Most people who have been diagnosed with a cancer of the oesophagus are older than 60 years of age. Men are more likely to be affected by this disease than women.

Cancer of the oesophagus is not attributable to any specific cause.

Risk factors for developing the disease:

• Barrett’s Oesophagus.
• Smoking.
• Alcohol consumption, particularly when associated with smoking.
• Irritations/lesions caused by exposure to chemical products or the frequent drinking of very hot liquids.
• Other forms of cancer, at the level of the head and the neck (epidermoid cancer).

Cancer of the oesophagus may sometimes develop in the absence of all these risk factors.

Cancer of the oesophagus is often asymptomatic during its first Stages. 

Most patients develop symptoms only when the tumour blocks light passing down the oesophagus. They will then have a test relative to the difficulty of swallowing (dysphagia).

The dysphagia is mostly for solids, has appeared recently and is developing progressively. 

It could also be a case of malnutrition.

As the cancer develops, the following symptoms may appear:

Chest pains. Pulmonary bronchial infection by the wrong path or tumour fistulization in the respiratory tree. Shortness of breath due to tracheal compression. Dysphonia due to recurrent attacks to the nerves (generally on the left). Claude Bernard-Horner syndrome by lesion through compression of a hollow vertebrae or pericarditis.

Signs and Symptoms:

• Dysphagia.
• Swallowing is difficult or painful. 
• Chest pains, behind the sternum or between the shoulder blades.
• Coughing or hoarseness.
• Weight loss and loss of appetite.
• Feeling very tired.
• Trouble breathing  (dyspnoea) trouble breathing in (due to compression of the trachea).

Other health problems may be at the origin of certain of these symptoms.

Talk to your GP/Family Doctor who will examine you and ask for complementary examinations if there is the suspicion of a cancer.

To confirm the diagnosis, the surgeon will require other complementary examinations, which could also help establish the « Stage » of the cancer.

Imaging techniques

Where you will be asked to drink a thick chalky liquid, called barium, which will coat the interior of your oesophagus, your stomach and small intestine. 

You will then have a Dynamic Motion X-ray (DMX)  producing clear motion images of the oesophagus and the stomach called an OGTD, Oeso-gastro-duodenal transit.

The OGTD will show on the X-ray if the form of the oesophagus has changed. 

If there are signs of a cancer, the doctor can also check if the disease has spread to the stomach.

Fibroscopy

An endoscopy of the stomach or oesophagoscopy allows the examination of the oesophagus by a straight but flexible tube (endoscope), which has a light at the end and also a video camera.

Biopsy

If the  gastroenterologist sees something abnormal during the endoscopy, several samples of tissue can be taken with the help of the endoscopic cutter. This procedure consisting of taking a sample of the cells of the organism in order to examine them under a microscope, is a biopsy.

A biopsy is normally required to establish with certitude the diagnosis of cancer.

Endoscopy

The endoscopy provides a more precise assessment of the  parietal and mediastinal extension.

It makes it possible to distinguish the  purely submucosal lesions/growths (T1) from the  lesions that infiltrated into the muscularis propria layer (T2), the mediastinal fat (T3) or adjacent organs (T4).

It can also precisely confirm the existence of ganglions (affected lymph nodes) and carry out a biopsy to confirm their pathological character (N+ : cancer infected ganglion).

If the cells are cancerous, the next stage is to determine how rapidly they can multiply.

Blood analyses

Using your blood sample, we can control in what measure your organs are functioning normally.

We look at the liver and kidney functions.

Extra examinations

If these diagnoses indicate that you have a cancer of the oesophagus, your medical care team will probably want you to have other examinations to produce images of tissue, organs and bones to see how far the cancer has spread.

These different tests (echography, CT scan, a magnetic resonance imaging (MRI) scan, a bone scintigraphy) will allow your surgeon to accurately evaluate the size of the tumour and see to what extent it has spread.

Once the diagnosis of a cancer is confirmed and your medical care team have obtained all the necessary information, it is essential to determine the development Stage of the cancer.

This process of deciding the Stage of the cancer consists of defining the size of the tumour, and checking if it has spread from the site where it started.

Five Stages have been defined for cancer of the oesophagus.

It is important to know the Stage of your cancer of the oesophagus, as this will help your medical care team to choose the treatment which suits you best.

The  curative treatment  for cancer of the oesophagus remains based on surgical operations: Esophagectomy

Your age, your general state of health, your respiratory, heart and liver functions will be taken into account to choose the best adapted technique for you.

Surgical treatment is only possible for patients capable of supporting major surgery  and where the tumour does not affect adjacent structures nor have metastases.

Chemoradiotherapy is a valid alternative.

Pre-operative chemoradiotherapy may be proposed as it increases the rate of resectability and even obtains (in 1/3 of cases) a preoperative tumoural sterilisation as well as for the elements removed.

When including all forms of cancer of the oesophagus, the survival rate  is less than 10% after 5 years.

The growth of ganglions plays an important role: a 25 % survival rate after 5 years if they are are absent (N0 : Stage I and IIa) and a 10% survival rate after 5 years if they are present (N+ : Stage IIb and III)

The presence of ganglions above the collar bone and at the level of the Coeliac trunk are considered as metastases.

If metastases are present the survival rate after 5 years is close to zero.

The decision to have surgery depends on the size of the tumour and its location. The operation will be carried out under a general anaesthetic and you will stay  in hospital at least for 10-15 days after the operation.

The surgical operation consists of removing part or the whole of the oesophagus, and is called an Oesophagectomy. It can be a total or partial. 

The location of the tumour and the Stage of the cancer are taken into consideration when determining what portion of the oesophagus should be removed.

The tumour must be removed whole (resection R0) and at the same time part of the healthy tissue above and below the cancer of the oesophagus,  as well as the adjacent lymphatic ganglions  (extracting affected ganglions).

In certain cases, we would also remove part, or the totality, of the stomach.

In this operation, we also remove the superior and internal part of the stomach, the rest of the stomach is prepared (gastroplasty) to be raised and sutured to the healthy part of the oesophagus. 

If it is not possible to bring the two organs together, the replacement for the removed oesophagus is generally made by part of the intestine (colon).

The oesophagectomy is said to be mini-invasive, if the time of the operation on the abdomen is made totally or partially by laparoscopy (with minimum incisions in the abdomen).

Different ways of operating in the thorax are possible:

• Traditionally the thorax is incised (thoracotomy) to remove the maximum number of ganglions with the targeted tissue.
• The operation can also be carried out without making a large incision in the thorax, by using endoscopic video surgery instruments:  (Thoracoscopy + laparoscopy/keyhole surgery; or laparoscopy on its own.

If the tumour cannot be removed, it is possible to instal an endoprosthesis (a hollow tube) in the oesophagus to keep it open.

This makes it easier for the patient to swallow food.

Complications of an Oesophagectomy

• Fistulas: More frequent at the level of the neck, more serious if in the thorax.
• Breathing complications: 20 to 40%, because of the thoracotomy and possible pneumothorax (collapsed lung).
• Recurrent paralysis of nerves:  Problems swallowing: false routes.
• Chylothorax, lymphatic fluid leaks into the space between the lung and chest wall 0 to 5% = An unnoticed lesion of the thoracic duct is a serious complication (death rate 50%) Further surgery: ligature of the thoracic duct.
• Anastomosis stenosis: Narrowing/shrinkage of the digestive suture, responsible for difficulty swallowing. Dilatation may be necessary.
• Diaphragmatic hernia: rare.

Certain treatments for cancer of the oesophagus may have made your mouth more sensitive, which could make you more vulnerable to infections.

It is, therefore, important to be examined and make any dental repairs necessary before the surgery.