Oesophageal Cancer

Oesophageal cancer is a cancer of the food pipe (oesophagus) that connects the throat to the stomach. It is relatively common in parts of East Africa, and most cases present at a late stage due to the gradual nature of early symptoms.

• Progressive difficulty swallowing, typically starting with solid foods and gradually affecting softer foods and liquids
• Unintentional weight loss
• Chest discomfort or a sensation of food sticking behind the breastbone
• Persistent cough, hoarseness, or, in advanced disease, vomiting of blood

• Risk is increased by chronic irritation of the oesophageal lining, including from long-term heavy alcohol use, tobacco use (smoked or chewed), and regular consumption of very hot beverages.
• Chronic gastro-oesophageal reflux disease is an important risk factor for one type of oesophageal cancer.
• Certain dietary patterns, including low intake of fruits and vegetables, may also contribute to risk.

• Suspected in anyone with progressive difficulty swallowing, particularly when it worsens over weeks and is accompanied by weight loss.
• Upper endoscopy with biopsy is the key diagnostic test, allowing direct visualisation of the oesophagus and tissue sampling to confirm cancer.
• Further imaging, such as CT scan where available, helps stage the disease and guide treatment planning.

Treatment depends on the stage of disease at diagnosis and is coordinated at a specialised cancer treatment centre.

Early-stage, localised cancer may be treated with surgical removal of the affected portion of the oesophagus, sometimes combined with chemotherapy or radiotherapy.

More advanced disease, which is common at diagnosis in this setting, is often treated with radiotherapy and/or chemotherapy aimed at controlling the cancer and relieving symptoms, particularly difficulty swallowing.

Nutritional support is an important part of care throughout treatment, given the impact of swallowing difficulty on food intake; in some cases, a feeding tube may be needed.

Anyone with new or progressive difficulty swallowing, especially with weight loss, should be referred promptly for endoscopic evaluation.

• Limit alcohol consumption and avoid tobacco use in any form.
• Avoid regularly drinking very hot beverages.
• Seek treatment for chronic heartburn or reflux symptoms rather than ignoring them long-term.
• Maintain a diet with regular fruit and vegetable intake where possible.
• Seek prompt assessment for any new or worsening difficulty swallowing rather than adapting to a softer diet and delaying care.