What causes esophageal cancer?

This cancer is particularly common in some parts of Africa and China and is probably related to local diet or the way food is cooked. In the West, important risk factors are cigarette smoking and alcohol consumption. A combination of the two appears to increase the risk. Severe acid reflux from the stomach seems to be a major factor in a recent increase in the number of people with adenocarcinomas.

A rare muscular disorder, achalasia, a condition in which there is a failure of relaxation of the muscular valve at the lower end of the esophagus, very occasionally leads to cancer.

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What are the symptoms of esophageal cancer?

There is a progressive difficulty in swallowing, initially for solids such as meat, and then for softer foods. Eventually there is difficulty getting liquids down. Patients lose weight and may have other symptoms such as coughing, choking, unexplained chest infections or a hoarse voice.

What tests confirm a diagnosis of esophageal cancer?

Going to the doctor early when symptoms arise is essential, particularly if there is a progressive deterioration in the ability to swallow. Urgent referral to an appropriate specialist is then necessary and a barium swallow is often carried out. This involves swallowing a white liquid containing barium, which shows up on X-ray, outlining the esophagus and revealing the level of obstruction.

Another test is to pass a narrow flexible telescope (endoscope) into the esophagusvia the mouth. This test is done using an anesthetic throat spray and/or a sedative injection. Any change in the lining of the esophagus can be seen and samples taken (biopsy) for laboratory examination.

If cancer is diagnosed, other tests may be done to see how extensive it is. These include an X-ray of the chest, an ultra-sound investigation that can be done via the skin, or using an endoscope. Other possible tests include a CT scan or magnetic resonance imaging (MRI).  A surgeon may also look inside the abdomen using a special tube called a laparoscope.