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Cancer of the OesophagusDr Kingsley’s comments Cancer of the Oesophagus The most common symptom of cancer of the oesophagus (the gullet) is difficulty swallowing. To begin with there is usually only the occasional problem, or it may only occur when trying to swallow something fairly solid like meat. Gradually, however, it becomes more and more obvious that something is wrong. By this time the patient is showing a degree of weight loss, which slowly becomes more and more obvious. A strange, but not all that uncommon, symptom of cancer of the oesophagus is recurrent chest infections, due to inhaling food items from the oesophagus into the lungs. Not surprisingly, the true reason for the infections is easily missed to begin with, but, with the other features, it soon becomes clear what the matter is. On occasions, there is very little difficulty swallowing, presumably because the way in which the cancer has grown has had little effect on the tube itself and on the way it passes food along it. Risk Factors. Alcohol and tobacco are the most common risk factors, and it is most uncommon to see a person with cancer of the oesophagus who does not smoke or drink quite a lot of alcohol. However, if someone does smoke and drink alcohol, there may still not ever develop oesophageal cancer. Interestingly enough, a deficiency of vitamins A, C and B2 (riboflavin), and a chronic deficiency of iron are associated with oesophageal cancer, and there is an association with a benign condition called Barrett’s oesophagus and cancer of the oesophagus. So such sufferers should be screened regularly to make sure it doesn’t develop into cancer. To my way of thinking, Barrett’s oesophagus should be brought under control by identifying the cause and eliminating it, so that there is no chance of it ever becoming cancerous. Names. Cancer of the middle and upper thirds of the oesophagus are usually identified as squamous cell cancinomas, while, in the lower third, over half are adenocarcinomas which have invaded upwards from the upper part of the stomach, sometimes from a Barrett’s oesophagus. In any case, the possible involvement of a bug called helicobacter pylori should be considered. It is not a very common condition in the so-called West, although I have seen quite a few people with it, but it is the leading cause of death from cancer in China. Investigations. The two main approaches are a barium swallow, which will show up the abnormality in most cases, and endoscopy (the passing of a camera into the oesophagus), when a biopsy will most commonly be taken to confirm the diagnosis. If you don’t want a sample to be taken, but agree to the procedure to clarify the diagnosis, you must tell the surgeon before the operation, as the taking of a biopsy sample is standard practice. A CT scan is most likely to be carried out to identify whether or not the cancer has spread outside the oesophagus, and how far it has spread, i.e. into the local tissues, local lymph nodes or further a field, such as into the chest space, the liver or the lungs. Various other scans may well be recommended to clarify the situation. An Explanation by Dr Kingsley Before Your Consultation about your Oesophageal Cancer Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having cancer in your oesophagus. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of your cancer in your oesophagus, but, by then, you were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat your condition in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. 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(c) 2006 |
