Oesophageal cancer (cancer of the gullet) is a malignancy that originates in the oesophagus. It is diagnosed in men approximately twice as often as in women, due to reasons such as smoking and alcohol drinking habits. Its incidence has been continuously decreasing. Most oesophageal cancers are advanced at the time of diagnosis. Therefore, curative treatment is rarely an option. There are two main types of oesophageal cancer: squamous cell carcinoma, which starts in cells of the inner lining of the oesophagus, and adenocarcinoma, which starts in gland cells.

Risk of disease

The risk factors are partially the same as in stomach cancer, but the role of Helicobacter pylori is not as significant. Excessive use of alcohol, smoking, advanced age and family history of oesophageal cancer increase the risk. The so-called Barrett syndrome is associated with an increased cancer risk. Barrett syndrome refers to pathological changes in cells of the lower portion of the oesophagus, caused by chronic acid exposure. The risk can be reduced by a more varied diet, abstinence from hard liquor and monitoring and treatment of the patient’s Barrett syndrome.

The most important risk factors for squamous cell carcinoma are smoking and the use of alcohol. Continuous and simultaneous excessive use of tobacco and alcohol can increase the risk to 100-fold. The main risk factors for adenocarcinoma include age, being male, overweight, smoking and, as the most important risk factor, reflux disease-related Barrett’s mucosa.

Symptoms

Oesophageal cancer can cause a number of different symptoms, including dysphagia (difficulty swallowing), pain, frequent intense vomiting at meals and rapid weight loss. At this point, the cancer has already caused significant obstruction of the oesophagus. Difficulty swallowing is the most typical initial symptom of oesophageal cancer. Pain and bleeding may sometimes be associated with the disease. If the cancer has already spread, metastases cause various symptoms, depending on their location.

Diagnosis

Oesophageal cancer is diagnosed by oesophagoscopy. Additional examinations may include an MRI scan, an intra-oesophageal ultrasound scan or a CT scan. Today, PET imaging is an important means for assessing the local extent of the cancer and the presence of metastases.

Treatment

Treatment options include surgery (removal of the tumor, stent placement), chemotherapy and radiotherapy. Small and local tumors are always removed surgically. Advanced oesophageal cancer is usually treated with radiotherapy, pharmacotherapy or a combination of these. Radiotherapy has a particularly important role in the treatment of squamous cell carcinoma. The treatment of adenocarcinoma is more focused on pharmacotherapy, but radiotherapy is also used.

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