Most of us have a symptom we have stopped noticing. The heartburn after a big meal. The tablet taken every morning for so many years that nobody remembers who first prescribed it. The bit of bread that catches, once, and then goes down fine, so you say nothing.
Ireland has one of the highest rates of oesophageal cancer in Europe, and there is no screening programme for it or for stomach cancer. No letter arrives in the post the way it does with BowelScreen or BreastCheck. Early detection rests entirely on somebody noticing a change and a GP taking it seriously, which makes knowing the warning signs less a matter of health anxiety than of doing a job nobody else will do for you.
TL;DR
- Around 520 people are diagnosed with oesophageal cancer and about 570 with stomach cancer in Ireland every year, most of them over 55, and more men than women.
- There is no national screening programme for either. Early detection depends entirely on symptoms being reported and referred.
- New difficulty swallowing at any age is an urgent red flag. So is unexplained weight loss with reflux, indigestion or upper abdominal pain after 55.
- Barrett’s oesophagus is a consequence of long-term reflux and the main known precursor to oesophageal adenocarcinoma. Progression is uncommon, but surveillance appointments matter.
- Helicobacter pylori infects roughly one in five people in Ireland, is usually picked up in early childhood, and can be tested for and treated.
Two cancers, one pathway
Oesophageal cancer affects the food pipe, stomach cancer the stomach itself. Different diseases, but for anyone sitting in a GP surgery with vague upper gut symptoms they behave like one problem, because they share risk factors, symptoms and the same diagnostic test: an endoscopy, a thin camera passed down through the mouth. The Irish Cancer Society puts oesophageal cancer at around 520 cases a year and stomach cancer at about 570, both more common in men and both clustering after 55.
The Irish part of the story is the type. Globally, oesophageal cancer is usually squamous cell carcinoma, driven by smoking and alcohol. Here, as in the UK, the dominant type is adenocarcinoma, which grows out of long-term acid reflux, and our rates are among the highest anywhere in the world. Incidence is estimated to have doubled over roughly two decades. That is not a quirk of geography. It tracks reflux, weight, smoking and drinking across a generation.
The symptoms that should earn you an urgent appointment
Irish GPs work to referral criteria that mark certain presentations as needing urgent direct access endoscopy, generally within two weeks. Worth knowing which ones they are, because if you present them clearly the conversation goes faster.
- New difficulty swallowing. Food catching, sticking or needing to be washed down. This is the single most important symptom and it warrants urgent investigation at any age. Our guide to swallowing difficulties after 50 covers the wider picture, but new and persistent trouble swallowing is never something to watch and wait on.
- Unexplained weight loss after 55, particularly alongside reflux, indigestion or upper abdominal pain. Weight coming off without effort is a symptom, not a win.
- Persistent vomiting, or feeling full very quickly at meals.
- Iron deficiency anaemia with no obvious cause. It can be the first measurable sign of a slow bleed. See our guide to anaemia after 50.
- Reflux that has changed: worse, different, or newly needing daily treatment when it never did before.
Notice what is not on that list: ordinary heartburn on its own, in someone who has had it for years and whose tablets work. That is genuinely reassuring most of the time. The risk is the opposite situation, where medication quietly controls the symptom while something underneath it changes. If your prescription has been repeating for years without a review, ask for one. A well-prepared GP visit with dates and specifics does more work than a vague sense that something is off.
Barrett’s oesophagus, without the fear
Years of acid washing back up can change the cells lining the lower oesophagus into something closer to intestinal lining. That is Barrett’s oesophagus, the main known precursor to oesophageal adenocarcinoma. People tend to hear “precancerous” and stop listening after that word, so hold on to the proportion: most people with Barrett’s never develop cancer. Research puts the overall annual risk of progression at well under one per cent, though it rises considerably when the surveillance biopsies show dysplasia, meaning genuinely abnormal cells. A large study using the Northern Ireland Cancer Registry found the risk concentrated in those whose first endoscopy showed intestinal metaplasia rather than those without it.
Which is exactly why the surveillance system exists, and why the appointment that feels like a nuisance is the point of the whole exercise. British Society of Gastroenterology guidance, which Irish units broadly follow, recommends repeat endoscopy every three to five years for shorter segments of Barrett’s without dysplasia, and every two to three years for longer ones. Dysplasia changes the plan entirely and is treatable, often endoscopically, before it ever becomes cancer. If you have a Barrett’s diagnosis and cannot remember your last scope, that is a phone call worth making this week.
The bacterium in the stomach
Stomach cancer has a cause that is genuinely modifiable. Helicobacter pylori is a bacterium that lives in the stomach lining, causes chronic inflammation and ulcers, and is the single biggest risk factor for gastric cancer. Roughly one in five people in Ireland carry it. Irish research indicates it is almost always acquired in early childhood, so this is not something you catch in your sixties.
It is detectable with a breath test, a stool test or a biopsy taken during endoscopy, and treatable with a course of antibiotics alongside acid suppression. Eradication rates have slipped in recent years because of antibiotic resistance and because the regimen is genuinely hard to finish properly, which makes taking every dose more important than it looks. If you have had ulcers, ongoing indigestion or a family history of stomach cancer, ask whether you have ever actually been tested.
What is in your hands, and what is not
The risk factors overlap almost completely with those for reflux: smoking, alcohol, carrying extra weight around the middle, and a diet heavy on processed and salt-preserved meats and light on fruit and vegetables. Smoking and drinking together multiply each other rather than simply adding up. Quitting after 50 still pays, and it pays sooner than most people expect.
Then there is the part that is not in your hands. Ireland has no screening programme for these cancers, unlike the three national programmes covered in our guide to cancer screening after 50. The National Cancer Strategy 2017 to 2026 runs out this year with its successor still to be written. And diagnostic capacity is under real strain: HSE figures reported this year showed 6,660 people waiting beyond the 28 day target for an urgent colonoscopy during 2025, up from 3,623 the year before. That is the lower gut rather than the upper, but it is the same endoscopy units and the same pressure.
Practically, that means two things. Ask your GP whether your referral has been marked urgent, and say so plainly if your symptoms are on the list above. And if you are waiting and something changes, particularly swallowing, go back rather than waiting your turn quietly. A changed symptom is new clinical information and it can move you up a list.
The Oesophageal Cancer Fund runs its Lollipop Day campaign at the end of February each year for exactly this reason: symptom awareness is the closest thing to a screening programme these cancers currently have. At Críonna Health we would rather you read this, decide none of it applies, and get on with your day. But if one line caught, make the appointment. Most of these symptoms turn out to be nothing serious, and the ones that are not turn out to be far more treatable when caught early, as our guide to living well after a cancer diagnosis makes clear.
This article is for general information and is not a substitute for medical advice. If you have any of the symptoms described here, contact your GP. The Irish Cancer Society Support Line is free on 1800 200 700.
📷 Photo by Vitaly Gariev on Unsplash
