The oesophagus (gullet) is part of the digestive system, which is sometimes called the gastro-intestinal tract (GI tract). The oesophagus is a muscular tube. It connects your mouth to your stomach.
In the UK, around 9000 people are diagnosed with oesophageal cancer each year.
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Types of oesophageal cancer
Knowing the type of oesophageal cancer you have helps your cancer doctor plan your treatment.
There are two main types of oesophageal cancer:
- squamous cell carcinoma – this develops in the thin, flat cells of the mucosa, which lines the oesophagus
- adenocarcinoma – this develops from glandular cells and is often linked with Barrett’s oesophagus.
Cancer can develop anywhere in the oesophagus. Cancers in the upper or middle oesophagus are usually squamous cell cancer. Cancers in the lower oesophagus are usually adenocarcinomas. This includes cancers that develop in the area where the oesophagus joins the stomach.
Most oesophageal cancers are either squamous cell carcinoma or adenocarcinoma. But there are other, rarer types of oesophageal cancer. These include:
- poorly differentiated neuroendocrine cancer
- small cell cancer
- soft tissue sarcomas, such as gastro-intestinal stromal tumours (GISTs).
The tests and treatments for these rarer types of oesophageal cancer are different from the ones we describe in this information. If you would like more information about this, you can:
The most common symptom of oesophageal cancer is difficulty swallowing. You may feel as though food is sticking in your throat or chest. This symptom can be caused by other conditions other than cancer. But it is important to get it checked by your GP. They can arrange tests or refer you to a specialist if necessary.
If you are worried about oesophageal cancer we have more information about the signs and symptoms.
We do not know exactly what causes oesophageal cancer. But certain things called risk factors can increase the chance of developing it.
Some of the main risk factors linked to oesophageal cancer include:
- long-term acid reflux
Having a risk factor does not mean you will get oesophageal cancer. And if you do not have any risk factors, you may still get oesophageal cancer.
We have more information about the causes and risk factors of oesophageal cancer.
At the hospital
If the biopsy results from your endoscopy show there are cancer cells, you will see a specialist doctor. This is usually a surgeon who specialises in oesophageal and gastro-intestinal cancers. Or you may see a gastroenterologist who specialises in treating oesophageal, stomach and digestive problems. You may also see a specialist nurse. Your specialist doctor or nurse will arrange more tests. These are to find out:
- which layers of the oesophageal wall the cancer is in
- if it has spread outside the oesophagus.
These tests may include:
Endoscopic ultrasound (EUS)
Some people may have a test called a barium swallow. For this test you drink a liquid called barium, which helps to show the oesophagus more clearly on an x-ray. You usually only have this test if you have not had an endoscopy.
Waiting for test results can be a difficult time, we have more information that can help.
The results of your tests help your doctors find out more about the position of the cancer and whether it has spread. This is called staging.
A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread.
Knowing the stage and grade helps your doctors plan the best treatment for you.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your cancer doctor or specialist nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.
You might have treatment to cure the cancer. If a cure is not possible, the aim of treatment is to control the cancer and help with the symptoms.
Your treatment for oesophageal cancer depends on:
- the type of oesophageal cancer you have
- where the cancer is in the oesophagus – in the upper, middle or lower oesophagus
- the stage of the cancer
- your general health
- your personal choices.
You can read about when different treatments are given in our treatment overview. These treatments may include:
Chemotherapy uses anti-cancer drugs to destroy cancer cells. It can be given before and after surgery. It can be given on its own, with radiotherapy (chemoradiation) or with targeted therapy. It may also be used for people who cannot have surgery.
Radiotherapy uses high-energy rays to treat cancer. It may be given in combination with chemotherapy (chemoradiation). If the cancer is more advanced, you may have radiotherapy on its own to shrink the tumour and help control symptoms.
Targeted therapy drugs work by targeting something in or around the cancer cell that is helping it grow and survive. Sometimes a targeted therapy drug called trastuzumab is given with chemotherapy to treat advanced oesophageal cancer.
The treatments can be used alone or in combination with each other. Your cancer doctor and specialist nurse will explain the treatments they think are best for you. They can help you make decisions about your treatment.
You may also have treatments as part of a clinical trial.
Treating advanced oesophageal cancer
Cancer that started in the oesophagus and has spread to other parts of the body is called advanced cancer. The cancer may be advanced when it is first diagnosed. Or it may have come back after treatment – this is called a recurrent cancer.
If you have advanced oesophageal cancer, you may be offered treatment such as chemotherapy, radiotherapy or targeted therapies. These treatments will not cure the cancer, but they may be able to shrink it. This may control it for a time and improve symptoms, such as difficulty swallowing.
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.
Macmillan is also here to support you. If you would like to talk, you can: