Esophageal Cancer: Causes, Symptoms and Treatment

The esophagus is a tube-like structure that runs from the throat to the stomach.

Food enters from mouth to stomach through the Esophagus. Esophageal cancer begins in the inner layer of the food pipe and can spread out to involve the other layers of the Esophagus and to other parts of the body (metastasis).

There are two main types of oesophageal cancer, Squamous and Adenocarcinoma. Squamous type of can occurs along the entire length of the esophagus whereas Adenocarcinoma occurs in the lower esophagus near the stomach and is believed to be largely related to acid and reflux disease.

Symptoms of Esophageal Cancer

Early on there may be no symptoms. In advanced cases, symptoms include:

• Difficulty or pain while swallowing
• Unexplained Weight loss
• Chest pain, Cough, Haemoptysis
• Hoarseness of voice
• Heartburn and indigestion

What Are Risk Factors for Esophageal Cancer?

Factors that increase a person’s risk of developing esophageal cancer include:

• Age: Esophageal cancer is mostly diagnosed in people over age 50.
• Gender: Esophageal cancer is more common in males.
• Smoking
• Tobacco use
• Heavy alcohol use
• Acidity or Gastroesophageal reflux disease
• Barrett’s esophagus:- Over time, stomach acid in the esophagus can cause changes in the cells that increase the risk for adenocarcinoma.
• Obesity

The risk of adenocarcinoma is higher in white obese men, but squamous cell carcinoma of the esophagus is more common in Asian and black populations.

 How Is Esophageal Cancer Diagnosed?

To diagnose esophageal cancer, the doctor will review your symptoms and order a few tests like endoscopy, biopsy, and imaging scans. The above information is required to plan your treatment.

• Endoscopy: An endoscope is a thin tube to examine the esophagus or stomach and to take a biopsy from unhealthy areas seen during endoscopy.
• Biopsy: During endoscopy, we can take tissue from the esophagus for the confirmation of cancer.
• CT Scan/ PET CT Scan: is done to look for disease spread (Staging)  and assess response to treatment given for cancer.

• Bronchoscopy: a bronchoscope, a thin, lighted tube that is inserted through the nose or mouth to check for cancer involvement in the trachea or airways.

What Are the Stages of Esophageal Cancer?

The stages of esophageal cancer are given a number (I to IV); the higher the number, the more advanced is the cancer. In general Stage, I & II cancer is confined to the esophagus, in Stage III disease spreads beyond the esophagus into surrounding structures whereas in Stage IV, the cancer has spread to other organs in the body.

How Is Esophageal Cancer Treated?

As with other cancers, treatment has greater chances of success if the cancer is detected early. Unfortunately, it is asymptomatic in the early stages and by the time it is detected, it is often already in an advanced stage (has spread throughout the esophagus and beyond).

Treatment of esophageal cancer depends on many factors, including the overall health or performance status of the individual and stage of cancer.

• Surgery: Surgery can be offered directly or after radiation and chemotherapy. It is an essential part of treatment and it includes either partial or complete removal of the esophagus, sometimes along with part of the stomach.
• Radiation therapy: Kills cancer cells with radiation and can be given before or after surgery, it is generally given before surgery to shrink the tumor and help surgery.
• Chemotherapy: typically used in combination with radiation therapy before surgery and sometimes after surgery.
• Targeted therapy: Newer treatments that target specific aspects of cancer to prevent cancer growth and spread.
• Immunotherapy: Uses immune system to control cancer cells.

Prevention

Although there is no sure way to prevent it we can certainly reduce the risk of esophageal cancer by adopting a healthy lifestyle and habits such as:

• Quit smoking.
• Stop drinking alcohol or try to reduce frequency.
• Consult if you experience persistent heartburn
• Exercise regularly and avoid becoming overweight.

By Dr. Abhishek Pareek, Surgical Oncologist, HCG Cancer Centre Jaipur