects generally go away gradually during the recovery periods between treatments or after treatment is over.

Diet and Oesophageal Cancer

Eating well during cancer treatment means getting enough calories and protein to control weight loss and maintain strength. Eating well often helps people with cancer feel better and have more energy.

However because many people with oesophageal cancer find it hard to eat well because they have difficulty swallowing. Also the common side effects of the treatment such as poor appetite, nausea, vomiting, dry mouth and mouth sore make it even more difficult.
Patients with oesophageal cancer are usually encouraged to eat several small meals and snacks throughout the day, rather than three large meals. When swallowing is difficult many patients still manage soft, bland foods moistened with sauces or gravies. It may be helpful to use a blender to process solid foods. The doctor, dietician and nursing staff will advise you and your families regarding nutrition before, during and after your treatment.

About This Booklet

This booklet is intended primarily for people who have oesophageal cancer or their relatives and are attending hospital with the condition. It should be used to educate people about their condition and understand it better. However if you have any further queries about oesophageal cancer disease please ask your doctor.

Published by Mr Thomas N Walsh
Department of Surgery
James Connolly Memorial Hospital
Blanchardstown
Dublin 15.
For further information please visit us at www.jcmh.ie

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