Oesophageal Cancer

Oesophageal cancer mainly occurs in older people and makes up approx. 2 % of all cancers in Switzerland. More men than women are affected by this cancer. Although there are no clear causes for oesophageal cancer, certain factors such as smoking or increased alcohol consumption are known to facilitate it.

Causes

There are two different types of oesophageal cancer: the most prevalent type is squamous cell carcinoma (80–85%). It is a malignant new growth of cobblestone-like mucosa skin. Adenocarcinoma involves a malignant proliferation of the cells which develop at the lower end of the oesophagus during regular backflow of stomach acid into the oesophagus.

Risk factors for oesophageal cancer

  • Strong alcohol
  • Smoking
  • Nitrosamines: They occur in smoked and cured meat, and in tobacco smoke
  • Scars (for example, after burns to the oesophagus)
  • Barrett syndrome (a complication caused by suffer chronic belching of sour stomach acid into the oesophagus, i.e. reflux disease)
  • Long-standing and intensive consumption of overly hot food and drinks
Symptome

Oesophageal cancer in the early stages usually proceeds symptom-free.

Symptoms in the later stages:

  • Feeling of pressure behind the sternum
  • Difficulty swallowing
  • Heartburn and burping
  • Weight loss
  • Pain
  • Diagnosis

 

Diagnosis
  • medical history, taking the symptoms into account
  • Reflection of the esophagus (esophagoscopy)
  • Tissue sample (biopsy)
  • X-ray examination with contrast agent
  • Computed tomography 
Treatment

If they are recognised very early, malignant changes can sometimes be removed endoscopically (endoscopy) and the likelihood of degeneration is minimised.

The goal of every treatment is firstly to restore or retain the nutritional passage. It only makes sense to remove the tumour if it can be excised without leaving residual tissue. The treatment of choice depends on the location, stage, type of tissue and any additional illnesses that the patient may have.

Tumours in the neck area are initially irradiated and treated with chemotherapy so that the affected part of the oesophagus can be removed. The missing part is unusually replaced with a section of the small intestine.

Tumours lying further inside the sternum can also be irradiated and treated with chemotherapy beforehand. The surgery is then either undertaken from the abdomen or by opening up the chest cavity; in complicated cases, also through combined access.

In both cases, it is crucial that the patient undergoes regular aftercare.

There are also cases where surgery is no longer possible; for example, if the tumour has already grown into the main artery or into the airways, or if there are already offshoots (metastases). In such cases, the following treatment option are available; however they will only be palliative.

  • Radiotherapy
  • Chemotherapy
  • Forcing stenoses open with an endoscopy
  • Insertion of stents to hold the oesophagus open
  • Preventative measures
Preventative measures

Perennial diseases of the oesophagus can cause affected cells of the oesophagus to degenerate, i.e. become malignant, and oesophageal cancer develops from this. By carrying out an endoscopy on the oesophagus or the stomach, the doctor can directly determine whether changes have occurred in the oesophagus. If anything appears to be atypical, the doctor can take direct tissue samples and have them tested. If you have difficulty swallowing or other problems in the oesophagus, please contact a doctor in good time so that he/she can clarify the underlying cause.