What is oesophageal cancer?

Oesophageal cancer (or US spelling -  esophageal cancer) begins when abnormal cells develop in the oesophagus. In Australia it is most commonly found in the lower section of the oesophagus, adjoining the stomach. The main types of oesophageal cancer are:

  • Adenocarcinoma which often starts near the gastro-oesophageal junction. It is linked with Barrett’s oesophagus. This is the most common form of oesophageal cancer in Australia.
  • Squamous cell carcinoma which starts in the cells that line the oesophagus.

Oesophageal cancer is not common. Men are much more likely than women to be diagnosed with this cancer.

It is estimated that more than 1,700 people were diagnosed with oesophageal cancer in 2023. The average age at diagnosis is 71 years old.


Oesophageal cancer signs and symptoms

Oesophageal cancer is slow- growing and usually detected in advanced stages, as there may not be any symptoms in the early stages. Symptoms of oesophageal cancer may include:

  • difficult or painful swallowing

  • new heartburn

  • reflux that doesn’t go away

  • vomit that has blood in it

  • black or bloody stools

  • unexplained fatigue

  • feeling of choking when swallowing

  • discomfort in the upper abdomen particularly when eating

  • unexplained weight loss.


Causes of oesophageal cancer

Risk factors for oesophageal cancer include:

  • smoking tobacco

  • alcohol consumption

  • diet low in fresh fruit and vegetables

  • obesity

  • exposure to certain chemical fumes

  • family history of gastrointestinal disorders

  • having an inherited genetic condition such as Cowden syndrome or Peutz-Jeghers syndrome (PJS)

  • certain medical conditions such as Barrett's oesophagus or gastro-intestinal reflux disease.


Diagnosis of oesophageal cancer

Recommended tests for oesophageal cancer are likely to depend on your symptoms. Tests to diagnose oesophageal cancer may include:

Endoscopy

The most common investigation for oesophageal cancer is an endoscopy. Your doctor will use an endoscope (thin, flexible tube with a camera at the end) to look at your digestive tract. A small amount of tissue may also be removed (biopsy) and examined by a pathologist to check for signs of disease.

Endoscopic ultrasound

Endoscopic ultrasound uses an endoscope with a probe which releases soundwaves that bounce off anything solid such as a tumour or organ. This test may indicate if cancer has spread into the oesophageal wall or lymph nodes.

Further tests

You may have blood tests to assess your general health, check for a low red blood cell count and see how well your kidneys and liver are working.

Scans or imaging tests such as CT/PET scan or a laparoscopy may be used to detect if the cancer has spread. Less frequently, tests such as a bone scan or an ultrasound may be used.

After a diagnosis of oesophageal cancer 

After being diagnosed with oesophageal cancer, you may feel shocked, upset, anxious or confused. These are normal responses. A diagnosis of a stomach or oesophageal cancer affects each person differently. For most it will be a difficult time, however some people manage to continue with their normal daily activities 

You may find it helpful to talk about your treatment options with your doctors, family and friends. Ask questions and seek as much information as you feel you need. It is up to you as to how involved you want to be in making decisions about your treatment. 

 


Treatment for oesophageal cancer

The type of treatment you have will depend on the extent of the cancer.

Staging

Tests for oesophageal cancer may also indicate the extent of the cancer and how far it has spread. This is called staging and will help your doctor decide on the best treatment for you.

Surgery

Surgery is commonly used to treat oesophageal cancer. The type of surgery is likely to depend on the size and location of the tumour.
 

You may have chemotherapy and/or radiation therapy before surgery to shrink the tumour. This is known as neoadjuvant treatment.

In surgery, part or all of the oesophagus is removed. If part of the oesophagus is removed the surgeon will rejoin the remaining part to your stomach. If the whole oesophagus is removed, your stomach or part of your bowel may be used to replace it.

Adjuvant treatment

You may have chemotherapy and/or radiation therapy after surgery in order to destroy any remaining cancer cells.

Palliative care

Palliative care aims to improve quality of life without trying to cure the disease, by alleviating symptoms of oesophageal cancer such as difficulty swallowing and nausea. Palliative care for oesophageal cancer may include radiotherapy, chemotherapy or other medications.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • GP (General Practitioner) - looks after your general health and works with your specialists to coordinate treatment.
  • Gastroenterologist - specialises in diseases of the digestive system.
  • Upper gastrointestinal surgeon- specialises in surgery to treat diseases of the upper digestive system.
  • Radiation oncologist - prescribes and coordinates radiation therapy treatment.
  • Medical oncologist - prescribes and coordinates the course of chemotherapy.
  • Cancer nurse - assists with treatment and provides information and support throughout your treatment.
  • Other allied health professionals - such as social workers, pharmacists, and counsellors.

Screening for oesophageal cancer

There is currently no national screening program for oesophageal cancer available in Australia.


Preventing oesophageal cancer

Lifestyle factors such as poor nutrition and being overweight or obese, smoking tobacco and high alcohol consumption significantly increase the risk of oesophageal cancer.


Prognosis of oesophageal cancer

Prognosis refers to the expected outcome of a disease. It is not possible for a doctor to predict the exact course of your cancer. However, your doctor may provide a guide to likely treatment outcomes based on your test results, the extent of the tumour, whether it has spread to the lymph nodes, your age and your overall health. This information will also help your doctor advise on the best course of treatment. 

Chances of successful treatment are better if the cancer is diagnosed early. If the cancer is found after it has spread from the primary site then the prognosis is not as good.