Symptoms

There is no clear-cut list of possible symptoms for cancer. The following are symptoms that may indicate cancer. If you are concerned about symptoms, ask for advice from your GP or the nurse in your local surgery.

• Prolonged coughing - Coughing or hoarseness that lasts more than three weeks could be caused by one of the cancers of the head and neck.


• Ongoing indigestion or swallowing problems - Indigestion that will not go away or keeps coming back, or swallowing problems, could indicate cancer of the oesophagus, stomach or throat (pharynx).


• Unexplained tiredness - Feeling very tired (fatigue) is often a key factor in many cancers.


• Unexplained weight loss - Most people with cancer will experience weight loss at some point. Unexplained weight loss may be the first sign of cancer.

Some possible causes of cancer of the oesophagus

• Reflux - Barrett's oesophagus (BO) occurs primarily as a result of gastro-oesophageal reflux disease (GORD) where refluxed gastric contents give rise to reflux oesophagitis. Very rarely, BO can also arise following ingestion of corrosive chemicals such as caustic acid or alkali, a condition referred to as corrosive oesophagitis. Why BO develops in some patients with severe oesophagitis and not in others remains to be determined but there may be a genetic predisposition in some individuals.


• Food - Nitrates form part of our normal diet and are found in pickled and unpickled vegetables, cured meats, fish, and various alcoholic drinks. Lettuce, spinach, celery and beetroot have relatively high concentrations of nitrate (>1g/kg), while potatoes and cabbage contain moderate levels (100mg to 1g/kg). The nitrate concentration in vegetables is rising. This has been attributed to the vast increase in use of artificial nitrogen-containing fertilizers that have been employed by intensive farming practices over the past 30 to 40 years. These observations are interesting with respect to the rising incidence of gastro-intestinal cancers. It would seem unfortunate yet possible that eating a diet rich in nitrate-laden vegetables and fruit containing vitamin C may increase the risk of developing these cancers. However, good oral hygiene may help protect against nitrates - the use of antibacterial mouthwashes containing chlorhexidine will result in less nitrite entering the stomach.
  
  Many foods, including chocolate, high-fat foods, essence of peppermint and caffeine, have been shown to decrease lower oesophageal sphincter (LOS) pressure. By avoiding such foods, as well as moderating the size of each meal, the severity of GORD could be reduced. Patients should also avoid lying flat after meals and not eat within 3 hours of bedtime. Chewing gum or sucking an oral lozenge after meals will prolong salivation and should aid acid clearance from the oesophagus.


• Smoking - Smoking is a well-recognised risk factor in a large number of cancers, particularly those of the lung, pharynx, larynx and oesophagus. Cigarette smoke and other tobacco products contain a large selection of highly carcinogenic compounds, but due to the delayed effect of cigarette smoking on cancer, it may take another 20 to 30 years before the relationship between oesophageal cancer and smoking can be assessed.


• Alcohol - Like smoking, alcohol is known to decrease the pressure of the lower oesophageal sphincter (LOS). Alcohol is also a source of ingested nitrates. Excessive alcohol consumption is a known gastric irritant that predisposes to reflux. The toxic nature of alcohol has also been proposed to damage the gastric and oesophageal tissues directly.


• Obesity - Being overweight has been linked to oesophageal adenocarcinoma. Indeed obesity was found to be an independent risk factor for oesophageal adenocarcinoma. In order to minimise strain-induced reflux, overweight individuals should avoid tight-fitting clothing, stop smoking, reduce the size of each meal and most importantly lose weight.