The gullet, or oesophagus, is the muscular tube that runs through your chest joining the back of your throat to your stomach. Cancers of the gullet develop in the cells lining the wall of the oesophagus and cause a swelling which narrows the tube and makes swallowing more difficult. The medical name for having problems with swallowing is dysphagia.

If an operation is not possible to remove the cancer then sometimes radiotherapy can be given to try and shrink the growth and make swallowing easier. The radiotherapy may often be combined with chemotherapy as well to improve its effectiveness. Although this is often helpful the radiotherapy does take some weeks to take effect and can sometimes make swallowing worse before it gets better.

Laser therapy may also help but the tumour may grow back quite quickly and so repeated treatments are usually needed.
Another way of relieving dysphagia is to put a tube inside the gullet to keep it open. In the past this has been quite successful but the results have improved considerably in recent years with the introduction of a new type of tube called a metallic stent.

The stent is a cylinder of woven metallic mesh, which may or may not have a flexible plastic covering. The stent is about 1cm in diameter but once it is in position the metallic mesh can be stretched to produce a tube about 2cm across which is usually sufficient to allow the normal passage of food through the gullet.

Insertion of the stent involves a stay in hospital but can often be done as a day-patient. Mild sedation is given and the stent, which as attached to a guide wire, is swallowed. Once it is in the right position a balloon is inflated to stretch the stent to the correct diameter. A slightly different approach uses self-expanding stents which, once in position, stretch on their own, without the need for the balloon.

Relatively normal eating can often start on the same day the stent is inserted, although chewing food well and having plenty of fluids with it is advised. Pain in the chest after insertion of the stent is quite common but usually settles within a day or so, although painkillers may be necessary during this time.

Sometimes tumour can grow back through the mesh of the stent and make the swallowing worse again. This is less likely if a plastic covered stent is used but this type of stent is more difficult to keep in position and can sometimes slip out of place. Despite these occasional problems stents do offer a very good way of getting rapid relief from dysphagia, usually with a minimum of side-effects.