‘Nuclear strike’ helps destroy rare cancer

The oesophagus is the tube that carries food from your throat to your stomach. It is also known as the food pipe or gullet.

In Singapore, oesophageal cancer was the 9th most frequent cause of cancer deaths in men, according to the Singapore Cancer Registry (2008-2012). Oesophageal cancer affects more men than women and is more common among the elderly.

“If you have increasing trouble swallowing solid foods or liquids or find that food is frequently getting stuck in your chest when eating, you should see a doctor to rule out any malignant growth in the oesophagus,” Dr Matthew Ng Chau Hsien, Consultant, Department of Medical Oncology, National Cancer Centre Singapore (NCCS), a member of the SingHealth group.

Symptoms of oesophageal cancer

Early-stage oesophageal cancer is usually asymptomatic but as it progresses, the following signs and symptoms may appear:

  • Difficulty swallowing both solid foods and liquids (dysphagia)
  • Regurgitation of food and saliva
  • Persistent cough and hoarseness
  • Unintended weight loss
  • Indigestion and heartburn
  • Pain, pressure or burning sensation at the chest level

Risk factors for oesophageal cancer

The main risk factors for oesophageal cancer are:

  • Obesity
  • Smoking and
  • Heavy drinking

Barrett’s oesophagus, a complication from chronic acid reflux, can also increase the risk of oesophageal cancer. Patients with this should undergo regular surveillance by endoscopes.

In addition, some studies have found a link between processed meat intake and oesophageal cancer, but the evidence is not yet conclusive.

Types of oesophageal cancer

There are two main types of oesophageal cancer:

  • Adenocarcinoma, which affects the lower oesophagus. Obesity and Barrett’s oesophagus are major risk factors.
  • Squamous cell carcinoma, which usually affects the upper and middle oesophagus. Smoking and heavy drinking are major risk factors.

Diagnosis of oesophageal cancer

Doctors may perform the following tests to diagnose oesophageal cancer:

  • Endoscopy
    A 30-minute procedure in which the doctor inserts an endoscope (a fiber-optic tube with a tiny camera lens) through the mouth and down the oesophagus. The doctor can check for cancerous growths and take samples of suspicious tissues for further analysis.
  • Computed tomography (CT)
    CT scans of the abdomen and chest can confirm whether cancer has spread to the liver or lungs for example.
  • Barium test
    This test involves swallowing a thick liquid containing barium (an inorganic compound) which coats the lining of the oesophagus to allow the taking of x-ray images.

Treatment for oesophageal cancer

Treatment options depend on the cancer stage.

For oesophageal cancer which has not spread to distant organs, surgery offers the best chance of a cure. For very early-stage oesophageal cancer, the tumour can be removed by endoscope instead. During surgery, the tumour and surrounding lymph nodes are removed. Sometimes the upper part of the stomach may be removed as well. In some patients, chemotherapy and radiotherapy before surgery may help improve outcomes further.

“In patients who are not fit for surgery but whose cancer remains localised, we may recommend a combination of chemotherapy and radiotherapy,” says Dr Ng.

For oesophageal cancer that has spread to distant organs, treatment is aimed at symptom relief and prolonging life. Chemotherapy may help to slow the cancer growth. Radiotherapy on its own can shrink the tumour and help improve swallowing.

If the tumour is causing difficulty in swallowing, a metal stent can be inserted to keep the oesophagus open. Alternatively, a feeding tube can be placed from the nose, along the oesophagus and into the stomach to provide nutrition.

Ref: R14