‘Red Flag Series’

What is cancer of the oesophagus?

Cancer of the oesophagus is also known as oesophageal cancer. The oesophagus is the long tube that carries food from the throat to the stomach.

More than 95% of oesophageal cancers are squamous cell carcinomas or adenocarcinomas. A delay in diagnosing or treating oesophageal cancer may lead to a claim for medical negligence.

Squamous cell carcinoma – this develops in the thin, flat cells of the mucosa, which line the oesophagus.

Adenocarcinoma – this develops in the glandular cells of the submucosal lining of the oesophagus, which produce mucus.

Cancer can occur anywhere along the length of the oesophagus. However, squamous cell cancers occur more commonly in the upper and middle regions. Adenocarcinomas tend to be more common at the lower end, including the junction where the oesophagus joins the stomach.

How prevalent is cancer of the oesophagus?

Worldwide, nearly half a million people are diagnosed with oesophageal cancer every year. It is the ninth most common type of cancer in the UK, with more than 8,500 new cases diagnosed each year.

What causes cancer of the oesophagus?

The exact causes of oesophageal cancer aren’t fully understood. It appears to be more common in people who have long-term acid reflux. This can occur when people have conditions such as gastro-oesophageal reflux disease (GORD).

Damage to the oesophagus caused by acid reflux can lead to a condition called Barrett’s oesophagus. In this condition, abnormal cells develop in the lining of the lower end of the oesophagus. It’s not a cancer, but a small number of people (around 1 in 200) with Barrett’s oesophagus may go on to develop cancer.

What are the warning signs of cancer of the oesophagus?

Symptoms of Cancer of the Oesophagus can include:

  •  pain or difficulty swallowing
  •  weight loss
  •  throat pain
  •  vomiting or regurgitating food
  •  pain or discomfort behind the breastbone or in the back
  •  a persistent cough or coughing up blood
  •  a hoarse voice
  •  acid indigestion

What are the treatment options for cancer of the oesophagus?

Factors influencing the treatment approach include how large the tumour has grown, how deeply it has invaded the layers of the oesophagus, whether it has spread and your general health.

When a patient is healthy enough, surgery is used to treat this cancer. Surgery is sometimes offered alone or combined with chemotherapy and radiotherapy. Surgery alone can be a cure if the cancer is found early and has not spread beyond the oesophagus. It is also used to relieve symptoms including swallowing problems.

A combination of chemotherapy and radiotherapy may be used without surgery and chemotherapy can be given before surgery. Radiotherapy is also used to relieve pain, enhance swallowing, or treat other symptoms of oesophageal cancer.

Where can negligence happen?

A claim for medical negligence may arise because of a number of reasons including test results being misreported and follow up appointments being missed because of hospital administrative errors. However, in my experience, the most common reason for a medical negligence claim regarding cancer of the oesophagus relates to a delay in diagnosis because the symptoms are misdiagnosed as less serious conditions. A delay in diagnosis may have a detrimental effect upon the treatment options available.