Oesophagus cancer – can it be treated?

The long-term survival rate of oesophagus cancer is quite low compared to other cancers. Only around 10% of people diagnosed with this type of cancer today will live for another 5 years. In contrast, breast cancer has a 5-year survival rate of nearly 90%.

The main problem is not the availability of oesophasgus cancer treatments – there are plenty of therapy options. It is more that this cancer is not recognised until it is in its advanced stages. Because the early symptoms are quite mild – such as heartburn, difficulty swallowing and minor discomfort when eating – many patients do not get checked out until their oesophagus cancer has already started to spread.

New treatments for advanced oesophagus cancer are being developed all the time, including laser surgery to cut a way through the tumour and photodynamic light therapy, which uses a combination of light sensitive drugs and laser light to kill the oesophagus cancer cells. In the meanwhile, being aware of the niggling symptoms that could be a sign of oesophagus cancer is therefore important. It is best to have a check up if something is worrying you. If all is well, you will get the all-clear and you can feel reassured that you did the right thing. If there is a problem, you are in a better position to get early treatment if necessary. 

This article on oesophagus cancer treatment is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.  

What is oesophagus cancer?

Oesophagus cancer (also called oesophageal cancer) is cancer of the tube that connects the back of your throat to your stomach. There are two main types:

• squamous carcinoma, which attacks the upper end of the oesophagus.

• adenocarcinoma, which attacks nearer the junction with the stomach.

Diagnosing oesophagus cancer

Oesophagus cancer is usually identified through a barium X-ray, which will show up any blockages or narrowing of the oesophagus. It is then confirmed by direct viewing through an endoscope, Tissue samples may be taken for biopsy to give further details.

Types of treatment for oesophagus cancer

The treatment you receive for oesophagus cancer will depend on the type of cancer, the stage it has reached and its location. It will also be influenced by your general health, your age and your own personal preferences.

If your oesophagus cancer is identified in its early stages, then the focus will be on surgery to cure your condition. However, if it is more advanced then the treatment will be aimed more at preventing further growth, and if possible, shrinking the tumor. In the most advanced stages of oesophagus cancer, any treatment will be simply focussed on making you feel more comfortable, controlling your pain and improving your quality of life where possible.

Surgery for oesophagus cancer

There are two types of oesophagus cancer surgery:

• Oesophagectomy – this is performed when the cancer has not spread beyond the oesophagus. The section of the oesophagus that contains the cancer is removed and the remaining tube is reconnected to the stomach.

• Oesophagogastrectomy – this is performed where the oesophagus cancer has spread to the surrounding tissues, and involved the removal of all the affected areas. This may include the lymph nodes and the top of the stomach. The remaining oesophagus is reconnected using a length of the large intestine.

Patients in good health with small tumours have a 25% chance of being cured by surgery. Often oesophagus cancer surgery is complemented by chemotherapy or radiotherapy, either before the surgery to shrink the tumour, or post surgery to prevent re-growth.

Chemotherapy and radiotherapy for oesophagus cancer

Some studies show that a combination of the chemotherapy and radiotherapy alone can be as successful as surgery in treating oesophagus cancer. Even with more advanced cases, the cure rate can be as high as 20%.

Chemotherapy uses anti-cancer chemicals to kill the cancer cells or stop them multiplying further. Unfortunately, many of the drugs used will also affect other tissues in the body, causing hair loss, nausea and vomiting, mouth sores and general fatigue. Although these side effects are only short term, they can make oesophagus cancer treatment a gruelling process. You will probably be offered other drugs to counteract the worst effects of the chemotherapy – such as anti-nausea medications – and these will help you to feel more comfortable.

Radiotherapy uses high energy radiation to destroy the oesophagus cancer cells. This can either be introduced from outside the body to the general area of the tumour, or from inside, giving a more targeted dose directly to the affected tissues. As with chemotherapy, the side effects can be quite traumatic, including fatigue, skin reactions, nausea and appetite loss.

Often chemotherapy and radiotherapy are used together, with frequent radiotherapy for a number of weeks.

Treating advanced oesophagus cancer

In the advanced stages of oesophagus cancer, surgery may no longer be possible. You may also be too weak or ill to undergo the intensive regime of chemotherapy or radiotherapy.  In such cases, the focus of your cancer treatment is to make you as comfortable as possible.

One procedure to achieve this is to introduce a swallowing tube, or stent, either around or through the tumour. This provides a route that allows you to continue to take in food and medicines. Where this is not possible, a feeding tube may be placed directly into your stomach through the chest wall, bypassing the oesophagus altogether.

Choosing the right treatment

The right treatment for your oesophagus cancer will depend on a number of factors, and it is often a case of balancing the benefits of the treatment with the side effects and other issues.

As the five year survival rate for oesophagus cancer is low, if you are in the advanced stages you may decide that the trauma of surgery, chemotherapy or radiotherapy is simply not worth it. You may opt instead for a less intrusive approach based on your personal comfort and dignity.

Your GP and specialist team will be happy to discuss treatment options with you, and you should talk these over with your family and friends. You will also be offered access to counselling services that can help you with your decision.

Profile of the author

Dr Kathryn Senior is an acclaimed medical journalist who has written over 500 feature articles for leading international journals within The Lancet group. As Senior Writer at Freelance Copy she produces high quality scientific and medical content for websites and printed publications for companies and organisations in the health, medical and pharmaceutical sectors.

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