In the latest of a series of articles about cancer, consultant surgeon YKS Viswanath and specialist nurse Nicky Lackin, from the James Cook University Hospital in Middlesbrough, write about oesophageal cancer.

THE oesophagus, also commonly known as the gullet, is the long tube which connects your throat to your stomach. It is approximately 12 inches long in adults and when you swallow it takes the food to the stomach. There has been an increase in the incidence of this cancer in Western Europe and North America over the last 15 years.

What causes it?

Although once a relatively rare cancer, it is becoming more common. It is seen in more men than women and generally it is an older person's disease. The cause is still unknown but one form of oesophageal cancer called glandular cancer (adenocarcinoma) appears to be more common in people who have had long-term acid reflux (flowing back of acid from the stomach into the gullet). Smoking, with or without high Body Mass Index (obesity), can predispose a person to oesophageal cancer. In smokers, another type of oesophageal cancer known as squamous cell cancer is more common.

What are the symptoms?

Difficulty swallowing is the most common, along with weight loss. There may also be pain or discomfort behind the breastbone or in the back, and indigestion (dyspepsia) with pain in the upper abdomen. Unfortunately, a good proportion of patients with difficulty swallowing will have advanced disease. People who are over the age of 55 with new or recurrent symptoms of heartburn, despite taking conventional medication, should seek advice from their GP. It must be remembered that a lot of these symptoms can be related to other conditions but it is best to go and speak to your GP.

How is it diagnosed?

Your GP will examine you and then ask you to go and see a specialist in your local hospital, who will arrange an endoscopy. This is a special test that looks directly into the oesophagus through a telescope. Biopsies can be taken at the same time if the hospital doctor thinks this is necessary.

What treatment

is available?

SURGERY

If the cancer is at an early stage and just seen within the oesophagus, the best treatment is surgery. This is major surgery and is only undertaken if your specialist, along with the other doctors who will be looking after you, feels that this is in your best interests. This will be discussed thoroughly with you.

CHEMOTHERAPY

Means that the patient will be given anti-cancer drugs which can kill cancer cells anywhere within the body.

RADIOTHERAPY

This means giving the patient radiation to the outside of the body, very much like having an x-ray but within a confined area to kill the cancer cells. Squamous cell cancer is known to respond better to radiotherapy than glandular cancer.

PALLIATIVE CARE

This means making the patient comfortable and treating any troublesome symptoms like pain, difficulty swallowing and indigestion as they happen, which will maintain their quality of life for as long as they live.

The role of screening

Currently, there is no robust evidence to suggest that screening will detect this cancer at an early stage.

Key points to remember:

* See your GP if you have any of the listed symptoms and they have lasted for a few weeks. If you have difficulty swallowing, however, you must see your GP as soon as possible.

* Try to stop smoking and reduce your alcohol intake if you drink more than the recommended amount per week.

* Try to eat as healthily as possible.

Speak to your GP if you are worried.