Oesophageal cancer

Also called Cancer of the gullet, Cancer of the food pipe

Difficulty swallowing that is getting worse is the symptom that must never wait. Long-standing reflux is the risk factor nobody treats as one.

What it is

Cancer of the oesophagus, the tube carrying food from the throat to the stomach.

The dominant risk factor in the UK is long-standing acid reflux. Years of gastro-oesophageal reflux disease can change the cells lining the lower oesophagus, a condition called Barrett's oesophagus, and a small proportion of those go on to become cancer. Smoking, alcohol and obesity all add to the risk.

That chain is worth knowing because it is the only common cancer with a decade of warning. Reflux treated properly, and Barrett's monitored, is a genuinely preventive pathway that many people are never told about.

Difficulty swallowing is the symptom that brings most people in, and by then the cancer is usually advanced. Swallowing that is progressively getting harder, solids first and then liquids, needs urgent endoscopy and not a trial of antacids.

Signs you might notice

Difficulty swallowing, getting worse over weeks: food sticking, then softer food, then liquids.

Food coming back up undigested.

Persistent indigestion or heartburn that is new, or that has changed.

Weight loss without trying.

Pain or discomfort behind the breastbone or in the upper abdomen.

Hoarseness lasting more than three weeks, a persistent cough, or vomiting blood.

Any new or worsening difficulty swallowing in an adult is an urgent two-week referral, whatever the age.

How it can affect day-to-day life

Eating is social, and losing it is isolating in a way that does not show in a clinic. People stop going out for meals long before they tell anybody why.

Weight loss is often severe by diagnosis, and nutrition support is central rather than supplementary. Ask for dietetics at the start rather than when weight has already gone.

A stent or a feeding tube changes daily life substantially and both are usually explained in a rush. Ask for the specialist nurse to go through it again, slowly, on another day.

Reflux is treated as trivial by almost everybody who has it. Somebody taking over-the-counter remedies daily for years deserves a proper review, not a repeat purchase.

Supporting someone well

Treat progressive difficulty swallowing as urgent. Say the word dysphagia and ask for a two-week referral.

Get long-standing reflux reviewed properly rather than self-treated indefinitely, and ask whether endoscopy is indicated.

If Barrett's oesophagus has been diagnosed, keep the surveillance appointments. That is the whole point of the diagnosis.

Ask for a dietitian and a specialist nurse early.

Small, soft, frequent meals, sitting upright, and unhurried time. Rushing a person with a narrowed oesophagus is how food gets stuck.

Learn what to do if food does become stuck, before it happens.

Where to get help

A GP practice urgently for any new difficulty swallowing.

The upper gastrointestinal clinical nurse specialist, once under a team.

Macmillan Cancer Support on 0808 808 00 00 for practical and financial help.

Guts UK for clear information on reflux and Barrett's oesophagus.