Cancer oesophagus

Oesophageal cancer occurs when the malignant cells begin to multiply rapidly in the oesophageal tissue. Although esophageal cancer is aggressive, many patients are asymptomatic until the cancer has already spread. This is because the oesophagus tries to compensate by stretching and making room for large bites of food. However, when the tumour multiplies and grows further, it starts blocking the esophageal opening. You may notice that it hurts swallowing and that you are facing trouble swallowing.

Types of oesophageal cancer

Oesophageal cancer is mainly of two types:

• Squamous cell carcinoma
  This cancer originates from the squamous cells lining the oesophagus and it usually affects the upper and middle parts of the oesophagus.
• Adenocarcinoma
  It is the most common esophageal cancer that develops in the tissue that produces mucus, helping you swallow. It generally involves the lower part of the oesophagus.

Esophageal cancer mostly affects males who are above 60 years of age.

The first symptom of esophageal cancer that most people notice is difficulty swallowing. Other symptoms include:

• Vomiting or coughing up of blood
• Pain in the back or the throat, between the shoulder blades or behind the breastbone
• Chronic cough or hoarseness
• Heartburn
• Unintentional weight loss

Esophageal cancer usually grows very fast. The oesophagus expands around the cancerous cells as the tumour grows. This is why most patients are asymptomatic until the cancer has spread.

The exact cause responsible for causing esophageal cancer is not known, but there are some risk factors which increase the chances of developing the disease. Those are:

• Alcohol consumption
  Heavy alcohol consumption enhances the chances of developing oesophageal cancer.
• Tobacco consumption
  This involves usage of smokeless tobacco and other forms of smoking.
• Obesity
  Being obese precipitates oesophageal inflammation that could give rise to a cancer.
• Chronic acid reflux and Barett’s oesophagus
  A change in the cells of the lower part of the oesophagus is called Barrett’s oesophagus. It happens due to chronic untreated acid reflux. Even in absence of Barrett’s oesophagus, patients who have chronic heartburn are susceptible to developing esophageal cancer.
• Human papillomavirus (HPV) infection
  HPV is a pathogen that can cause changes in the tissues of the mouth and the vocal cords and on the feet, hands, and genitals.
• History of cancer
  Those who have had head or neck cancer have an increased risk of developing esophageal cancer.
• Other conditions
  Esophageal cancer is associated with some congenital conditions that are relatively rare. One such condition is achalasia cardia, a rare condition that makes swallowing hard. Another rare condition known as tylosis is associated with esophageal cancer. Tylosis is characterised by excessive growth of skin on the soles of the feet and the palms of the hands.
• Occupational exposure to certain chemicals
  If you are exposed to dry cleaning solvents for a long period of time, you are more susceptible to developing oesophageal cancer.

The doctor first asks many questions about the symptoms and medical history of the patient. Following are some of the tests that are commonly performed to confirm the diagnosis:

• Barium swallow
  A series of X-rays are performed to examine the oesophagus. A liquid will barium is ingested so that the oesophagus is easily visible on an X-ray.
• Computed tomography (CT) scan
  A CT scan helps the healthcare providers understand if the tumour has spread to the abdomen or the chest cavity.
• Esophagogastroduodenoscopy (EGD)
  A thin and flexible tube known as endoscope is used by healthcare providers to visualise the inside of the oesophagus.
• Esophageal endoscopic ultrasound
  The images of the inside of the oesophagus are created by sound waves. This test may be performed as a part of Esophagogastroduodenoscopy.
• Biopsy
  During Esophagogastroduodenoscopy, the healthcare provider may resect a small part of the tissue to visualise it under the microscope and examine it for cancer cells. The information gained from biopsy is used for the classification, staging, and diagnosis of esophageal cancer. The foundation for cancer treatment is laid by cancer staging.

When staging esophageal cancer, healthcare providers look for several factors including the depth and location of the cancer, its spread to the surrounding lymph nodes and distant spread.

Grading of the tumour is also done. Tumour grades help determine whether tumour cells act and appear like normal cells. Low-grade tumours may be less aggressive as they are slow-growing, while high-grade tumours can be more aggressive as their cells divide very rapidly.

The treatment of cancer oesophagus depends on the grade and stage of the cancer. Following are some of the main treatment options available:

• Surgery
  The most common treatment for early-stage cancer oesophagus is esophagectomy. In this procedure, half or most of the oesophagus is removed along with some surrounding tissue. A new oesophagus is created by the surgeon by pulling up some portion of the stomach into the neck and the chest.
• Radiation therapy
  Radiation damages the cancer cells by directing a beam of radiation at the tumour. It may be used as adjuvant therapy after or before surgery to shrink the tumour and make the surgery less complicated.
• Chemotherapy
  Chemotherapy either stops the growth of cancer cells or damages them completely.
• Endoscopic submucosal dissection (ESD)
  ESD may be used for the treatment of very early-stage cancer oesophagus.
• Endoscopic mucosal resection (EMR)
  This procedure is used by surgeons to resect tumours from the esophageal mucosal lining.
• Endoscopic laser therapy
  With the help of this treatment, symptoms are eased when the tumour is obstructing the oesophagus, making swallowing hard.
• Photodynamic therapy (PDT)
  Drugs called photosensitisers are used to destroy tumours. These drugs are activated by light and a chemical reaction that damages the cancer is created.
• Targeted therapy
  An abnormally high amount of HER2 protein is carried by some esophageal cancer cells. This protein facilitates the growth of the cancer cells. Through targeted therapy, doctors treat cancer oesophagus with drugs destroying the HER2 protein.
• Immunotherapy
  Immune checkpoint inhibitors are involved in this treatment. Your immune system’s response to esophageal cancer cells is restored by these cells.

Cancer of the oesophagus is one of the most common cancers worldwide. It is also one of the hardest to treat cancer. This is because it is almost asymptomatic until the cancer is spread. Even if the cancer can’t be completely cured, treatment options are available to help people live long lives.

The Centre for Cancer at Kokilaben Dhirubhai Ambani Hospital, Indore offers diagnostic and curative services for a diverse range of cancers. Our team of highly talented doctors and allied medical staff are supported by state-of-the-art equipment and modern machines. This comprehensive team of cancer specialists is dedicated to treating the patients in the best possible way with an aim to render the patients physically fit and healthy so that they can return to their normal day-to-day activities.

The centre also houses a centre for rehabilitation medicine that helps individuals to overcome health disabilities and attain a degree of optimal health. The coordination of all rehabilitation programs is conducted by medical and surgical teams who have years of experience in dealing with complex cases and are committed to provide the highest quality of treatment and care to the patient.