Cancer of the oesophagus or gullet develops as a result of cell changes in the lining of the oesophagus.

There are two main types of cancer of the oesophagus: squamous carcinoma, which is more common at the upper end of the gullet, and adenocarcinoma, which is more common at the lower end, particularly around the junction between the gullet and the stomach.

There has been a recent increase in the proportion of tumours arising close to the junction of stomach and gullet, but the reasons for this are not yet known.

In a condition called Barrett's oesophagus the lining of the gullet changes to being more like the lining of the stomach. Patients with Barrett's oesophagus are at an increased risk of developing cancer of the oesophagus and may benefit from regular follow-up and supervision by a doctor.

The first symptom of the disease is almost always difficulty in swallowing. There is the feeling that food is getting stuck, often behind the lower end of the breastbone. At first the problem is only with solid food but later even semi-solids and liquids can cause problems.

Pain felt between the shoulder blades can also be troublesome. This discomfort is sometimes triggered by eating.

Another characteristic symptom is regurgitating unaltered food a few minutes after having difficulty swallowing the food. The patient often tries to handle these problems by eating less and avoiding solid food. This causes weight loss and fatigue.

Later on, heartburn, vomiting, and vomiting of blood may become the dominant symptoms. The early symptoms are relatively minor and tend to creep up on patients. This means it is often several months before they consult their doctors.