Introduction Cancer of oesophagus (food-pipe or gullet) is a relatively rare cancer of the bowel tract in Singapore. It is less common than cancer of the colon or stomach but has a poor prognosis with an overall 5-year survival rate of 5-10%. It is essentially a disease of the older age group with the majority of cases diagnosed after 60 years of age. It is more common in male than female. Other risk factors are smoking, excessive alcohol consumption, individuals with acid reflux/Barrett's oesophagus and diet lacking in fresh fruits and vegetables.

View of cancer of the gullet during gastroscopy

Symptoms Early cancers of the oesophagus are usually asymptomatic and are detected by chance only. By the time symptoms appear the cancer is usually in the advance stage. The main symptom is increasing difficulty with swallowing, initially with solid food and this is followed by liquid and finally complete inability to swallow even one own's saliva. Unfortunately by the time swallowing difficulty develops, the cancers have usually invaded more than two-third of the wall of the gullet and may have spread to lymph nodes or other organs. Other symptoms are chest pain, cough, painful swallowing and weight loss. Investigations Tests for Diagnosis of cancer Endoscopy or gastroscopy is the best test as it allows visualisation of the tumour and tissue to be taken for biopsy. Barium meal is an alternative test to visualise the tumour but it does not allow biopsies to be taken. Tests for Staging of cancer Following confirmation of the cancer, your doctor may proceed with further investigations such as CAT scan and endoscopic ultrasound to stage or assess the extent and spread of the cancer. The cancer is considered to be early if it is only limited to the wall of the gullet. It is advanced if it has spread beyond the wall of the gullet to the surrounding tissues, lymph nodes or other organs. Staging of the cancer is critical in the planning and formulating of treatment options for individual patient. Treatment The treatment varies from patient to patient, depending on a number of considerations, such as the stage of the cancer, patient's age, the medical and functional status of the patient. Curative treatment Surgical resection to remove the cancer completely remains the only form of curative treatment for those who have early cancer. Only 10% of patients are amenable to surgical resection as most patients present late. Palliative therapy For the majority of the patients who are not amenable to surgical resection, the cornerstone of palliative therapy is aimed at relieving patient's difficulty with swallowing. These therapies will allow patients to maintain adequate nutrients intake and quality of life. The commonly used methods are: 1) placing a self-expandable metal tubes (stent) across the narrowing caused by the cancer so as to open up the passage way or 2) to burn away parts of the cancer by LASER. All these procedures are minimally invasive and can be performed using the gastroscopy or endoscope. Immediate relief of dysphagia can be achieved in 80-90% of the patients. Radiotherapy and chemotherapy can be also be applied for palliation but unlike the above methods, it does not achieve immediate relief and may takes 6-8 weeks to produce any significant improvement in swallowing. Conclusions Oesophageal cancer is still relatively rare in Singapore and usually affects the elderly population. Currently there is still no good screening test for early detection of this cancer. Patients with certain conditions, such as chronic acid reflux disease with Barrett's esophagus may benefit from regular endoscopy surveillance to detect early cancerous changes. For the majority with advance disease, highly effective palliative measures are available to relieve their symptoms so that their quality of life is not severely impaired.