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The oesophagus,
sometimes spelled esophagus, and also known as
the gullet, is part of the gastro-intestinal
tract and takes food through the chest to the
stomach. The stomach needs acid to
function, but the oesophagus does not react well
to this acid. There is therefore a sphincter valve
at the join of the oesophagus and the stomach to
prevent the acid rising.
There are about 7,500 cases of oesophageal
cancer in the United Kingdom each year (about 13
per 100,000 people) and the ninth most common
cancer.
There are two types: adeno and squamous.
Adeno-carcinoma is increasing in the western
world, tends to occur in the lower third of the
oesophagus, and may be connected with persistent
acid reflux (heartburn) and other factors.
Squamous cancer is more common in the eastern
world, tends to occur in the upper and mid third
of the oesophagus and is thought to be somewhat
more influenced by diet, smoking and alcohol.
Early diagnosis and treatment of the condition
is important. For a report, based on
an Australian radio programme in 2001 (so beware
that this is a different part of the world!)
click
here.
Symptoms which indicate there may be cancer in
the oesophagus are often vague and fairly common
and therefore can be overlooked. However, as
with any other area of your body, any changes,
however subtle, should not be ignored if they
are persistent.
If you have any of the following symptoms you
should see your local doctor and discuss them
further
-
Swallowing difficulties or a sensation of food
sticking in your chest
-
Pain or discomfort as food passes down the
oesophagus
-
Persistent heartburn/acid reflux (persistent
would be 2 to 3 weeks without passing off)
-
Persistent cough or hoarseness
-
Persistent hiccups
-
Regurgitation of food on a regular basis
-
Persistent nausea/retching/heaving
-
Unexpected weight loss/unusual tiredness
Your GP may initially give you a medication to
see if that can solve your symptoms. If after
two to three weeks your symptoms have not gone
away, he/she may refer you for an endoscopy.
This is a camera which is passed down your
oesophagus (with sedation if you prefer) where
the endoscopist can have a look at the lining of
the oesophagus and the stomach. They may take
biopsies if they are unhappy about anything they
see. This does not necessarily mean you have
cancer – it may be that they have seen some
ulceration or other changes in the normal
linings.
Having tests then ultimately receiving a
diagnosis of cancer is a frightening and often
shocking experience. The waiting for test
results and the fears generated whilst you are
agonising over what could be wrong with you can
be very wearing on both the patient and their
loved ones.
When the results of the tests are all finally
done and assessed you will be called to see your
consultant for the results. If the consultant
tells you that you have cancer, you may hear
nothing past that point in the consultation – we
are oftent told that the rest of the appointment
is a blur. It is a form of shock and quite
understandable; that is why it is so important
for you to take someone with you to important
appointments. They will often hear things that
you don’t. It is at this point that we like
patients to hear about us. It is important to
know that you are not alone and that we are
there to support and help.
It is also about this stage when an upper
gastrointestinal clinical nurse specialist
(Upper GI CNS) may take over co-ordination of
your individual case. Most centres will have
such a nurse and if you are not automatically
assigned one then ask. He/she will oversee the
continuity of your treatments, appointments and
your best interests during the journey you are
facing. They will also be able to interpret any
jargon, explain what will happen to you in more
detail and help you and your family find your
way through the complex process of various
medical departments and different skills areas
you will be experiencing.
Following your diagnosis, there may be further
tests to establish the true nature of the
tumour, including size, depth and what it is
doing, i.e. whether it is confined to the
oesophagus/stomach or has started to spread.
Once these tests are finished, a plan of your
treatment needs to be made. Thankfully, this is
no longer a single person’s decision – the
treatment plan is decided by drawing opinion and
expertise from every available and relevant
medical discipline. Medical experts from
radiology, surgery, pathology, oncology and your
specialist nurse will meet to discuss your
particular case and the best plan for you. You
will then have an appointment when the plan can
be discussed with you.
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