Oesophageal cancer

Oesophageal cancer, or cancer of the gullet, is becoming more common, especially over the last 30 years. It is more common in men than women, and effects older people predominantly. Oesophageal cancer typically originates in the inner layers of the lining of the oesophagus and grows outward.
Risk factors include tobacco, alcohol, reflux disease (GORD), radiation and Barrett's oesophagus.
There are two main types, adenocarcinoma and sqaumous cell carcinoma.

Symptoms
Dysphagia (difficulty swallowing) is the most common symptom, occurring when the tumour grows and obstructs the normally hollow oesophagus. However, symptoms tend to occur when the tumour has grown to a large size, hence, most patients are not diagnosed until the late stages of the disease, making this type of cancer difficult to treat.
Other symptoms include weight loss, hoarseness, chest and back pain.

Diagnosis
To diagnose oesophageal cancer, a physician will first ask questions concerning specific symptoms and their nature and timing, medication and previous medical history.
A physician may perform several examinations to aid in diagnosis and decide on treatment.
These include X-ray with barium swallow to help localise the tumour. This involves swallowing barium to show the lining of the oesophagus on the x-ray.
In order to visualise the tumour and obtain tissue samples (biopsies), endoscopy may be performed. This involves advancing a lighted viewing instrument (endoscope) into the oesophagus.
To investigate the possibility that metastasis (spread) has taken place), a chest x-ray, bone scan, CT scan and blood tests to assess liver function may be performed.

Treatment
Treatment for esophageal cancer is determined by the stage of the disease and the patient's general health. A stent may be placed in the oesophagus to relieve symptoms of dysphagia and improve passage of food into the stomach.
Surgery involves removing the oesophagus (oesophagectomy). The stomach may be drawn up in order to replace the function of the oesophagus, or part of the colon may be used to replace it (colon interposition).