Key Facts
Cancer of the oesophagus is relatively rare in Europe, but it has become more common over the last 30 years. Approximately 45,000 new cases are diagnosed each year across Europe (which is about 2% of all new cancer cases). It mainly affects people over the age of 50 and there are very few cases in people under the age of 45.
There are two distinct types of oesophageal cancer:
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Key Figures
| Total number of new cancer cases in Europe (2006) |
3.2 million |
| Total number of cancer deaths in Europe (2006) |
1.7 million |
| Number of new oesophageal cancer cases (2006) |
45,000 |
|
(34,300 men) |
|
| (11,700 women) |
| Number of oesophageal cancer deaths (2006) |
38,500 |
|
(29,300 men) |
|
(9,200 women) |
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Cancer Types
There are two different types of cancer that start in the oesophagus:
The two cancers have different causes and treatment and are therefore described separately in the sections below.
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Causes of Oesophageal Cancer
Causes of Squamous Cell Oesophageal Cancer
In Europe, the main risk factors for developing squamous cell cancer of the oesophagus are smoking and alcohol.
Causes of Oesophageal Adenocarcinoma
People who are more than 25% overweight have a higher risk of the acidic contents of the stomach flowing back into the oesophagus. If this happens, the acidic stomach contents will cause inflammation and cell damage which can lead to Barrett’s oesophagus. This condition can, in turn, develop into oesophageal adenocarcinoma.
Barrett’s oesophagus, therefore, is referred to as a pre-malignant or pre-cancerous condition.
10% of patients with gastro-oesophageal reflux are affected by Barrett's oesophagus and of these 1% per year develop a carcinoma. Overall, Barrett's oesophagus increases the risk of developing cancer by 30 times.
Barrett's oesophagus does not produce any symptoms in itself and is usually discovered accidentally during investigation for other conditions.
Patients with Barrett’s oesophagus can be treated with life-long acid suppression. Anti-reflux surgery may be advised in some cases to reduce the chances of the condition developing into cancer.
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Prevention of Oesophageal Cancer
Preventing Squamous Cell Oesophageal Cancer
The best ways to protect against developing squamous cell cancer are to stop smoking and to drink alcohol only in moderation.
Preventing Adenocarcinoma of the Oesophagus
There are a number of measures that can be taken to protect against developing adenocarcinoma of the oesophagus. These include:
- reducing to or maintaining a healthy weight
- treating Barrett’s oesophagus if it is found
- having a diet which contains zinc, selenium and antioxidant vitamins A, C and E. (All these dietary elements are found in fresh fruit and vegetables and to some extent in meat and eggs).
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Common Symptoms
The classic symptoms of oesophageal cancer are:
- difficulty in swallowing – firstly with solids then with softer foods and liquids
- indigestion associated with acid reflux from the stomach
- unexplained weight loss
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Diagnostic Tests
An endoscopy (looking inside the oesophagus with a flexible telescope) allows doctors to:
- see the lining of the oesophagus
- assess the size of any tumour that is present
- take a biopsy of suspicious areas
Positron Emission Tomography (a PET scan) uses small amounts of radioactive material to detect cancer and other diseases in the body. Different radioactive materials are given as an injection or a drink. Once in the body the material concentrates in certain tissues giving off focal radiation which can be detected by the scanner to produce visual images. Experts can then use these images to help make a diagnosis.
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Treatment
Treatment - Squamous Cell Cancer of the Oesophagus
Treatment for cancer of the oesophagus is either surgery, combined with radiotherapy and chemotherapy (chemoradiation) or a combination of the two (i.e surgery and chemoradiation).
Surgery
In younger patients, surgery may be performed, preceded by chemotherapy and radiotherapy. Surgery is not an option for all patients and the surgery will involve a major operation. If the disease has spread outside the oesophagus a combination of radiotherapy and chemotherapy without surgery may be more effective.
Treatment - Adenocarcinoma of the Oesophagus
Adenocarcinoma of the oesophagus is a difficult disease to treat as it can spread to other areas of the body at an early stage.
If there is no evidence that the cancer has spread and there are no other reasons to avoid surgery, chemotherapy followed by surgery is likely to be the best option.
In some centres, the effect of a course of chemotherapy is assessed using a sophisticated scan (PET scan). Positron Emission Tomography (PET Scan) uses small amounts of radioactive material to detect cancer and other diseases in the body. Different radioactive materials are given as an injection or a drink. Once in the body the material concentrates in certain tissues giving off focal radiation which can be detected by the scanner to produce visual images. Experts can then use these images to help make a diagnosis. Patients with a good response will benefit more from treatment with surgery.
Adenocarcinomas do not respond well to radiotherapy so this is not often used in the treatment of these tumours.
Chemotherapy is also used after surgery to destroy cancer cells that have not been removed during surgery.
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Key Trends
- Results of treatment are significantly better in specialist centres.
- Continuing research into the best combination of treatments and the best doses of these treatments is a key research area.
- Scanning to determine which patients will respond well to treatment is being developed in some centres.
- Monoclonal antibodies may be useful in the treatment of squamous cell cancers but not in the treatment of adenocarcinomas.
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