Oesophageal Cancer

What is oesophageal cancer?

Oesophageal cancer refers to cancer that develops within the oesophagus, the tube that transports food from your throat to your stomach to be digested.

There are three layers of the oesophageal wall, which include the mucosa (made up of squamous cells), submucosa and muscle layer (muscularis propria), in addition to the outer covering (adventitia).

The two most common types of oesophageal cancer are:

  • Adenocarcinoma – cancer that develops in the glandular cells which line the oesophagus. This type of cancer typically forms in the lower section of the oesophagus
  • Squamous cell carcinoma – cancer which begins in squamous cells that line the oesophagus. This often develops in the middle and upper part of the oesophagus

Other types of oesophageal cancer include small cell carcinoma, lymphoma, neuroendocrine tumours and gastrointestinal stromal tumours.

Oesophageal cancer is the 19th most common cancer in Singapore, with men more likely than women to develop oesophageal cancer.

Stages of oesophageal cancer

Oesophageal cancer can be described in stages depending on how early or advanced the cancer is.

The TNM system is used to stage oesophageal cancer and helps doctors understand what your cancer looks like. TNM stands for:

  • Tumour – the degree to which the tumour has affected other tissue.
  • Node – is a measure of the extent of lymph node involvement.
  • Metastasis – the degree to which the cancer has spread to other organs of the body.

The TNM information, along with other tests helps determine the stage of your oesophageal cancer.

  • Stage 0 – the cancer is only in the top layer of the oesophageal lining (epithelium) and has not spread to deeper layers of the oesophagus.
  • Stage I – the cancer has grown into the mucosa, submucosa or muscle layer (muscularis propria).
  • Stage II – the cancer has spread to the muscularis propria or outer layer of the oesophagus (adventitia). Alternatively, the cancer has grown into the mucosa or submucosa and has spread to one or two nearby lymph nodes.
  • Stage III – the cancer has spread to the mucosa, submucosa, adventitia or muscularis propria and no more than six nearby lymph nodes. Alternatively, the cancer has grown into the pleura, pericardium or diaphragm and no more than two nearby lymph nodes.
  • Stage IV – the cancer has spread beyond the oesophageal wall to nearby lymph nodes and parts of the body such as the pleura, pericardium, diaphragm, trachea, aorta and spine, or throughout the body to distant lymph nodes and/or organs such as the liver or lungs

Signs and symptoms of oesophageal cancer

Oesophageal cancer is slow-growing and can be difficult to detect as there are often no symptoms during the early stages. However, as the disease progresses symptoms may include:

Pain or difficulty swallowing

such as a feeling of choking when swallowing


Vomiting blood

Black or bloody stools

Unexplained fatigue

Discomfort in the upper abdomen

particularly when eating

Weight loss

Coughing or hoarseness

Treatment for oesophageal cancer

Frequently asked questions

What are the risk factors for oesophageal cancer?

While the exact causes of oesophageal cancer are unknown, there are a number of modifiable and non-modifiable factors which increase your risk of oesophageal cancer.

Adenocarcinoma risk factors:

  • Being overweight or obese
  • Pre-existing medical conditions such as gastro-oesophageal reflux disease (GORD) and Barrett’s oesophagus
  • Smoking
  • Being over the age of 60
  • Having an inherited genetic condition such as Peutz- Jeghers syndrome (PJS) or Cowden syndrome

Squamous cell carcinoma risk factors:

  • High alcohol consumption
  • Smoking
  • Being over the age of 60
How can oesophageal cancer be prevented?

To prevent oesophageal cancer, you should consider:

  • Quitting smoking
  • Limiting alcohol intake
  • Having a healthy, balanced diet, with a variety of fruits and vegetables
  • Maintaining a healthy weight
How is oesophageal cancer diagnosed?

There are many different tests that are used to diagnose oesophageal cancer. This may include an endoscopy, which uses an endoscope to investigate the digestive tract and remove tissue (biopsy), or an endoscopic ultrasound which can indicate if the cancer has spread into the oesophageal wall or lymph nodes. Further tests may include CT/PET scans or laparoscopy to detect if the cancer has spread.


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