Oesophageal Cancer

Oesophageal cancer starts in the lining of the gullet, the tube that carries food from the throat to the stomach. There are two main types: squamous cell carcinoma, usually in the upper and middle part, and adenocarcinoma, usually at the lower end near the stomach.

It is often found late because the gullet stretches and symptoms appear only when the passage has narrowed considerably. Treatment is demanding and typically combines chemotherapy or chemoradiotherapy with major surgery, so where and by whom it is done matters.

Symptome

• Food sticking or difficulty swallowing that gets progressively worse, first with solids
• Unintended weight loss
• Pain behind the breastbone or on swallowing
• Persistent heartburn or indigestion that has changed
• Hoarse voice or chronic cough
• Vomiting or bringing food back up
• Black stools or anaemia

Ursachen und Risikofaktoren

Squamous cell cancer is strongly linked to smoking and alcohol, particularly together, and also to very hot drinks, achalasia and earlier radiotherapy to the chest. Adenocarcinoma is linked to long-standing acid reflux, Barrett's oesophagus, central obesity and smoking. Both types are more common in men and after the age of 55. In most patients several factors act together over decades.

Wie es diagnostiziert wird

• Gastroscopy with biopsy: Shows the tumour and gives the tissue diagnosis and type.
• CT of chest, abdomen and pelvis: Looks for spread to lymph nodes, liver and lungs.
• PET-CT: Detects distant spread not visible on CT and prevents futile surgery.
• Endoscopic ultrasound: Measures how deep the tumour goes into the wall and samples nearby nodes.
• Fitness assessment: Lung function, heart tests and nutritional review, since treatment places heavy demands on the body.
• Tumour markers: HER2, PD-L1 and mismatch repair testing guide drug choice in advanced disease.

Behandlungsmöglichkeiten

• Endoscopic resection: For very early tumours limited to the lining, sometimes followed by ablation of surrounding Barrett's.
• Chemoradiotherapy or chemotherapy before surgery: Standard for locally advanced disease, given over several weeks.
• Oesophagectomy: Removal of most of the gullet with the stomach pulled up as a replacement, by open, keyhole or robotic approach. Hospital stay is typically 10 to 14 days and full recovery takes months.
• Definitive chemoradiotherapy: An alternative to surgery, particularly for squamous cancers and tumours high in the gullet.
• Immunotherapy and targeted therapy: Used after surgery in some cases and in advanced disease.
• Stents and palliative care: A stent or radiotherapy relieves swallowing difficulty when cure is not possible.

Wenn es dringend ist

Complete inability to swallow liquids or saliva, vomiting blood, black tarry stools, or chest pain with fever after an endoscopy or dilatation need emergency hospital care where you are.

Reisen nach Türkiye zur Behandlung

Pre-operative treatment, surgery and recovery span four to six months, which makes this one of the harder cancers to treat far from home. Realistic options are a rapid staging work-up and multidisciplinary opinion (about a week), surgery alone at a high-volume unit after chemotherapy at home, or the full course if you can relocate with a carer. Outcomes of oesophagectomy are closely tied to surgical volume, so ask for the unit's numbers. No responsible team can predict your outcome before staging is complete.

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