Esophageal Cancer

Overview of Esophageal Cancer in India

The disease known as esophageal cancer begins in the esophagus, where the body stops swallowing food at the top (throat) and sends it through the esophagus and into the stomach for digestion. Treatment usually involves surgery to remove the cancer, but may also utilise chemotherapy, radiation, or a combination of both. Additionally, targeted therapy and immunotherapy may be used. Men have a higher risk of developing this cancer than women. Risk factors for esophageal cancer include drinking alcohol and using tobacco products.

What is Esophageal Cancer?

Esophageal cancer develops in the esophagus, which is the muscular tube that connects the throat to the stomach. This tube functions as a vital system, which transports food and liquids from the mouth to the stomach for the purpose of digestion.

Esophageal cancer typically originates from the esophageal inner lining and then proceeds to invade surrounding tissues and distant organs as the disease advances. The two main types are adenocarcinoma, which typically occurs in the lower part of the esophagus, and squamous cell carcinoma, which is more common in the upper and middle portions.

Although esophageal cancer has a fast progression rate, its treatment results improve when doctors detect the disease in its early stage. Doctors can treat the disease successfully because they have developed better diagnostic methods and more effective treatment strategies.

Types of Esophageal Cancer:

Esophageal cancer can be classified based on the cell type involved. Your diagnosis of esophageal cancer will affect the treatment options available to you. Esophageal cancer classifications include:

Adenocarcinoma

Adenocarcinomas begin in the glandular cells lining the esophagus. These glands secrete mucus; therefore, adenocarcinomas usually occur at the distal end of the esophagus. In the United States, adenocarcinoma is the most frequently diagnosed esophageal cancer and occurs primarily in white males.

Squamous cell carcinoma

Squamous cell carcinomas begin in the thin, flat cells that cover the surface of the esophagus. Squamous cell carcinomas usually occur in the proximal and middle portions of the esophagus. Squamous cell carcinoma is the most prevalent type of esophageal cancer in the world.

Other Rare Types

Other rare forms of esophageal cancer include small cell carcinoma, sarcoma, lymphoma, melanoma, and choriocarcinoma.

Cancer stages include:

Stage I: Localised (T1 N0 M0) – high chance of cure.

Stage II or III: Locally advanced and will require surgery along with chemoradiation therapy.

Stage IV: Metastatic esophagus cancer, focus on palliative care.

Procedure:

Esophageal cancer treatment can vary depending on factors such as stage, overall health and personal preference, with often a combination of treatment options.

Surgery 

Surgical removal of the tumour and a small amount of surrounding normal tissue may be possible for early esophageal cancers. For more advanced esophageal cancers, larger sections of the esophagus and adjacent lymph nodes can be surgically removed by means of an esophagectomy and reconnected to the stomach.

Chemotherapy 

Chemotherapy works by using very powerful chemicals to kill cancer cells. It is provided either before surgery (neoadjuvant chemotherapy), after surgery (adjuvant chemotherapy) or for patients with advanced disease. Side effects from chemotherapy may include nausea, increased risk of infection, hair loss, and fatigue.

Radiation Therapy

Radiation therapy is the use of high-energy radiation beams directed only at the place where the cancer is found (the tumour). Radiation may also be used with chemotherapy to treat esophageal cancer (chemoradiation). Side effects can include skin irritation around the area being treated, difficulty swallowing, and fatigue.

Endoscopic Therapies

At the very beginning stages of cancer or high-grade dysplasia, you may be able to have an endoscopic procedure, such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), to remove the affected area. You could also have radiofrequency ablation (RFA) to destroy any parts of the affected area that cannot be surgically removed.

Targeted Therapy

Targeted therapy uses medications to attack specific proteins or pathways in cancer cells. For example, trastuzumab attacks the HER2 receptor on HER2-positive esophageal cancer cells.

Immunotherapy

Immunotherapy works by boosting your body’s natural immune system to fight cancer. For example, pembrolizumab is considered immunotherapy and may be given to you if your esophageal cancer has been diagnosed at an advanced stage.