Cancers of the oesophagus and of the stomach are still relatively rare in comparison to those of the colon and the rectum. Two types can be distinguished for the oesophagus. The first, called epidermoid carcinoma, is linked to the consumption of alcohol and tobacco. The second, called adenocarcinoma, is a rare complication involving gastro-oesophageal reflux.

Distinguishing between the two types of cancers is carried out by identifying their location. Epidermoid carcinoma is more frequently situated in the upper and mid part of the oesophagus, while adenocarcinoma is always located in the lower third. Yet it is examination under the microscope of fragments taken during an endoscopy which provide a definitive answer.

Cancer of the stomach is found less frequently these days than it was in the past. This can perhaps be explained by the reduction in the frequency of persistent gastric ulcers, which constitute the main risk factor. There are now efficient treatments available which allow Helicobacter pylori bacteria to be eliminated, which is the main cause of ulcers. Removing these bacteria from the stomach means stomach ulcers do not become chronic, and do not degenerate into cancer. The presence of these bacteria is however very frequent, but that does not mean that a person who is a carrier will be affected by stomach cancer.

A feeling of having a blockage in the oesophagus, called dysphagia, is an alarm signal which requires an endoscopic examination. Cancer of the stomach triggers no specific symptoms and often remains silent in the initial stages. Other much less specific signs, at times often suggest the presence of this cancer, such as anaemia, unexplained weight loss and sustained loss of appetite, for example.

 

In the event of cancer of the oesophagus or of the stomach being suspected, the first examination to be carried out is an endoscopy of the organs, known as a “gastroscopy” or an “oesophagogastroscopy”. This very precise technique is carried out under local anaesthetic or light sedation. It enables the oesophageal wall and the stomach to be looked at directly and if there is a tumour, to ascertain the extent of the localized spread. Click here to learn more about this examination (link to the “gastroscopy” fact sheet). This examination can be completed by an echoendoscopy which enables the localized spread of the tumour to be assessed. Click here to learn more about this examination (link to the “echoendoscopy” fact sheet).

Other imaging examinations are often carried out, such as a CT scan in conventional radiology and the PET scan in Nuclear Medicine, to study the extent of cancer of the oesophagus. Click here to learn more about the latter examination.

Surgery is the main treatment for cancers of the oesophagus and the stomach. Some tumours which are very superficial to start with can now be treated in a completely satisfactory manner either by endoscopic resection, or by functional surgery according to the respective indications. This assumes, of course, expertise which can only be acquired in centres which have experienced specialists. On the other hand, for tumours which are more extensive, it is acknowledged that an operation should be carried out which will consist of partially or completely removing the affected organ, opening up the thorax and/or the abdomen. The essential element of the surgery is radical removal of all the neighbouring ganglions of the organ or seat of the tumour. Only practiced in exceptional centres in the Western world, such as ours, these interventions are often long and delicate. They require an expert surgical team, an experienced team of anaesthetists and also an intensive care service which is well-versed in following these patients who systematically spend the first post-operation days here. The close collaboration which exists between these three teams guarantees optimal patient care, minimizing all the risks linked to the operation.

 

For some patients for whom surgery would be too disfiguring, or who are too weak to benefit from an operation, and where the risks would become too great, a combination of radiotherapy and chemotherapy is proposed, with very satisfactory results. Both these treatments are administered in outpatient clinics, radiotherapy in 5 or 6 weeks and chemotherapy, at a rate of 4 cycles, of 3 or 4 weeks each.

Curietherapy, a radiotherapy method, is carried out on people who cannot be treated by classic external radiotherapy. This method uses a radioactive iridium wire which has an effect at short distance (2 to 3 cm), enabling the eradication of cancerous tumour in the oesophagus. This procedure is not as effective as external radiotherapy, but means treatment can be shorter, thus producing fewer secondary effects. It is often used when there is considerable difficulty swallowing (dysphagia) due to obstruction of the oesophagus by the tumour. An alternative in the event of obstruction is the placement of an oesophageal prosthesis (a tube slipped inside the oesophagus), which means oral feeding can still take place. Curietherapy and prosthetics are often associated with providing the patient with relief from the obstruction.

 

When cancer affects organs other than the oesophagus or the stomach, in other words if it metastasises, only chemotherapy can provide any sort of benefit.

 

Patient care requires collaboration amongst medical oncologists, radiotherapists, surgeons, anatomical pathologists and gastroenterologists, who meet up each week with the aim of taking the best decision for each particular patient.