Condition & Treatment – Esophageal Cancer

Key facts:

  • In India, it is the sixth most common cause of cancer related deaths. Incidence peaks in the sixth decade in most parts of the world.
  • Accounts for 1% of all malignancy & 6% of all GI malignancy.
  • The two most common forms of esophageal cancer are named for the type of cells that become malignant(cancerous) are squamous cell carcinoma (SCC) and adenocarcinoma (AC).

Risk Factors:

  • Smoking, heavy alcohol use
  • Obesity, chronic gastroesophageal reflux disease
  • Barrett esophagus can increase the risk of esophageal cancer.
  • ICMR data indicate a very high incidence of esophageal cancers associated with tobacco (bidis and cigarettes)
  • Poor nourishment and consumption of hot beverages (in people who generally neither smoke nor consume alcohol).

In the state of Kashmir, smoking (hookahs), snuff, sundried spices and vegetables, hot salted tea with baking soda, and red chilies have been implicated as risk factors.

Clinical signs and symptoms:

  • Most common Signs and symptoms of esophageal cancer are weight loss and painful or difficult swallowing.
  • Pain behind the sternum/breastbone.
  • Hoarseness and cough.
  • Indigestion and heartburn.

Investigations:

The following tests and procedures may be used:

Physical exam and history :

To examine lump/swelling or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Chest x-ray

Barium swallow : A series of x-rays of the esophagus and stomach after patient drinks a liquid that contains barium. The liquid coats the esophagus and stomach, and x-rays are taken. It helps in assessment of level of obstruction and patency of lumen.

Upper GI Endoscopy(UGIE):

A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. It also helps in taking the biopsy for establishing a histopathological diagnosis.

Biopsy

Endoscopic ultrasound (EUS): For esophageal cancer, the endoscope is inserted through the mouth. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

CT scan

PET scan (positron emission tomography scan): A procedure to find malignant cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.

Treatment

  • Radiation therapy: Often combined with chemotherapy and used before surgery and sometimes after surgery. Radiotherapy may also be used for relieving symptoms of advanced esophageal cancer.
  • Chemotherapy: Use of drugs to kill cancer cells. This can be used before or after surgery or in combination with radiation therapy.
  • Surgery:
    • Endoscopic resection (for very small tumors)
    • Removing a part of esophagus (esophagectomy)
    • Removing a part of esophagus and upper portion of stomach (esophagogastrectomy)

In most cases of Cancer Esophagus, the primary treatment is Chemo-radiation which may be or may not be followed by surgery.

Follow Up

  • History and physical examination every three to six months for one to three years, then every six months for years 4 and 5, then annually
  • Radiologic imaging and upper gastrointestinal (GI) endoscopy, as clinically indicated
  • Dilation for anastomotic stenosis
  • Nutritional counselling

Steps to reduce your risk of esophageal cancer

  • Quit smoking
  • Control alcohol intake
  • Eat more fruits and vegetables
  • Maintain a healthy weight
Back