OESOPHAGEAL cancer (oesophageal carcinoma) is cancer that occurs in the oesophagus, a long hollow muscular tube that is responsible for moving food from your throat to your stomach.

It can occur anywhere along the oesophagus. It usually begins when DNA in the cells that line the oesophagus mutates. Cells expand and divide out of control as a result of the changes.

e unusual cells that accumulate in the oesophagus form a tumour that can invade surrounding structures and spread to other parts of the body.

Most oesophageal cancers can be classified as one of two subtypes, namely adenocarcinoma or squamous cell carcinoma. ere is also a third type of oesophageal cancer that is rare called small cell carcinoma. e type of cells affected determines the classification.

Symptoms

Oesophageal cancer in its early stages typically has no symptoms. Prominent symptoms usually only appear after the cancer has infiltrated more than 60%of the circumference of the oesophageal tube, resulting in a narrowing of the tube.

Symptoms often include difficulty or pain when swallowing (dysphagia).

is is because as it grows, the tumour starts to block the pathway to the stomach. Even liquid may be painful to swallow.

Other possible symptoms include pain, pressure or a burning sensation in the chest or behind the breast bone, worsening indigestion or heartburn and coughing or hoarseness, as well as unintended weight loss.

Causes

It is unclear what causes oesophageal cancer. However, there are certain risk factors that make oesophageal cancer more likely.

It is thought that chronic irritation of your oesophagus may contribute to the changes that cause oesophageal cancer by damaging the DNA in cells that line the inside of the oesophagus.

Risk factors

ere are a number of factors which increase a person's risk of developing oesophageal cancer. ey includegender.Men are three to four times more likely than women to develop oesophageal cancer.

Your risk increases with age. Men over the age of 75 have a higher risk than younger people. It is rare for people under the age of 45 to have oesophageal cancer.

Smoking cigarettes,cigars, pipes or other use of tobacco increases your risk of oesophageal cancer especially squamous cell carcinoma.Heavy alcohol use is another possible risk factor.

Having gastro-oesophageal reflux disease also puts you at risk of oesophageal cancer. is is when contents and acid from the stomach back up into the oesophagus.

Barrett's oesophagus, a condition that affects the lower part of the oesophagus, can lead to oesophageal cancer.Barrett's oesophagus may be caused bygastro-oesophageal reflux disease.

Being obese, a steady habit of drinking extremely hot liquids, eating insufficient fruit and vegetables, undergoing radiation treatment to the chest or upper abdomen and difficulty swallowing because of an oesophageal sphincter that will not relax are other possible risk factors.

Diagnosis

Oesophagus cancers are usually found because of the signs or symptoms a person is having. If oesophagus cancer is suspected, a medical examination, tests, and a biopsy (a sample of oesophaguscells) will be needed to confirm the diagnosis. If cancer is found, further tests will be done to help determine the extent of the cancer.

If you are having trouble swallowing,a barium test may be done. is involves swallowingthick chalky liquid called barium to coat the walls of the oesophagus. When x-rays are taken the barium shows up any changes or abnormalities in the tissue.

An endoscopy, which involves passing a flexible tube with a video camera on it down your throat into the oesophagus, is another means of examining your oesophagus to look for areas of cancer or irritation. An endoscope may also be used for a biopsy to collect a tissue sample for analysis.

A CT scan may be carried out to reveal whether oesophageal cancer has spread to other organs or lymph nodes nearby.You may be asked to drink one to two pints of a liquid called oral contrast beforehand to help better view the oesophagus and intestines.

Treatment

What treatments you receive for oesophageal cancer are based on the type of cells involved in your cancer, possible side effects, your cancer's stage, your overall health and your preferences for treatment.

For a tumour that has not spread beyond the oesophagus and lymph nodes, doctors often recommend combining different types of treatmentsuch as radiation therapy, chemotherapyand surgery.

e order of treatments varies and several factors are considered including the type of oesophageal cancer.

For squamous cell cancer chemotherapy and radiotherapy are commonly recommended as the first treatment. Surgery may be used afterwards depending how well this treatment has worked.

For adenocarcinoma the most common treatment is chemo radiotherapy followed by surgery. Surgery is almost always recommended after chemo radiotherapy unless there are factors that increase the risks from surgery such as a patient’s overall health.

Small tumours are surgically removed. If your cancer is limited to the superficial layers of your oesophagus and has not spread, your surgeon may suggest removing the cancer as well as a margin of healthy tissue circling it.

Surgery can be done using an endoscope passed down your throat and into your oesophagus. It may be that an oesophagectomy is required.

During an oesophagectomy, the surgeon removes the portion of your oesophagus that contains the cancer along with a portion of the upper part of your stomach and nearby lymph nodes. e remaining oesophagus is reconnected to your stomach. Usually this is done by pulling the stomach up to meet the remaining oesophagus.

Oesophageal cancer can recur after it has been treated.

Prevention

While there is no way to completely avoid oesophageal cancer, there are steps you can take to lower the risk.

Stop smoking. It is a proven oesophageal cancer and other cancer risk factor. Stop or reduce your alcohol consumption.

If you have constant heartburn, it may be a symptom of gastro-oesophageal reflux disease, which is a risk factor. It is wise to see a doctor to have this treated.

Maintain a daily exercise routine to prevent being overweight.

e information in this article is provided as a public service by the Cimas iGo Wellness programme, which is designed to promote good health. It is provided for general information only and should not be construed as medical advice. Readers should consult their doctor or clinic on any matter related to their health or the treatment of any health problem. — igo@cimas.co.zw or WhatsApp 0772 161 829 or phone 024-2773 0663.