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.
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 oesohageal cancer, called squamous cell and adenocarcinoma. The risk factors for developing oesophagus cancer include a condition called Barrett’s oesophagus, excessive alcohol consumption, and smoking. However, oesphagus cancer can arise when none of these risk factors are present.
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.
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.
The symptoms of oesophagus cancer include difficulty swallowing and weight loss. It is important to realize that these symptoms can also occur in other non-cancerous conditions.
There are around 290 new diagnoses of oesophageal cancer each year in New Zealand and sadly, 5-year survival rates remain below 30%.