Upper Gastrointestinal Tract Screening
At present, screening for these cancers only exists for those with symptoms.
Oesophageal cancer is more common among men than among women. The lifetime risk of oesophageal cancer in the United States is about 1:125 in men and about 1:417 in women. It is more common in the white population, while American Indians, Alaskan natives and Hispanics have a lower rate of oesophageal cancer, followed by Asian/Pacific Islanders. It is much more common in other parts of the world such as Iran, Northern China, India and Southern Africa. Treatment has improved and survival rates are getting better.
During the 1960s and 1970s only about 5% of patients survived at least five years after being diagnosed. Now about 20% of patients survive at least five years after diagnosis and this includes patients with all stages of oesophageal cancer. Survival rates for people with early stage cancer are higher.
Any history of upper abdominal pain, reflux, dyspepsia or haematemesis or dysplasia or anyone aged 55 and over with weight loss and these symptoms should be referred for urgent upper GI endoscopy. It should also be considered in patients with upper abdominal pain, with anaemia or a raised platelet count and who has nausea or vomiting or weight loss or reflex or dyspepsia.
Cancer of the oesophagus starts when cells in the lining of the oesophagus begin to grow out of control. Oesophageal cancer can start anywhere along the oesophagus, but it starts in the inner layer of the oesophagus wall and grows outward to the other walls. The wall of the oesophagus has several layers, mucosa and this is the layer that lines the inside of the oesophagus. It has three parts; the epithelium, which is where most cancers of oesophagus start, then the thin layer of connective tissue under the epithelium and then the muscular layer below this thin layer.
Oesophageal Cancer Risk Factors
The chance of getting oesophageal cancer increases with age. Fewer than 15% of cases are found in people under the age of 55.
Men are more likely than women to get oesophageal cancer.
Tobacco and Alcohol
The use of tobacco products of any type is a major risk factor for oesophageal cancer. The more and longer use increases the cancer risk. Someone who smokes 20 cigarettes a day or more has at least twice the chance of getting adenocarcinoma of the oesophagus than that of a non-smoker. This risk does not go away if smoking is ceased. The link to squamous cell oesophageal cancer is stronger but this risk does reduce if smoking ceases.
Alcohol also increases the risk of oesophageal cancer. The greater amount of alcohol drunk, the higher the chance of getting oesophageal cancer. Alcohol increases the risk of squamous cell carcinoma more than the risk of adenocarcinoma.
Smoking combined with drinking alcohol raises the risk of squamous cell type of oesophageal cancer much more than using either alone.
Gastroesophageal Reflux Disease
If acid escapes from the stomach up into the lower part of the oesophagus, gastroesophageal reflux disease or reflux occurs. This causes symptoms such as heartburn or pain that seems to start in the middle of the chest. In some cases, though, no symptoms are found.
People with GORD have a slightly higher risk of getting adenocarcinoma of oesophagus. This risk appears to be higher in those who have more frequent symptoms. GORD is very common and most people who have it do not get oesophageal cancer. GORD can cause Barrett’s oesophagus which is linked to an even higher risk.
When reflux of the stomach into the lower oesophagus occurs over a long period, it can damage the inner lining of the oesophagus. This causes the squamous cells to be replaced with gland cells. These gland cells look like cells that line the stomach and small intestine and are more resistant to stomach acid. This condition is known as Barrett’s oesophagus. The longer that someone has reflux, the more likely it is that they will develop Barrett’s oesophagus. Most people with Barrett’s have had symptoms of heartburn but occasionally may have no symptoms at all. People with Barrett’s oesophagus are at a much higher risk of developing adenocarcinoma of the oesophagus. However, most people with Barrett’s oesophagus do not get oesophageal cancer. The gland cells in Barrett’s oesophagus can become more abnormal over time and this can result in dysplasia, a precancerous condition and this can be identified on endoscopy and treated accordingly.
People who are overweight have a higher chance of getting adenocarcinoma of the oesophagus. This is in part explained by the fact that people who are obese are more likely to have gastroesophageal reflux disease.
Certain substances in the diet may increase oesophageal cancer risk. For example, a diet high in processed meat may increase the chance of developing oesophageal cancer. However, this is as yet unproven.
A diet high in fruit and vegetables probably lowers the risk of oesophageal cancer. The causes of this are not clear but it may relate to the number of vitamins and minerals which they contain.
Hot liquids may increase the risk for the squamous cell type of oesophageal cancer. This may result from the long term damage to the cells lining the oesophagus from hot liquids.
Regular physical activity lowers the risk of adenocarcinoma of the oesophagus.
This is a condition whereby the muscle at the lower end of the oesophagus does not relax properly. Food and liquids that are solid have trouble passing into the stomach and tend to collect in the lower oesophagus which then becomes stretched out over time. Cells lining the oesophagus in this area can become irritated from being exposed to foods for longer than normal amounts of time. People with achalasia have a risk of oesophageal cancer that is many times normal. On average the cancers are found about 15 to 20 years after the achalasia occurs.
This is a rare, inherited disease that causes extra growth of the top layers of skin on the palms of the hands and soles of the feet. People with this condition also developed small growths, papillomas in the oesophagus and are at very high risk of getting squamous cell cancer of the oesophagus. People with tylosis are recommended to have regular monitoring with upper endoscopy.
This is a rare syndrome also called Paterson-Kelly syndrome whereby webs form in the upper part of the oesophagus and are associated with anaemia due to low iron levels, tongue inflammation (glossitis), brittle fingernails and sometimes a large spleen. A web is a thin piece of tissue extending out from the inner lining of the oesophagus that causes an area of narrowing. Large webs can cause food to get stuck in the oesophagus, which leads to problems swallowing and chronic irritation in that area from the trapped food. 1:10 people with this syndrome eventually develop squamous cell carcinoma of the oesophagus or cancer in the lower part of the throat.
Injury to the Oesophagus
Lye is a strong chemical found in industrial and household cleaners. Accidental drinking can lead to a severe chemical burn which can cause a stricture. People with these strictures have an increased risk of squamous cell oesophageal cancer.
History of Certain Other Cancers
People have had certain other cancers such as lung cancer, mouth cancer and throat cancer have a high risk of getting squamous cell carcinoma of the oesophagus as well. This may be because these cancers can also be caused by smoking.
HPV – Human Papilloma Virus Infection
Infection with certain types of HPV is linked to a number of cancers including throat cancer, anal cancer and cervical cancer. Signs of HPV infection have been found in up to one third of oesophageal cancers from patients in parts of Asia and South Africa, but signs of HPV infection have not been found in oesophageal cancer from patients in other regions. HPV is a rare cause of oesophageal cancer.
Can Oesophageal Cancer be Found Early?
No screening test currently has been shown to lower the risk of dying from oesophageal cancer in patients who are at average risk.
However, people who have a high risk of oesophageal cancer such as those with Barrett’s oesophagus should be followed up early to look for early cancers and pre-cancers. Upper GI endoscopy is an important test in diagnosing oesophageal cancer
To learn more about the screening services of The London General Practice please visit the health screening pages on our web site.