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Oesophageal Carcinoma - Causes, Symptoms & Treatment

Oesophageal carcinoma is a malignant tumour of the oesophagus (food pipe). It is one of the most dangerous cancers of the digestive tract and is often diagnosed at an advanced stage.

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Things worth knowing about "Oesophageal carcinoma"

Oesophageal carcinoma is a malignant tumour of the oesophagus (food pipe). It is one of the most dangerous cancers of the digestive tract and is often diagnosed at an advanced stage.

What is Oesophageal Carcinoma?

Oesophageal carcinoma (also called oesophageal cancer or esophageal cancer) is a malignant tumour arising in the oesophagus, the muscular tube that carries food and liquids from the throat to the stomach. It is one of the most lethal cancers worldwide, largely because it often causes no symptoms in the early stages and is therefore frequently diagnosed only once the disease has progressed.

Types of Oesophageal Carcinoma

There are two main histological types:

Squamous cell carcinoma: Arises from the flat (squamous) cells lining the inner surface of the oesophagus. It most commonly affects the upper and middle thirds of the oesophagus.
Adenocarcinoma: Develops from glandular cells and usually occurs in the lower part of the oesophagus, frequently associated with Barrett oesophagus - a condition caused by chronic acid reflux.

Causes and Risk Factors

Several risk factors have been identified:

Tobacco and alcohol use: The most significant risk factors for squamous cell carcinoma.
Chronic gastro-oesophageal reflux disease (GORD/GERD): Leads to Barrett oesophagus, a precancerous condition linked to adenocarcinoma.
Obesity: Increases risk, particularly for adenocarcinoma.
Dietary factors: Low intake of fruits and vegetables and frequent consumption of very hot beverages.
Achalasia: A motility disorder of the oesophagus that impairs normal swallowing.
Genetic predisposition: A family history of oesophageal cancer may increase risk.

Symptoms

In the early stages, oesophageal carcinoma is usually asymptomatic. As the disease advances, typical symptoms include:

Dysphagia: Difficulty swallowing, initially with solid foods and later with liquids
Unintentional weight loss
Persistent hoarseness or chronic cough
Pain or pressure behind the breastbone (retrosternal pain)
Heartburn or acid regurgitation
Vomiting or blood in vomit
Black, tarry stools (indicating gastrointestinal bleeding)

Diagnosis

Diagnosis is established through a combination of investigations:

Oesophago-gastro-duodenoscopy (OGD): An endoscopic examination of the oesophagus allowing direct visualisation and tissue sampling (biopsy) for histological analysis.
Computed tomography (CT) scan: Used to assess the extent of the tumour and detect possible lymph node involvement or distant metastases.
Endoscopic ultrasound (EUS): Evaluates the depth of tumour invasion into the oesophageal wall and local lymph nodes.
PET-CT scan: A whole-body scan to detect distant spread of the cancer.

Treatment

Treatment depends on the tumour stage, histological type, and the overall health of the patient.

Surgery

Oesophagectomy - surgical removal of part or all of the oesophagus - is the cornerstone of curative treatment for localised tumours. It can be performed as open surgery or using minimally invasive (laparoscopic or robotic) techniques.

Chemotherapy and Radiotherapy

Neoadjuvant chemoradiotherapy (given before surgery) is commonly used to shrink the tumour prior to resection. In patients who are not surgical candidates, definitive chemoradiotherapy may be offered as the primary treatment.

Targeted Therapy and Immunotherapy

For advanced or metastatic disease, newer treatments are available, including immune checkpoint inhibitors (e.g., pembrolizumab, nivolumab) and HER2-targeted therapy (e.g., trastuzumab) for patients whose tumours express the HER2 protein.

Palliative Treatment

When the cancer cannot be cured, treatment focuses on relieving symptoms and improving quality of life. This may include placement of an oesophageal stent to improve swallowing, pain management, or palliative chemotherapy.

Prognosis

The prognosis of oesophageal carcinoma depends strongly on the stage at diagnosis. When detected early, survival rates are significantly better. However, overall five-year survival rates remain around 15–25 %, as the majority of cases are diagnosed at an advanced stage. Early detection and prompt treatment substantially improve outcomes.

References

Lordick F. et al. - Oesophageal cancer: ESMO Clinical Practice Guideline. Annals of Oncology, 2022; 33(10): 992–1004.
World Health Organization (WHO): Cancer Fact Sheet - Oesophageal Cancer. Available at: www.who.int/news-room/fact-sheets/detail/oesophageal-cancer
Rustgi A.K. & El-Serag H.B. - Esophageal Carcinoma. New England Journal of Medicine, 2014; 371(26): 2499–2509.

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