Oesophageal cancer: Huge numbers of the most rapidly increasing type of cancer, which has a higher mortality rate than breast cancer, are not being diagnosed until it's too late because of public ignorance.
Tom Walsh, consultant surgeon in gastro and intestinal surgery at Connolly Hospital in Blanchardstown, Dublin, said that while the public was well versed in the warning signs for breast, bowel and skin cancer, a majority did not know that difficulty swallowing, combined with weight loss, was a telling symptom of oesophageal cancer.
Connolly Hospital is a nationally recognised centre of expertise in oesophageal cancer and it has developed protocols in dealing with chemotherapy and radiotherapy prior to surgery.
"There are two types of oesophageal cancer - the adeno type associated with the stomach and the squamous associated with the throat.
"The incidence of adeno type has increased more than any other human tumour. To take some figures from the US, in 1975 5 per cent of oesophagus tumours were of the adeno type, in 1990 they accounted for 50 per cent."
There were a number of reasons for this rapid increase, he said, mainly associated with growing affluence. While the squamous tumour was associated with too much alcohol and smoking and has been known as the "blue-collar" tumour, the adeno tumour is known as the "white collar" tumour.
"One of the risks is the frequent reflux of stomach acid into the gut. It is associated with increased weight pressing in on the gullet and a malfunction of the gullet. It's also associated with more frequent meals and increased pressure on the stomach."
It is of increasing concern that as many as two-thirds of people who present with the classic symptoms of oesophageal cancer - difficulty swallowing combined with weight loss - only do so after having had the symptoms for three months.
Research commissioned by Connolly Hospital and carried out by the Smurfit School of Business into public awareness of the cancer, published last month, found just 9 per cent of respondents had an immediate knowledge of it.
"When prompted with some more information, a further 34 per cent had some knowledge," said Mr Walsh. "But that's still less than half with some degree of awareness."
This ignorance is partially explained by the relatively low incidence of stomach and gullet cancer. There are about 700 cases per annum in the State compared with 1,700 cases of breast cancer.
A widespread screening programme is therefore unlikely. However, as Mr Walsh points out, the mortality rate is far higher for gut cancer. While there are 630 deaths from breast cancer each year, there are 650 from gullet and stomach cancer.
With a mortality rate of about 90 per cent and low awareness of the cancer, it is imperative, according to experts, that awareness of the symptoms is improved.
Anyone with a long history of heartburn should be checked with a scope. Risk also increases with age.
A scope examination will ascertain whether they have a 'Barretts oesophagus'.
"This is where the lining of the gullet comes to resemble that of the intestine, and goblet cells are present," said Mr Walsh
If a person is found to display such indications, they should be put on a surveillance programme, he said.
Treatment for the cancer will include surgery, but also chemotherapy or radiotherapy.
Mr Walsh said that when the British surgeon Ivor Lewis developed the surgery for the removal of oesophageal cancer in the 1920s, he said he hoped then that patients with the disease would present immediately.
"But 80 years later here we are with two-thirds of people presenting three months after they first experienced the symptoms."
The third annual Lollipop Days, held to raise awareness of oesophageal cancer, take place next Friday and Saturday, March 4th and 5th.
