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Oesophageal Cancer

About the oesophagus

The oesophagus, or ‘food pipe’, carries food from the mouth to the stomach. It is about 26 cm long in adults and passes through the chest, behind the windpipe and the heart. The oesophagus has three main sections – the upper, middle and lower. It carries food and liquids to the stomach using waves of muscle contractions.

The wall of the oesophagus has several layers (the mucosa, sub-mucosa and muscularis) that help to push food down towards the stomach. Glands in the wall produce mucus to help food slide down more easily when swallowing. The oesophagus joins to the top part of the stomach (called the cardia) where a valve (the gastro-oesophageal sphincter) keeps the stomach contents from coming back up into the oesophagus.

​Oesophageal Cancer

Oesophageal Cancer can develop anywhere along the length of the oesophagus but it most commonly arises in the lower third, towards the stomach end. There are two main types of oesophageal cancer:

  • Adenocarcinoma is cancer that begins in cells that produce and release mucus and other fluids most often in the lower part of the oesophagus near the stomach.
  • Squamous cell is cancer that begins in flat cells lining the oesophagus

Symptoms & Risk Factors

There are often no symptoms of oesophageal cancer, particularly in the early stages. However, if there are symptoms, they may include:

  • Difficulty swallowing
  • Heartburn
  • A persistent cough
  • Pain, pressure, or burning in the throat or chest
  • Hoarseness/ harsh, raspy, strained voice
  • Unexplained weight loss
  • Loss of appetite
  • Tiredness
  • Vomiting
  • Black or bloody stool

It is important to realize that these symptoms can also occur in other non-cancerous conditions. However, if you experience any of these symptoms as new and/ or recurring it's important to see your doctor for further investigation.

Risk Factors

A risk factor is anything that increases the chance of developing cancer. Most do not directly cause cancer in the first instance, but they can influence the development of tumours.

The risk factors for developing oesophagus cancer can be split between 'lifestyle' and medical/ genetic risks.

Lifestyle factors include:

  • High alcohol consumption
  • Smoking tobacco
  • Diet low in fresh fruit and vegetables
  • Obesity
  • Exposure to certain chemical fumes
Medical/ Genetic factors include:
  • Family history of gastrointestinal disorders
  • Medical conditions such as Barrett’s oesophagus, gastro-oesophageal reflux disease (GORD) or achalasia.

Diagnosis

Oesophagus cancer is usually diagnosed by endoscopy, where a flexible tube with a camera on the end is passed down from the mouth, and samples of tissue, called biopsies, are taken and sent to the lab for testing. Other tests used include barium x-rays and CT scans.

For more detail on diagnosis and staging visit the Pancare Foundation website.

Treatment

The treatment of oesophagus cancer depends on its site within the oesophagus, the stage of the cancer (how advanced it is at the time of diagnosis), and whether the person is otherwise medically fit. Treatment options include surgery, radiotherapy, and chemotherapy. These treatments are sometimes used in combination.

The prognosis after treatment depends on the stage and the treatment given. In the best circumstances, cure is possible. If cure is not possible, the symptoms caused by the cancer can often be alleviated.

For more detail on potential treatments and staging visit the Pancare Foundation website.

NZ statistics

There are around 330 new diagnoses of oesophageal cancer each year in New Zealand and sadly, 5-year survival rates remain below 30%.

Men are twice as likely to be diagnosed with cancer of the oesophagus than women.

Oesophageal Cancer Stories

Oesophageal Cancer Trials and Research

THYmine 2

5-Fluorouracil (5-FU) is one of the most common chemotherapy drugs used in the treatment of oesophageal cancer. However, every year hundreds of Kiwis suffer debilitating, and potentially life-threatening toxicity from 5FU Chemotherapy treatment. THYmine 2 is investigating a new test that could identify at-risk patients before they start their treatment. Thanks to Gut Cancer Foundation supporters, we have funded the vital role of the clinical trials manager.

Lead investigator on the trial, Dr Nuala Helsby, discusses the importance of the THYmine 2 trial and the key role that Gut Cancer Foundation funding has played so far:

TOPGEAR

574 patients across 70 sites in 8 countries and 3 continents have been recruited to the TopGear clinical trial. TopGear is a vital trial to determine the best combination of chemotherapy, radiotherapy and surgery to improve cure rates for patients with gastric (stomach and oesophageal) cancer. After 12 years, TopGear has completed patient recruitment.

Thanks to Gut Cancer Foundation supporters, New Zealanders have had access to this trial and the support has ensured New Zealand has played an important role in this international collaboration. The length and breadth of TopGear shows just how complex it can be to successfully create and recruit to clinical trials.

Our colleagues at the Australasian Gastro-Intestinal Trials Group (AGITG) have done an incredible job to bring this trial to completion, and we are grateful to our supporters for helping New Zealand play its part.

With the trial moving into its final stages, we look forward to keeping you updated with the trial’s findings as results are made available.

For more information on this trial and others being enabled by your support, click here.