Oesophageal cancer
Incidence
There are 7800 new cases each year in the UK which is approximately 13 per 100,000 of the population and has been rising for the past 30 years mainly in men for reasons unknown. The male to female ratio is 5:1
Risk factors
There are two types of oesophageal cancer with one type being associated with deprivation being found more commonly in the north of England than the south.
Only France has a higher rate than the UK in Europe but worldwide the highest incidence is along a geographical belt that includes parts of Iran, Turkey, Russia, Afghanistan and China.
Preventative factors: Smoking and being overweight are risk factors. Acid regurgitation can also lead to chronic inflammation of the lower oesophagus known as Barretts oesophagus and this can eventually lead to the development of cancer in a few cases. Excess alcohol is also a risk factor.
Any condition that leads to chronic inflammation of the oesophagus can lead to an increased risk such as a condition called achalasia which leads to acid regurgitation and coeliac disease.
There is evidence of HPV virus infection in 15% of cases. This virus is responsible for most cervical cancers as well as some head and neck and anal tumours.
A previous history of radiotherapy to the chest for the treatment of breast cancer leads to a slightly increased risk seen after 15 years with a greater risk associated with the same treatment for lymphoma.
Heredity
The large majority have no heritable cause. There is one rare condition called tylosis which is associated with severe thickening of the skins of the palms and soles. Children have a 50% chance of inheriting this disorder if either parent is affected and is associated with an increased risk of oesophageal cancer.
Diet
The regular intake of fruit and vegetables has been shown to be preventative. Zinc deficiency is also associated with increased risk, as is chronic iron deficiency due to poor diet Oesophageal cancer appears to be more common in people who drink very hot beverages compared to those who drink warm fluids.
Symptoms and signs
The commonest symptom is difficulty in swallowing foods and then later liquids. There is usually associated weight loss and vomiting may occur in order to bring up the food which in unable to enter into the stomach due to the stricture. Chest pain due to acid regurgitation may also be a presenting symptom.
Treatment
Surgery is the treatment of choice but is often not possible due to the spread of the disease at presentation. Other options include radiotherapy or chemotherapy or a combination of these.