Oesophageal cancer – frequently misjudged and diagnosed too late

Frauke Fiegl, Chairwoman of the Board of DKV Deutsche Krankenversicherung AG and ERGO Krankenversicherung AG, talks to Prof. Dr. Arnulf Hölscher, Head of the Contilia Centre for Oesophageal Diseases at Elisabethkrankenhaus Essen. Prof. Dr. Arnulf Hölscher is one of our approximately 100 DKV Best Care top experts, offering second opinions and comprehensive treatment recommendations to our Best Care policyholders facing serious illnesses.

Prof. Hölscher, thank you very much for taking the time to talk to us. As a visceral and thoracic surgeon, you are the head of the Contilia Centre for Oesophageal and Gastric Diseases at the Elisabeth Hospital in Essen. What is it about the oesophagus that makes it particularly susceptible to cancer?

Oesophageal cancer is one of the most aggressive tumours of the digestive tract. It is all too often diagnosed late – not least because its early warning signs, such as Barrett’s oesophagus, cause no pain at all. Reflux, or heartburn as it is commonly known, is a widespread condition and can be more than just an annoying burning sensation. However, many patients are unaware of this. Long-term reflux damages the mucous membrane of the oesophagus. In some cases, Barrett's oesophagus develops and changes the tissue, which increases the risk of cancer. If this condition is not detected or controlled, it may progress into a malignant tumour.

Some readers may now be reminded of their last celebration – perhaps Christmas dinner or another festive occasion – when, after a hearty meal and a glass or two of wine, their stomachs began to protest. At what point should people start to worry, and what warning signs shouldn’t be ignored?

The early stages of oesophageal cancer rarely cause any symptoms As the disease progresses, symptoms may include difficulty swallowing, unintended weight loss, pain behind the breastbone, or persistent hoarseness. If you suffer from long-term heartburn, it’s worth considering a gastroscopy – even if you don’t have any acute symptoms.

What can patients with reflux do to prevent it at this early stage?

Regular endoscopic check-ups are key, especially for those with chronic heartburn. In cases of Barrett’s oesophagus, even minimally invasive procedures can prevent cancer from developing. A balanced diet, giving up smoking, and maintaining a healthy weight also go a long way in reducing risk.

If oesophageal cancer is diagnosed, what treatment options are now available?

Thanks to advances in visceral surgery, tumours can now be removed surgically – often using minimally invasive techniques – with greater precision and less trauma than ever before. Interdisciplinary teams develop tailored treatment plans for each patient. The earlier a tumour is discovered, the better the chances of recovery. We can do a great deal for our patients nowadays – but it’s crucial that they seek a diagnosis as early as possible.

On 1 July 2025, a special patient conference took place at the Contilia Clinic in Essen. Why did you choose this format and how do you look back on the event?

This conference marked a significant step forward. Heartburn is a daily reality for many – but it can be life-threatening. Chronic reflux can, over time, alter the lining of the oesophagus and pave the way for pre-cancerous changes. Although this link is well established in medical circles, it’s still not widely recognised by the general public. The event focused not just on medical presentations, but on real dialogue: patients who had already undergone treatment spoke candidly about their experiences with diagnosis, therapy, and life afterwards – directly engaging with those currently suffering from the condition. The atmosphere at the Contilia Clinic was shaped by openness, trust and empathy. Former patients encouraged those affected and showed them that even a grave diagnosis is not the end of the road. Hearing these stories first-hand gave many attendees hope and a fresh outlook on their own journey.

Thank you for sharing your insights and advice.