Oesophageal cancer
Two histological types with different risk factors — and one symptom, difficulty swallowing, that should never be left to wait.
What it is
Oesophageal cancer occurs in two main histological types with different risk factors: squamous cell carcinoma, linked mainly to smoking and alcohol, and adenocarcinoma, linked to chronic gastro-oesophageal reflux and Barrett’s oesophagus.
Symptoms and diagnosis
The characteristic symptom is progressive difficulty swallowing — solids first, liquids later. It is often accompanied by weight loss and retrosternal pain.
Difficulty swallowing is never a symptom to wait on. It needs endoscopy, not empirical treatment.
Treatment options
In disease treatable with curative intent, the usual strategy combines chemoradiotherapy before surgery, and in some cases immunotherapy afterwards. In advanced disease treatment is biomarker-driven, with chemotherapy as the backbone.
Restoring swallowing and supporting nutrition are addressed alongside treatment, not after it.
How this is approached at the practice
Every case is discussed in a multidisciplinary team meeting (MDT) — surgeon, radiation oncologist, pathologist, radiologist and, where needed, psycho-oncologist and dietitian. The treatment decision is not made by one doctor alone.
Before any treatment is proposed, the tumour undergoes full molecular and immunohistochemical characterisation, so the choice targets your specific biology rather than a generic protocol. Every alternative is presented with its trade-offs, and a second opinion is treated as an ally.
Biomarkers tested
Molecular and immunohistochemical characterisation is done before treatment is chosen, so the decision rests on this particular tumour’s biology.
Frequently asked questions
Does chronic reflux lead to cancer?
In the great majority of people, no. Long-standing reflux can, however, lead to Barrett’s oesophagus, a condition that is monitored endoscopically because it raises risk.
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