esophageal cancer

Q 1 what is esophageal cancer?

Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. Oesophagus also called food pipe, is a long tube that carries food from the throat to the stomach. 

Q 2 what are the types of esophageal cancer?

  • Adenocarcinomas 
  • Squamous cell carcinoma is the most common type
  • Gastrointestinal stromal tumors (GISTs)
  • Leiomyoma

Q 3 what causes esophageal cancer? 

  • Reflux disorder, such as gastroesophageal reflux disease (GERD)
  • Barrett’s esophagus, which is a condition characterized by damaged esophageal lining due to GERD
  • Achalasia, a condition where the muscle at the bottom of the esophagus doesn’t relax properly
  • Smoking
  • Overweight
  • Consuming alcohol

Q 4 What are the symptoms of esophageal cancer?

  • Difficulty swallowing is the most common symptom of oesophageal cancer.

Cancer can narrow the esophagus, making it difficult for food to pass down.

If the tumor continues to grow, even liquids may become difficult to swallow.

  • Persistent indigestion or heartburn
  • Loss of appetite and weight loss
  • Vomiting
  • Pain or discomfort in your chest or back
  • Cough
  • Hoarseness
  • Vomiting of blood

A word of caution 

  • All of these symptoms can also be caused by conditions that are not cancer. Kindly consult your doctor first. 

Q 5 How esophageal cancer is diagnosed? 

  • Endoscopy An endoscopy is a procedure that allows the doctor to see inside the oesophagus. A thin, flexible tube with a light and camera at the end is passed into mouth and down towards your stomach.

  • During endoscopy, a biopsy is done from esophageal mass to confirm the diagnosis and to know the type of cancer. 
  • Biopsy means removing a small piece of tissue from cancer mass and sent it to a pathologist for examination under a microscope. 

A word of caution

  • There is a common myth that taking biopsy leads to the spread of cancer cells in body. This is not true. Taking biopsy does not lead to the spread of cancer cells in body.
  • Biopsy confirms that it is cancer and not infection and also helps in knowing the type of cancer so that further treatment can be planned accordingly.  

Further testing

Once esophageal cancer has been diagnosed, further tests are done to look for a local extension of disease and to confirm whether cancer cells have spread to other parts of the body or not. These tests may include:

  • Blood tests – to assess the state of liver, kidneys and bone marrow
  • CT scan of chest and abdomen – To find out the local spread of disease
  •  Endoscopic ultrasonography  – To the local spread of disease 
  • PET scan – To know the distant spread of disease 

Q 6 What is esophageal cancer staging?

Staging is a measurement of how far cancer has spread.

After all the tests have been completed and the results are known, it should be possible to predict what stage the cancer is. The higher the stage, further cancer has spread 

  • Stage 0, which is not true cancer, but rather abnormal cells (high-grade dysplasia) that could develop into esophageal cancer.
  • Stage I, in which the cells have already become cancerous and have grown into the deeper layers of the esophageal wall.
  • Stage II, in which cancer has progressed into the main muscular layer of the esophagus.
  • Stage III, in which the cancer is present in the outer layer of the esophagus (not just the esophageal wall) or has started to grow into the lymph nodes or nearby organs.
  • Stage IV, in which cancer has spread to distant lymph nodes or distant organs.

A word of caution 

The above staging is a simplified version for your basic understanding. The reader is advised to follow the TNM staging system developed by the American Joint Committee on Cancer (AJCC) in which 

  • T stands for the size and location of primary cancer
  • N stands for nodes. It tells whether cancer has spread to the nearby lymph nodes
  • M stands for metastasis. It tells whether cancer has spread to distant parts of the body

Q 7 How esophageal cancer is treated? 

When deciding treatment options for a particular patient, the doctor will consider the following factors and will decide the individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • The location of the cancer
  • Your overall health and ability to recover from surgery, radiation therapy or chemotherapy
  • Your personal preferences

Following are the general guidelines but treatment may vary from patient to patient:  

Three main categories for treatment purpose are

  • Early esophageal cancer: Surgery followed by +/- chemotherapy +/- radiation therapy. The decision for chemo and radiation therapy depends on the final pathology report after surgery. 
  • Locally advanced esophageal cancer: chemo +/- radiation therapy followed by surgery 
  • Advanced esophageal cancer (metastatic):  Option include chemotherapy / radiation therapy/targeted therapy. Treatment decision depends upon organ involved and the general condition of the patient.

Surgery 

For early esophageal cancer: Very early cancer can be treated with the use of endoscopy guided resection known as endoscopic mucosal resection (EMR). There will be no surgical scar on the body. 

For locally advanced cancer: Surgery includes esophagectomy in which the whole of the esophagus (food pipe) is removed and a new food pipe constructed with help of stomach. It can be done with the help of laparoscopy also.  

Different types of esophagectomy are transhiatal esophagectomy (THE), Ivor-Lewis transthoracic esophagectomy, and tri-incisional esophagectomy. The choice of procedure depends upon the location of cancer in the esophagus. 

For advanced cases that present with dysphagia (inability to take liquids) can be treated with several endoscopic approaches to providing palliation.

  • Placement of a prosthetic self-expanding metal stent (SEMS)
  • Placement of NJ tube
  • Dilatation
  • Laser therapy
  • Endoscopic injection therapies
  • Photodynamic therapy
  • Brachytherapy