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Oesophageal Cancer

Oesophageal cancer occurs when uncontrolled abnormal cells develop in layers of the oesophageal wall.

Last modified: December 14, 2021

Quick facts about oesophageal cancerQuick facts

The oesophagus is the tube that transports food from your throat to your stomach to be digested. There are three layers of the oesophageal wall, which include the mucosa (made up of squamous cells), submucosa and muscle layer (muscularis propria), in addition to the outer covering (adventitia)
Most oesophageal cancers begin in the lower section of the oesophagus
In Malaysia, there were 427 new diagnoses of oesophageal cancer in 2022.
It is the 20th most common cancer in Malaysia.

Types of oesophageal cancerTypes of oesophageal cancer

The two most common types of oesophageal cancer are:

Oesophageal adenocarcinoma

Cancer that develops in the glandular cells which line the oesophagus. This type of cancer typically forms in the lower section of the oesophagus.

Oesophageal squamous cell carcinoma

Cancer that begins in squamous cells that line the oesophagus. This often develops in the middle and upper part of the oesophagus

Other types of oesophageal cancer include small cell carcinoma, lymphoma, neuroendocrine tumours and gastrointestinal stromal tumours.

Signs and symptoms of oesophageal cancerSigns and symptoms

As signs and symptoms for oesophageal cancer can be similar to other common conditions, it’s important to see your GP or healthcare professional if you experience any of the symptoms below. Discussing anything concerning with your doctor as soon as possible can help give you peace of mind and offer the best chance of successful treatment if you receive an oesophageal cancer diagnosis.

Oesophageal cancer be difficult to detect as there are often no symptoms during the early stages. However, as the disease progresses symptoms may include:

Pain or difficulty swallowing such as a feeling of choking when swallowing
Heartburn or indigestion
Vomiting blood
Black or bloody stools
Unexplained fatigue
Discomfort in the upper abdomen particularly when eating
Unexpected weight loss
Coughing or hoarseness

Stages of oesophageal cancerStages

The TNM system is used to stage oesophageal cancer, and it helps doctors understand what your cancer looks like. The TNM stands for:

Tumour – The extent to which the tumour infiltrates into surrounding tissue
Node – Is a measure of surrounding lymph nodes involvement
Metastasis – Describes whether or not the cancer has spread to other parts of the body

The TNM information, along with other tests, helps determine the stage of your oesophageal cancer using the guidelines below:

Stage 0

The cancer is only in the top layer of the oesophageal lining (epithelium) and has not spread to deeper layers of the oesophagus.

Stage I

The cancer has grown into the mucosa, submucosa or muscle layer (muscularis propria).

Stage II

The cancer has spread to the muscularis propria or outer layer of the oesophagus (adventitia). Alternatively, the cancer has grown into the mucosa or submucosa and has spread to one or two nearby lymph nodes.

Stage III

The cancer has spread to the mucosa, submucosa, adventitia or muscularis propria and no more than six nearby lymph nodes. Alternatively, the cancer has grown into the pleura, pericardium or diaphragm and no more than two nearby lymph nodes.

Stage IV

The cancer has spread beyond the oesophageal wall to nearby lymph nodes and parts of the body such as the pleura, pericardium, diaphragm, trachea, aorta and spine, or throughout the body to distant lymph nodes and/or organs such as the liver or lungs.

Treatment for oesophageal cancer

There are many different types of treatment for oesophageal cancer. Your treatment will depend on you and your cancer.

Learn more

Frequently asked questions about oesophageal cancerFAQs

Is oesophageal cancer hereditary?

For most oesophageal cancer cases, genetic mutations are somatic (meaning they happen in cells only specific to that individual and are not inherited). In rare cases, genetics can play a role in the development of oesophageal cancer, particularly for people who have inherited gene mutations such as the RHBDF2 gene. However, the known risk factors of oesophageal cancer are high alcohol consumption and cigarette smoking.

What causes oesophageal cancer?

The cause of oesophageal cancer is not fully known, however there are a number of modifiable and non-modifiable factors which increase your risk of oesophageal cancer.

Age – older Malaysians are at a higher risk of oesophageal cancer
Being overweight or obese
Heavily drinking alcohol
Smoking
Drinking very hot liquids (above 65°C) frequently
Family history – including oesophageal cancer, pre-existing medical conditions such as gastroesophageal reflux disease (GERD), Barrett’s oesophagus and achalasia or inherited genetic conditions such as Peutz-Jeghers syndrome (PJS) or Cowden syndrome

How common is oesophageal cancer?

Oesophageal cancer is an uncommon cancer in Malaysia, affecting 427 people in 2022. It affects both men and women, young and old, however is more common in older Malaysians.

How is oesophageal cancer diagnosed?

There are many different tests that are used to diagnose oesophageal cancer. This may include an endoscopy, which uses an endoscope to investigate the digestive tract and remove tissue (biopsy), or an endoscopic ultrasound which can indicate if the cancer has spread into the oesophageal wall or lymph nodes. Further tests may include CT/PET scans or laparoscopy to detect if the cancer has spread.

What can I do to decrease my risk of oesophageal cancer?

There are a number of lifestyle-related factors you can consider to reduce your risk of developing oesophageal cancer, like:

Quit smoking – Cigarette smoking carries a significantly higher risk of developing oesophageal cancer
Get regular exercise – Cancer Australia recommends at least 30 minutes of moderate-intensity exercise each day
Reduce your alcohol intake – If you choose to drink, try to limit your alcohol intake to no more than two standard drinks a day. Alcohol consumption has a dose-response relationship with cancer (meaning the more you drink the higher the risk of developing cancer). Drinking alcohol has been related to cancers of the oesophagus
Eat a healthy, balanced diet – Eat a fibre-rich diet from grain and legume sources, as well as enjoy a variety of fruit (2 serves) and vegetables (5 serves) per day, limit your intake of salt and saturated fats, and avoid all processed meat

ReferencesReferences

For a full list of references, click here.

1. World Health Organisation. Global Cancer Observatory 2022. Retrieved on 24 January 2025 https://gco.iarc.who.int/media/globocan/factsheets/populations/458-malaysia-fact-sheet.pdf

2. Cancer Australia. (2021). Oesophageal cancer. Retrieved on 15 November 2021 from https://www.canceraustralia.gov.au/cancer-types/oesophageal-cancer/overview

3. Cancer Council. (2021). Understanding Stomach and Oesophageal cancers. Retrieved on 15 November 2021 from https://www.cancercouncil.com.au/wp-content/uploads/2021/11/Understanding-Stomach-and-Oesophageal-Cancers-2021.pdf

4. American Cancer Society. (2021). Esophageal Cancer Stages. Retrieved on 15 November 2021 from https://www.cancer.org/cancer/esophagus-cancer/detection-diagnosis-staging/staging.html

5. Cancer Council Victoria (2021). Stomach and oesophageal cancer. Retrieved on 23 November 2021 from https://www.cancervic.org.au/cancer-information/types-of-cancer/stomach_and_oesophageal_cancer/stomach-oesophageal-cancer-overview.html

6. American Cancer Society (2020). Causes of esophagus cancer. Retrieved 23 November 2021 from https://www.cancer.org/cancer/esophagus-cancer/causes-risks-prevention/what-causes.html

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