Medical Mistake Claims - Simpson Millar LLP

Oesophageal cancer could be triggered by obesity

Author: Neil Fearn  Bullet  Dated: 30/03/2013

The Independent recently reported that "obesity may be behind big rise in cancer of the gullet".

Oesophageal cancer is uncommon in the UK. However, over a period of 20 years or so the number of cases diagnosed each year has risen and around 8,200 people develop oesophageal cancer each year in the UK.

There are 2 main types:

  • 1. Adenocarcinoma of the oesophagus. This occurs in about 6 out of 10 cases in the UK. This type arises from cells within mucous glands. (The lining of the oesophagus contains many tiny glands which make mucus. The mucus helps food to slide down into the stomach easily.) This type mainly occurs in the lower third of the oesophagus.
  • 2. Squamous cell carcinoma of the oesophagus. This occurs in about 4 out of 10 cases in the UK. This type arises from cells which are on the inside lining of the oesophagus. This type mainly occurs in the upper two thirds of the oesophagus.

The Independent claims that genetic mutations found in tissue samples of patients with cancer of the oesophagus suggest that most cases are now adenocarcinoma, found at the bottom of the oesophagus and most likely caused by acid reflux. The oesophagus has a sphincter at its base to prevent the acid in the stomach gurgling back into it, damaging the lining and causing heartburn. In some men the sphincter ceases to work properly, a problem aggravated by obesity, allowing the lining to be eaten away which in turn may lead to cancer. Forty years ago cases were more likely to be squamous cell cancer found at the top of the oesophagus and likely to be caused by smoking and drinking.

However, it should be remembered that many people develop oesophageal cancer for no apparent reason although there are certain risk factors that increase the chance that oesophageal cancer may develop and obesity is only one of them.

Risk factors include:

  • Ageing. It is more common in older people. Most cases are in people over the age of 55. It is also more common in men
  • Diet is probably a factor. A high-fat diet is thought to increase the risk and eating a lot of fruit and green vegetables is thought to reduce the risk. Obesity may increase the risk too because if you are overweight it puts extra pressure on the stomach and encourages acid reflux. Losing some weight may ease the symptoms
  • Where you live. Oesophageal cancer is much more common in China and certain other Far Eastern countries than in Europe
  • Smoking
  • Drinking a lot of alcohol, especially spirits
  • Long-standing acid reflux from the stomach (gastro-oesophageal reflux disease (GORD)). This condition is common and causes inflammation at the lower end of the oesophagus. However, it has to be stressed that the risk is small - most people with acid reflux do not develop cancer
  • Barrett's oesophagus. This is a condition at the lower end of the oesophagus where the cells which line the oesophagus have become changed. In many cases this is related to long-term inflammation caused by acid reflux. The changed cells have an increased risk of becoming cancerous. About 1 in 100 people with Barrett's oesophagus develop adenocarcinoma of the oesophagus at some stage
  • Other uncommon conditions are associated with an increased risk and include: achalasia (a condition which causes a widening at the bottom of the oesophagus); tylosis (a very rare inherited skin condition); and Paterson Brown-Kelly syndrome (a rare syndrome which includes iron deficiency and changes in the mouth or oesophagus)
  • Long-term exposure to certain chemicals and pollutants may irritate the oesophagus if you breathe them in and may increase the risk
  • One recent study found that drinking black tea at temperatures of 70°C or higher increases the risk
  • Another study has found that people who get a flushed face when they drink alcohol also have a greater risk of developing oesophageal cancer when they also drink alcohol. This is because they lack a certain enzyme

The Independent also states that oesophageal cancer has one of the poorest survival rates of any cancer, with more than 8 out of 10 patients dying within 5 years. Unfortunately, most cases in the UK are not diagnosed at an early stage. This is because when an oesophageal cancer first develops and is small it usually causes no symptoms. Some do not cause symptoms until they are quite advanced and all of the early symptoms can be due to other conditions, so tests are needed to confirm oesophageal cancer.

If the cancer is diagnosed when it has grown through the wall of the oesophagus, or spread to other parts of the body, a cure is less likely. However, treatment can often slow down the progression of the cancer. Currently, about a quarter of people diagnosed with oesophageal cancer are still alive five years after diagnosis.

Symptoms to look out for:

  • Difficulty with swallowing (dysphagia). This is often the first symptom and is caused by a tumour narrowing the passage in the oesophagus. Food may appear to stick as you try to swallow. If it gets worse, then drinks may also be difficult to swallow
  • Vomiting after eating (which is really regurgitating food which has become stuck)
  • Pain in the chest or in the back of the chest when you swallow (odynophagia)
  • Weight loss
  • Vomiting blood
  • Coughing. Particularly when you swallow
  • A hoarse voice
  • Acid reflux symptoms may first develop, or get worse, when you develop a cancer at the lower oesophagus next to the stomach. Symptoms include heartburn (pains in the chest). Note: acid reflux is common and most people with acid reflux do not have cancer

Despite the awareness of the symptoms, the need for early detection and treatment, simple mistakes are still made by some doctors and those mistakes result in a failure to diagnose the cancer in a timely manner causing unnecessary pain and suffering, a reduced quality of life and a reduced life expectancy.

Mistakes may include failing to carry out a complete examination, or further assessment which would confirm the disease, or a delay in carrying out appropriate tests such a as a CT scan, Ultrasound scan or a biopsy. There may even be a failure to report abnormal examination findings resulting in a delay in treatment which would impact of life expectancy.

Alternatively, the results may be interpreted incorrectly providing an incorrect diagnosis of cancer when there is no evidence of malignancy resulting in unnecessary surgery which could impact upon quality of life.

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