Many people have never even heard of cancer of the oesophagus – a form of cancer affecting the pipe that connects the mouth to the top of the stomach.
Yet rates of this cancer are on the rise.
According to new figures we released today, the rise is most rapid in men – among whom a particular form of the disease, called adenocarcinoma, is one of the fastest rising cancers in the UK.
But what’s causing this rise? And – most importantly – what can be done about it?
In this post, we’ll look at what’s going on, and whether our lifestyles might be behind the rise.
And we’ll also meet a heroic team of marathon-running medics who are doing everything they can to change the picture for patients diagnosed with oesophageal cancer – one of the hardest forms of cancer to treat successfully, but one which generally gets little attention in the media.
What is oesophageal cancer?
Every day around 23 people in the UK are diagnosed with oesophageal cancer, about eight out of ten of whom are aged 60 or over, and about two thirds of whom are men.
As with many types of cancer, things in our ‘modern’ lifestyles can affect the risk – the disease is more common among people who smoke, drink heavily, are overweight or obese, or who eat a diet low in fruit and veg. And people with long-term persistent heartburn – something that can also be linked to obesity – have a higher risk too.
In general, survival rates for cancer of the oesophagus are low compared with other cancers – partly because the disease is often diagnosed at a late stage.
Overall, for every 100 people diagnosed with the disease, only around 13 are alive five years later. But when the disease is diagnosed in its earliest stage, this figure rises to about 80 out of 100. Sadly, only a small proportion of patients are diagnosed this early.
Treatment for early-stage disease usually involves a course of chemotherapy to shrink the tumour, followed by surgery, and aims to cure it. For later stage disease, treatment is aimed at controlling the disease and alleviating symptoms.
Different types, different causes?
There are two main types of cancer that affect the oesophagus, called squamous cell carcinomas and adenocarcinomas, and the evidence suggests they have different triggers.
Squamous cell carcinomas seem to be linked to smoking and drinking. Rates have remained roughly constant in men and women since the mid 90s.
Adenocarcinoma – the form that’s on the increase – is also linked to smoking, but less strongly than squamous cell carcinomas. But it also seems to be linked to long-term acid reflux (heartburn), which itself is more likely if you’re overweight or obese.
There are a few theories about how heartburn can lead to cancer. The main one is that having long-term, persistent heartburn causes chronic inflammation in the cells lining the oesophagus. As well as causing them to divide more rapidly – this inflammation also seems to cause tell-tale chemical changes to the DNA inside them.
These changes, researchers think, lead to a condition called Barrett’s Oesophagus, which – in a small minority of people – can go on to develop into cancer.
People diagnosed with Barrett’s Oesophagus are offered regular screening with an endoscope (a camera that goes down your throat) to spot early signs of cancer.
As you can see from the graph below, rates of oesophageal cancer in men have risen by almost 60 per cent over the last 30 years, and by 10 per cent in women – but why?
When we looked at the breakdown of what was causing the increase, we found something surprising: it was almost entirely down to rising rates of adenocarcinoma in men.
Why would this be?
One culprit could be increasing rates of heartburn. According to a recent Norwegian study, discussed here on NHS Choices, “the number of people experiencing at least one acid reflux attack a week has risen from 11.6 per cent to 17.1 per cent in just over a decade, while those suffering severe symptoms is up from 5.4 per cent to 6.7 per cent”.
Only a small proportion of people with heartburn will go on to get oesophageal cancer, but if this rise in Norway reflects the UK situation, it’s worrying nevertheless.
And if heartburn is really on the rise, what’s the reason?
One obvious cause could be the nation’s growing waistline – in recent decades, rates of overweight and obesity have slowly but steadily climbed. And there’s solid evidence linking obesity to adenocarcinomas of the oesophagus.
However, intuitive as it may sound, researchers don’t yet know for definite whether heartburn caused by rising obesity is leading to more oesophageal cancer – it wouldn’t explain the differences in rates between men and women (as the rate of increase in obesity has been approximately equal in men and women).
So why the increase in adenocarcinoma in men? We can’t be sure, and there’s a lot more work to be done here too. However, we have some theories.
One idea is that women’s hormones might play a role in protecting them against the disease, and there’s some evidence for this.
Another idea might be that the type of obesity that’s more common in men, called abdominal obesity, might be linked to increased rates of oesophageal cancer (it does increase the risk of certain other cancers). However, there’s no evidence yet to show whether this type of obesity is especially linked to oesophageal cancer, so at this stage this remains just an idea.
Early diagnosis is important
Whatever the reason, we know that early diagnosis makes a difference. Which brings us to two more issues:
Firstly, over-the-counter heartburn medicines – Rennies, Zantac and the like. These are readily available, so people with long-term heartburn sometimes try to control things by popping a pill every now and again – rather than seeing a doctor.
Secondly, we know that people don’t always know a huge amount about cancer symptoms (and men less so than women) – which in the case of oesophageal cancer are difficulty swallowing food, or food feeling like it’s got stuck in your throat, as well as long-term heartburn. So people may not seek help from a GP for something that could be a sign of a serious problem.
In short – don’t ignore any changes to your body that aren’t normal for you – either long-term heartburn or food getting stuck in your throat.
Do go and see your GP, and get checked out. It’s unlikely to be cancer, or lead to cancer, but it’s always better to be safe.
What can be done?
Research is the key to progress against cancer, and there are three key areas where research can make a difference:
- We need to understand more about what raises the risk of oesophageal cancer and how we can help people live healthy lives to reduce the risk.
- We need to improve the way we (as a society) diagnose oesophageal cancer, so that people with the disease get to a specialist earlier.
- We need to find better ways to treat the disease, especially at a late stage.
At Cancer Research UK we’re funding research in all these areas. For example, we’re funding a very promising trial led by researchers in Cambridge, looking at whether collecting cells from the oesophagus using a device called a cytosponge can spot early signs of the disease.
And one of the most exciting projects we’re involved with is our work as part of the International Cancer Genome Consortium (ICGC) – an international project to map all the genes involved in several different types of cancer, to look for clues for new treatments and better understanding. Our scientists are bringing their gene-hunting expertise to bear on oesophageal cancer, and we’re expecting their first round of results to emerge later this year.
(You can read more about their work in our oesophageal cancer Research Leaflet).
Running for progress
But we want to leave you with the exciting and inspirational story of a team of medics from Southampton, who want to make a difference for people affected by this terrible disease.
They’re currently training to run the New York Marathon in November, both to raise awareness of oesophageal cancer, and to raise money to fund our ICGC genetics project.
We’ll be following their progress over the coming months, but here’s the first instalment of their story – The Cancer Marathon – which also follows their patients as they go through treatment for oesophageal cancer.
This is something surgeon Tim Underwood (one of the runners) often describes as “like running a marathon without any training”.
And if you want to support their marathon effort, you can do so over at JustGiving, where their page is www.justgiving.com/thecancermarathon. They’re trying to raise £100k, so every donation will count, no matter how small.