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Oesophageal Cancer SINGAPORE

What is oesophageal cancer?

The oesophagus is a hollow muscular tube that connects the mouth to the stomach. It is responsible for moving food from the throat to the stomach. Oesophageal cancer can occur when a malignant tumor forms in the lining of the oesophagus. As the tumor grows, it can affect the deep tissues and muscle of the oesophagus. A tumor can appear anywhere along the length of the oesophagus, including where the oesophagus and the stomach meet.

What are the common types of oesophageal cancer?

  • Squamous cell carcinoma occurs when cancer starts in the flat, thin cells that make up the lining of the oesophagus. This form most often appears in the top or middle of the oesophagus, but it can appear anywhere.

  • Adenocarcinoma occurs when cancer starts in the glandular cells of the oesophagus that are responsible for the production of fluids such as mucus. Adenocarcinomas are most common in the lower portion of the oesophagus.

Causes of Oesophageal Cancer

As with most cancers, the cause of oesophageal cancer isn’t yet known. It’s believed to be related to abnormalities (mutations) in the DNA of the cells related to the oesophagus. These mutations signal the cells to multiply more rapidly than normal cells. These mutations also disrupt the signal for these cells to die when they should. This causes them to accumulate and become tumors.

Who is at risk for developing oesophageal cancer?

During the early stages of oesophageal cancer, you probably won’t experience any symptoms. As your cancer progresses, you may experience:

  • unintentional weight loss

  • indigestion

  • heartburn

  • pain or difficulty when swallowing

  • frequent choking while eating

  • vomiting

  • food coming back up the oesophagus

  • chest pain

  • fatigue

  • chronic cough

  • hiccups

Diagnosing oesophageal cancer

Testing methods for diagnosing oesophageal cancer include the following:

 

  • An endoscopy / oesophagoscopy involves the use of an instrument with a camera attached to a tube that goes down your throat and allows your doctor to view the lining of your oesophagus to check for abnormalities and irritation.

  • A barium swallow is an X-ray imaging test that allows your doctor to see the lining of your oesophagus. To do this, you swallow a chemical called barium while the images are being obtained.

  • A biopsy is a process in which your doctor removes a sample of the suspicious tissue with the help of an endoscope and sends it to a lab for testing.

  • A CT scan, PET scan, or MRI may be used to see if cancer has spread to other parts of the body.

Treating oesophageal cancer

Your doctor may recommend surgery if the cancer hasn’t spread to other parts of your body.

 

Your doctor may instead recommend chemotherapy or radiation therapy as the best course of action. These treatments are also sometimes done to shrink tumors in the oesophagus so that they can then be removed more easily with surgery.

 

Surgery

The most common procedure used to treat Oesophageal cancer would be the Oesophagectomy. This type of procedure is done to remove parts of or most of the oesophagus along with the tissues surrounding it that contain the cancerous cells. The surgeon would then reposition the stomach further up the chest or use a piece of the small intestine to preserve the oesophageal function. He may also remove samples from the lymph nodes to check for lymph cancer.

 

Radiation therapy

This form of treatment involves the use of X-rays and protons to generate powerful beams of energy that will be precisely directed to the locations of the cancer cells to kill it. This may be used pre-surgery for those with cancer that has not spread to the rest of the body. For people who are unable to undergo surgery, this combined with chemotherapy would be the primary treatment method. Lastly, for those with cancer that has spread to the rest of the body, this may be a form of treatment to reduce pain.

 

Chemotherapy

This is usually a combined treatment of both oral and injectable medication administered over weeks or months. These are extremely strong drugs used to kill the cancer cells and can be used pre-surgery to shrink cancer. It can also be coupled with radiation treatment for those that are unable to undergo surgery. Lastly, for those with cancer that has spread throughout the body, this is a form of treatment to reduce pain.

 

Endoscopic Submucosal Dissection (EDS) Or Endoscopic Mucosal Resection (EMR)

These are used to treats tumours detected when they are small and have not spread to the rest of the body. This is done endoscopically without having the patient undergo the removal of their oesophagus. In cases where the tumour is large enough to cause a blockage in the oesophagus, endoscopic laser therapy may be used to cut a hole in the blockage to improve swallowing.

Photodynamic Therapy

This treatment makes use of drugs that can be activated by non-thermal light. It will be taken up by the cancer cells thereby destroying it when activated. This is used to ease the symptoms of oesophageal cancer, in particular, difficulty swallowing.