Oesophagal cancer (Carcinoma)

The oesophagus is a tube that connects the mouth and throat with the stomach (“food pipe”). When a person swallows, the muscular wall of the esophagus contracts to help push food down to the stomach. There are two main types of cancer that can occur in the oesophagus. Squamous cell carcinoma occurs more commonly in the upper or middle part of the oesophagus. 
A denocarcinoma occurs in the lower part of the oesophagus.

Who gets oesophageal cancer? 

Studies show that oesophageal cancer is more commonly diagnosed in people over 55 years. Men are affected twice as commonly as women.

The exact cause is unknown; however there are well-recognised risk factors. Excessive alcohol consumption, smoking and obesity are major risk factors. Stopping drinking alcohol and smoking may reduce the chance of getting oesophageal cancer as well as other types of cancers. Sometimes adenocarcinoma of the oesophagus runs in families. 

The risk of cancer of the oesophagus is also increased by irritation of the lining of the oesophagus. In patients with acid reflux, where contents from the stomach back up into the oesophagus, the cells that line the oesophagus can change and begin to resemble the cells of the intestine. This condition is knows as Barrett’s oesophagus. Those with Barrett’s oesophagus have a higher risk of developing oesophageal cancer.

Less common causes of irritation can also increase the chance of developing oesophageal cancer. For example, people who have swallowed caustic substances like acid can have damage to the oesophagus that increases the risk of developing oesophageal cancer. 

What are the symptoms of oesophageal cancer?

Very small tumours at an early stage do not generally cause symptoms. Patients commonly experience difficulty swallowing as the tumour gets larger and the width of the oesophagus becomes narrowed. At first, most have trouble swallowing solid foods such as meats, bread or raw vegetables. As the tumour grows, the oesophagus becomes more narrowed causing difficulty in swallowing even liquids. Cancer of the oesophagus can also cause symptoms of indigestion, heartburn, vomiting and choking. Patients may also have coughing and hoarseness of the voice. Involuntary weight loss is also common. 

How is oesophageal cancer diagnosed?

The doctor will generally start by taking a complete history and performing a physical examination. Most patients undergo a test called endoscopy where a thin flexible lighted instrument with a camera at the end is passed through the mouth into the oesophagus. This scope allows the doctor to see the inner layer of the oesophagus. Biopsies can be taken during this procedure if needed and submitted to the pathologist for examination under a microscope to detect cancer cells.

A CT scan of the neck, chest and abdomen may help to identify if there is any spread of the cancer to other organs in the body so that the doctor can determine appropriate management. 

Endoscopic ultrasound is a newer technique that can be used to provide detailed assessment of the depth of the tumour and involvement of adjacent lymph nodes. This instrument is similar to the endoscope above except there is ultrasound embedded at the tip of the scope.

What is the treatment for oesophageal cancer?

Depending on the stage of oesophageal cancer the patient may undergo surgery, radiation and/or chemotherapy. Other measures that may improve symptoms include stretching or dilation, tube prosthesis (stent) and radiation or laser treatment to reduce the size of the cancer.

Doctors are actively looking at new ways of combining various types of treatment to see if they may have a better effect on treating oesophageal cancer. Many patients with oesophageal cancer undergo some form of combination therapy with surgery, radiation and chemotherapy.

Stomach cancer (Gastric cancer)

The stomach is part of the digestive system and connects the oesophagus to the small intestine. Once food enters the stomach the muscles in the stomach help to mix and mash the food using a motion called peristalsis. Stomach cancer can develop in any part of the stomach and can spread throughout the stomach and to other organs such as the small intestines, lymph nodes, liver, pancreas and colon. 

Who gets stomach cancer?

No one knows the exact reason why a person gets stomach cancer. Researchers have learned that there are certain risk factors associated with the development of stomach cancer. Those over the age of 55 years are more likely to get stomach cancer and men are affected twice as often as women

Stomach cancer is more common in some parts of the world such as Japan, Korea, parts of Eastern Europe and Latin America. Some studies do suggest that a type of bacteria known as Helicobacter pylori, which can cause inflammation and ulcers in the stomach, can be an important risk factor for developing gastric cancer.

Studies show that people who have had stomach surgery or have a condition such as pernicious anemia, or gastric atrophy (which result in lower than normal production of digestive juices) can be associated with an increased risk of developing gastric cancer. 

There is also some evidence that smoking increases the risk of developing gastric cancer.

What are the symptoms of gastric cancer?

Patients may not have any symptoms in the early stages and often the diagnosis is made after the cancer has spread. The most common symptoms include: 

• Pain or discomfort in the abdomen 
• Nausea and vomiting

Loss of appetite 

• Fatigue or weakness 
• Bleeding (vomiting blood or passing blood in stools) 
• Weight loss 
• Early satiety (inability to eat a complete meal because of a “full feeling”)

How is gastric cancer diagnosed?

In addition to taking a complete history and performing a physical exam, your doctor may do one or more of the following tests: 

Endoscopy- An endoscope is inserted through the mouth into the oesophagus and then into the stomach. Sedation is given prior to insertion of the endoscope. If an abnormal area is found, biopsies (tissue samples) can be taken and examined under a microscope to look for cancer cells.

Upper GI series- The patient is asked to drink a barium solution. Subsequently x-rays of the stomach are taken. The barium outlines the inside of the stomach helping to reveal any abnormal areas that may be involved with cancer. This test is used less often than it used to be, and patients now often undergo endoscopy first. 

If cancer is found, the doctor may schedule additional staging tests to determine if the cancer has spread. A CT scan may be used to determine if cancer has spread to the liver, pancreas, lungs or other organs near the stomach.

Staging of gastric cancer may also be performed by using endoscopic ultrasound. Endoscopic ultrasound can help to determine the depth of spread of the tumour into the wall of the stomach and involvement of adjacent structures as well as assess for any enlarged lymph nodes that may be invaded with cancer cells. 

What is the treatment for stomach cancer?

Treatment plans may vary depending on the size, location, extent of tumour and the patient’s overall health. Treatments include surgery, chemotherapy and /or radiation therapy. 

Surgery is the most common treatment. The surgeon can remove part of the stomach (gastrectomy) or the entire stomach. Lymph nodes near the tumour are generally removed during surgery so that they can be checked for cancer cells.
Researchers are exploring the use of chemotherapy before surgery to help shrink the tumour and after surgery to help kill residual tumour cells. Chemotherapy is given in cycles with intervals of several weeks depending on the drugs used.
Radiation therapy is the use of high-energy rays to damage cancer cells and stop them from growing. Radiation destroys the cancer cells only in the treated area.

Doctors are looking at the combination of surgery, chemotherapy and radiation therapy to see what combination would have the most beneficial effect.