When someone says “oesophageal cancer,” it can feel like the ground disappears beneath you. The oesophagus—that quiet, muscular tube that carries food from your throat to your stomach—suddenly becomes the centre of worry, appointments, and big decisions.
I’ve written this post to help you make sense of it all. Whether you’ve just heard the words “you have cancer,” you’re supporting a loved one, or you’re simply trying to understand the disease, here’s what you need to know—clearly, honestly, and without sugar-coating.
What is oesophageal cancer?
Oesophageal cancer starts when cells in the lining of the oesophagus grow out of control. There are two main types:
Squamous cell carcinoma – more common in the upper and middle oesophagus. Strongly linked to smoking and heavy alcohol use.
Adenocarcinoma – usually found in the lower oesophagus near the stomach. The biggest risk factor is long-term acid reflux (GERD) that leads to Barrett’s oesophagus.
In the UK, around 9,300 people are diagnosed each year. In the US, it’s about 21,000. Survival has improved, but it remains a serious disease—early detection makes a huge difference.
Common symptoms (don’t ignore these)
Difficulty swallowing (dysphagia) – feels like food is “stuck”
Unexplained weight loss
Pain or burning in the chest, especially after eating
Chronic heartburn that won’t go away
Hoarse voice or long-term cough
Vomiting blood or black stools (emergency signs)
If swallowing becomes painful or you’re losing weight without trying, please see your doctor straight away. These symptoms don’t always mean cancer—hiatus hernias and strictures cause similar trouble—but it’s always worth checking.
Risk factors you can change—and some you can’t
You can lower your risk by:
Quitting smoking
Cutting down alcohol (especially spirits)
Treating reflux properly (don’t just live on antacids for years)
Eating more fruit and vegetables, less processed meat
Maintaining a healthy weight
Things you can’t change:
Age (most diagnoses after 60)
Being male (3–4 times more common in men)
Family history (rare but possible)
How is it diagnosed?
Endoscopy – a camera down the throat (takes 10 minutes, mild sedation)
Biopsy – tiny tissue samples checked for cancer cells
CT/PET scans and sometimes endoscopic ultrasound to see if it has spread
Yes, the endoscopy feels odd, but it’s quick and gives definitive answers.
Staging – what the numbers mean
Stage 0 – abnormal cells only (Barrett’s with high-grade dysplasia)
Stage I – cancer in the oesophagus wall only
Stage II/III – deeper or into nearby lymph nodes
Stage IV – spread to distant organs (lungs, liver)
Five-year survival:
Stage I: ~50–80%
Stage II/III: ~20–40%
Stage IV: ~5–20%
These are averages. Many people do far better, especially with modern treatment.
Treatment options
Treatment depends on stage, location, and your overall health.
Early stage (I and some II)
Endoscopic removal (EMR or ESD) or minimally invasive surgery
Sometimes no chemotherapy needed
Locally advanced (II–III)
Neoadjuvant chemoradiotherapy (chemo + radiotherapy) to shrink the tumour
Followed by surgery (oesophagectomy) in suitable patients
Or definitive chemoradiotherapy if surgery isn’t possible
Stage IV
Chemotherapy, immunotherapy (e.g., pembrolizumab), or targeted therapy
Stents or feeding tubes to keep the oesophagus open
Palliative care alongside active treatment
Surgery is big—either Ivor-Lewis or transhiatal oesophagectomy—but robotic techniques and enhanced recovery programmes mean most people leave hospital within 8–12 days.
Life during and after treatment
Nutrition is everything. Many patients need a feeding tube (JEJ or PEG) temporarily.
Speech and language therapists help retrain swallowing.
Reflux often gets worse after surgery—small, frequent meals and sleeping propped up help.
Dumping syndrome (feeling faint after eating) is common but manageable.
Support groups (like OPA in the UK or EC Aware in the US) are gold. You’ll meet people who’ve had the same operation and are back hiking, travelling, living.
A message to newly diagnosed patients
You’re allowed to feel terrified. You’re also allowed to feel hopeful. Medicine has come a long 15-year survival stories are no longer rare. Ask for a clinical nurse specialist—they’re your lifeline. Write questions down before appointments. Bring someone with you. And remember: one day at a time is enough.
Useful resources
UK: Oesophageal Patients Association (opa.org.uk) – brilliant helpline
US: Esophageal Cancer Action Network (ecan.org)
Australia: Cancer Council 13 11 20
Worldwide: World Esophageal Cancer Forum on Facebook (closed group, very active)
You’re not alone in this. Thousands of us have walked the same path and come out the other side.
If you have a specific question—about stents, HER2 testing, dumping syndrome, or just need encouragement—drop it in the comments or send me a message. I’ll answer as best I can.
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