Introduction
Risk Factors
Treatment of Oesophageal Cancer
Cancer can affect the cells lining the inner aspect of
The exact cause of oesophageal cancer is unknown.
However studies have shown that any of the following
factors can increase the risk of developing cancer
Surgery is the main treatment of all solid cancers.
the oesophagus. Normally, cells grow, divide, and
produce more cells when they are needed. This
process keeps the body healthy and functioning
properly. Sometimes however, cells keep dividing
when new cells are not needed and this swelling is
called a tumour.
Tumours can be benign or
malignant.
Benign tumours are not cancer and can usually be
removed surgically are rarely come back.
Malignant tumours are cancers.
The cells are
abnormal and grow out of control. These cells may
travel around the body and cause severe problems
where they implant. They can destroy the tissues
they invade. Some cancer cells produce chemicals
that cause weight loss, loss of appetite and ultimately
death.
Oesophageal Cancer
Cancer that begins in the oesophagus
(oesophageal cancer) is divided in to two types,
1.
Age: Oesophageal cancer is more likely to
develop in people, as they get older. Most people
who develop it are over 60.
2.
3.
Gender: Oesophageal cancer is more common in
males.
Radiation therapy may be used alone or in
Tobacco use: Smoking cigarettes increases the
combination with chemotherapy and/or surgery to
destroy the cancer. It may be used as the main
treatment especially if the size or location of the
tumour makes the operation difficult. Doctors may
also combine radiotherapy with chemotherapy to
shrink the tumour before surgery.
risk of ALL forms of cancer.
4.
Alcohol use: Chronic or heavy alcohol abuse is
another major risk factor- mainly for squamous
cancer.
5.
Medical History: Patients who have other forms
of head and neck cancer have an increased risk of
developing a second cancer in the oesophagus.
6.
This aims to remove the entire tumour. Usually
chemotherapy and radiotherapy are given before
surgery to shrink the tumour. You may also require
chemotherapy
after
surgery.
Sometimes
chemotherapy and radiotherapy are the only
treatments required.
Barrett's Oesophagus. This is a condition that
occurs due to chronic heartburn or acid reflux. It is
the only known risk factor for Adenocancer.
Chemotherapy involves the use of anticancer
drugs to kill cancer cells. These drugs travel
throughout the body and are given by injection in to
vein. It may be used with radiotherapy to shrink the
tumour before surgery. As chemotherapy travels
throughout the body it can kill cells that have
travelled outside of the operation field.
What is Barrett's Oesophagus?
Long-term regurgitation of acid from the stomach into
the oesophagus can increase the risk of oesophageal
cancer.
Squamous Cell cancer and Adeno cancers (or
carcinomas the more common medical usage)
depending on the type of cells that are malignant.
Squamous cell cancer arises in cells that line the
upper and middle part of the oesophagus.
Adenocarcinomas usually develop in the glandular
tissue in the lower part of the oesophagus. The
treatment is similar for both types of cancer
The tissues at the bottom of the oesophagus near the
stomach can become irritated if stomach acid
frequently regurgitates into the oesophagus. Over
time, cells in the irritated part of the oesophagus may
change and begin to resemble the cells that line the
stomach.
This condition, known as Barrett’s
Oesophagus, is pre-malignant. In other words in
certain people it can become cancer.
Fortunately, endoscopy and biopsy can identify who is
at risk and at-risk people can be followed closely to
detect it early. It is important to be reassured that 99%
of people with chronic heartburn or reflux or Barretts
oesophagus are not at risk for cancer.
What are the Side Effects of the
Treatment?
The side effects of cancer treatment depend on the
type of treatment and may be different for each
person.
Complications of Surgery
Surgery for this cancer is major and is associated
with a number of predictable and some
unpredictable
complications.
Predictable
complications include pain, infection, bleeding, in the
area of the operation but as these are predictable
they are now well controlled with medication.
Many patients will develop chest inflammation. This
may be reduced by breathing exercises before
surgery and physiotherapy after surgery.
Because this is a major operation bleeding at the time
of operation may occur.
After surgery leakage from the joining of the stomach
may require re operation.
Infection, clot in the legs and a clot in the lung are
also possible.
Your surgeons will do all that is possible to prevent
complication. Like all operations there complications
associated with each particular type of surgery and
your surgeon will explain these with you.
Less predictable are complications such as lung
failure. This may occur after an otherwise uneventful
operation and partial recovery.
The outcome
depends on its severity.
Complications of Radiation Therapy
Radiation Therapy affects normal cells as well as
cancerous cells. Side effects of radiation depend
mainly on the dose and the part of the body treated.
However common side effects are
1.
Dry, sore mouth and throat
2.
Difficulty Swallowing
3.
Fatigue
4.
Loss of appetite
5.
Skin changes at the site of treatment
Complications of Chemotherapy
Chemotherapy like radiation therapy affects normal
as well as cancerous cells. The side effects depend
largely on the specific drugs and the amount of drug
administered. Common side effects however are
1.
Nausea and vomiting
2.
Loss of appetite
3.
Hair loss
4.
Skin rash and itching
5.
Mouth and lip sores
6.
Fatigue
These side effects generally go away gradually during
the recovery periods between treatments or after
treatment is over.
Diet and Oesophageal Cancer
Eating well during cancer treatment means getting
enough calories and protein to control weight loss
and maintain strength. Eating well often helps people
with cancer feel better and have more energy.
However because many people with oesophageal
cancer find it hard to eat well because they have
difficulty swallowing. Also the common side effects of
the treatment such as poor appetite, nausea,
vomiting, dry mouth and mouth sore make it even
more difficult.
Patients with oesophageal cancer are usually
encouraged to eat several small meals and snacks
throughout the day, rather than three large meals.
When swallowing is difficult many patients still manage
soft, bland foods moistened with sauces or gravies. It
may be helpful to use a blender to process solid foods.
The doctor, dietician and nursing staff will advise you
and your families regarding nutrition before, during and
after your treatment.
About This Booklet
This booklet is intended primarily for people who
have oesophageal cancer or their relatives and
are attending hospital with the condition. It
should be used to educate people about their
condition and understand it better. However if
you have any further queries about oesophageal
cancer disease please ask your doctor.
Published by Mr Thomas N Walsh
Department of Surgery
James Connolly Memorial Hospital
Blanchardstown
Dublin 15.
For further information please visit us at
www.jcmh.ie
Patient Information on
CANCER OF THE
OESOPHAGUS
The Oesophagus (pronounced e-sof-a-gus) is the
hollow tube that carries food and liquids from the throat
to the stomach. In the adult it is 10 inches long.