If you have difficulty swallowing, go for oesophageal cancer screening

Oesophageal cancer, also called oesophageal carcinoma, is characterised by a tumour or lump that is formed as a result of cells which grow out of control in the oesophagus. Oesophageal continues to have poor prognosis globally.

In spite of improved diagnostic techniques and treatment, most patients, particularly in Africa, are diagnosed when the disease is at an advanced stage.

There are two types of oesophageal cancer: Adenocarcinoma, which occurs in the lower part of the oesophagus close to the stomach, and squamous cell carcinoma, which occurs in the upper part of the oesophagus.

Previously, squamous cell carcinoma was the more common type, but Western literature indicates a rising incidence of adenocarcinoma.

Dear Doc,

I read on the Internet that men are at more risk of oesophageal cancer than women. Why is this so?

Daisy

Dear Daisy,

This is a rather difficult question to answer because the exact reason is not known. However, what is known is that oesophageal cancer is the leading cancer in males in Kenya, and is ranked second in Uganda.

The ratio of males to females affected is 2:1. Some assumptions have been made in an attempt to answer this question; for instance, it is believed that men have more risk factors than women because more men smoke cigarettes and drink alcohol than women. But, there could be other reasons that are not known.

Dear Doc,

I am a smoker; will I get oesophageal cancer? What else can cause this disease?

Billy

Dear Billy,

Smoking is one the risk factors for oesophageal cancer, but that does not mean you will get the disease. However, it is advisable to quit smoking because the more and longer you continue smoking, the higher your risk of getting oesophageal cancer.

Other risk factors include age (especially 50-60 years), sex (being male), eating a high-starch diet or a diet with little fruits and vegetables, or eating a lot of red meat, which has nitroso amines.

Heavy consumption of alcohol is also linked to the disease, especially hard liquor. People who have Barrett’s oesophagus (reflux of stomach acids into the lower part of oesophagus) or achalasia (failure of the lower oesophageal sphincter to relax properly) have a high risk of developing oesophageal cancer.

In addition, beverages like hot tea can result in thermal mucosal injuries. An d foods that can irritate the oesophagus like dry bread or mursik can cause changes in it, which can in turn lead to oesophageal cancer.

Notably, squamous cell carcinoma is common in blacks, while adenocarcimona is more common among Caucasians.

Dear Doc,

Is there a link between smoking and the development of oesophageal cancer, or is it a myth? Wesley

Dear Wesley,

It is not a myth. Smoking is associated with almost all types of cancer, except breast cancer. Tobacco contains many carcinogens (cancer-causing agents) that are known to trigger cancer.

For cancer to develop, it requires several triggers, which include the genetic make-up of a person. Smoking is just one of the triggers that can be avoided.

Dear Doc,

How is oesophageal cancer detected and are there screening tests available?
KK

Dear KK,

Oesophageal cancer can be detected early via screening programmes in the high-risk populations, such as in people with Barrett’s oesophagus. However, what is important is the history of the patient complaining of symptoms related to oesophageal cancer.

This is followed by clinical examination and investigations through medical tests such as an endoscopy or a special X-ray called barium swallow.

High risk areas like China have in place screening programmes where those at risk have an upper GIT endoscopy done every year. This helps to detect cancer in its early stages, when chances of successfully treating it are high.

However, in other countries, screening remains a dream due to lack of screening programmes.

Dear Doc,

What are some of the symptoms to watch out for in case one has oesophageal cancer?
Jeremy

Dear Jeremy,

Normally, early oesophageal cancer shows no symptoms at all. But as the disease progresses, it might cause an obstruction in the oesophagus, which could lead to the following symptoms: progressive difficulty in swallowing — dysphagia — for a period of more than six months, particularly in men aged 50-60.

Initially, a person finds it difficult to swallow solid foods, then light foods, porridge, and with time, even swallowing fluids and saliva becomes painful.

Unintentional weight loss, usually of more than 10 per cent of a person’s normal body weight. Some people might suffer from iron deficiency anaemia.

Other symptoms are related to the spread of the cancer, such as changes in the voice, abdominal distension because of fluid accumulation, and pleural effusions (fluid in the chest). See a doctor immediately if these symptoms are prolonged.

Dear Doc,

My friend’s dad was diagnosed with oesophageal cancer. What are his treatment options? Can it be cured?

Pat

Dear Pat,
The treatment for oesophageal cancer depends on a person’s overall health and the extent (stage) of the cancer. Treatment can be aimed at curing the cancer, or as a palliative in cases in which it is not possible to remove the cancerous cells. Palliative treatment is used to ease symptoms such as pain when swallowing, but it does not cure the cancer.

Other treatment options include surgery, chemotherapy and radiation therapy, and can be used either alone or in combination, depending on the extent of the cancer. In stages 1 and 2 of cancer, surgery is aimed at curing it but in stage 3, it is used for palliative purposes.

Surgery can involve the removal of a section of or the entire oesophagus and some part of the stomach. Non-operative treatment is done for cancer that is in stage 4.

Curative treatment should not be attempted on patients who have poor lung function and heart problems. This is because the risk of death outweighs the benefits of treatment.

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