Cancers of the oesophagus and stomach
The oesophagus is the tube through which we swallow food and the stomach is an organ in the upper part of the abdomen,which receives swallowed food and begins the process of digestion. Cancers can start in either of these locations. About 400 people are diagnosed with oesophageal cancer in NSW each year and just over 600 people are diagnosed with stomach cancer.
Causes
Cancers of the oesophagus start in its lining. There are two main types: adenocarcinoma and squamous cell carcinoma. Cancers start in the stomach wall and are almost always of the adenocarcinoma type. Because both the oesophagus and stomach are involved in transporting and digesting food, cancers that start in these locations often cause changes in the ability to swallow and absorb food.
Symptoms
When a cancer starts in the oesophagus, it can cause difficulty in swallowing food, with a feeling that food is “getting stuck” before reaching the stomach. This usually begins with solid foods getting stuck, but can worsen to a degree where liquids can’t be swallowed. Sometimes these cancers can also cause pain. Because people find it difficult to eat and swallow normally, weight loss is also common.
Stomach cancer often makes people that they are full, even after eating only a small amount of food. As a result weight loss can occur. They can also produce a feeling of indigestion, bloating, nausea or vomiting. Sometimes stomach cancers result in bleeding, which can produce black bowel motions.
Diagnosis
To diagnose oesophageal or stomach cancer a procedure called
gastroscopy (sometimes also known as endoscopy, oesophagoscopy or upper GI
endoscopy) is performed. This involves a flexible tube being swallowed, through
which doctors can look at, and take a sample (biopsy) of any suspicious
areas. It is also possible to attach an
ultrasound machine to the gastroscopy equipment and perform endoscopic
ultrasound. This provides extra information about possible spread of the
cancer.
Other tests that are often performed if oesophageal or
stomach cancer is diagnosed include CT scans to look for the size and shape of
the cancer as well as to identify signs of spread; and a PET scan to look for
spread of the cancer. Laparoscopy is
also often performed to help assess people with stomach cancer. This is a form
of keyhole surgery where doctors are able to look inside the abdomen, directly
at the outside lining of the stomach and other organs. This is done to check
for signs of spread of the cancer within the abdomen.
Treatment
The treatment that is given for oesophageal or stomach
cancer depends on many factors, including the size and spread of the cancer,
other illnesses that people may have and the patient’s wishes. A team that
includes surgeons, medical and radiation oncologists, nurses and dietitians,
usually provide treatment for these cancers. Other health professionals, such
as psychologists / counselors, social workers, and palliative care specialists
may also play a part in providing care.
For oesophageal cancer chemotherapy and radiotherapy are
often used in combination. These treatments are sometimes used in an attempt to
cure the cancer. At other times, they are used to improve symptoms, such as
difficulties with swallowing, without curing the underlying cancer. Operations
to remove the oesophagus are also sometimes performed. If swallowing remains a
problem, a thin tube, called a stent can be put into the esophagus to try and
improve this problem. If you are a patient, it is important to check with your
doctor which treatment(s) is right for you.
For stomach cancers that have not spread, surgery to remove
the stomach (gastrectomy) may be performed. Chemotherapy is sometimes given
before or after this operation to improve the chances of success. If the cancer
has spread beyond the stomach it is usually not possible to cure it, and
treatments are chosen to help with symptoms and prolong life. The treatments
may include chemotherapy, and radiotherapy.