Oesophageal Cancer

There are two main subtypes of oesophageal cancer:

• Adenocarcinoma: Typically occurs in the lower third of the oesophagus
• Squamous cell carcinoma: Most often found in the middle and upper third of the oesophagus

Management strategies for both subtypes differ slightly based on specific pathology. 

Oesophageal cancer may not cause obvious symptoms in the early stages. As the disease progresses, patients may experience the following symptoms:

Early stages: 

• Refractory hyperacidity
• Difficulty swallowing solids or liquids, with food often feeling stuck in the oesophagus

Advanced stages:

• Unexplained weight loss
• Frequent vomiting after eating
• Pain in the chest or back
• Hoarseness or change in voice

Several lifestyle and medical conditions can increase the risk of oesophageal cancer. The most common causes and risk factors include:

• Smoking
• Alcohol consumption
• Gastroesophageal reflux disease (GERD): Chronic acid reflux or heartburn
• Barrett's oesophagus: A condition where the normal lining of the food pipe changes due to repeated acid irritation
• Chewing tobacco causes hyperacidity due to its irritant properties

To diagnose oesophageal cancer and determine the cancer stage, doctors may recommend a combination of tests:

• Upper gastrointestinal (GI) endoscopy: a thin flexible tube with a camera is passed through the mouth to examine the oesophagus and stomach
• Endoscopic ultrasonography (EUS): a special endoscope with an ultrasound probe to check the depth of tumour spread
• Biopsy: removal of a small tissue sample from the tumour to check under a microscope
• Imaging tests, including CT and PET-CT scans
• Barium swallow (used sparingly nowadays): patient drinks a contrast liquid (barium) to outline the oesophagus on X-rays

The treatment plan of oesophageal cancer is formulated on the basis of the stage of the disease and the patient’s overall health. Options may include:

Very Early Stages:

• Endoscopic Mucosal Resection (EMR): Removal of the inner lining containing the tumour using an endoscope.
• Endoscopic Submucosal Dissection (ESD): Removal of slightly deeper growths through endoscopy.
• Surgical removal of the oesophagus may be recommended, using conventional, video-assisted thoracoscopic surgery (VATS), or robotic approaches.

Locally Advanced Cases:

• For squamous cell carcinoma, treatment typically involves a combination of chemotherapy and radiotherapy in smaller doses, followed by surgery.
• For adenocarcinoma, the sequence may involve administering chemotherapy first, followed by surgery, and subsequent chemotherapy as a follow-up.

Locally Advanced Cases Not Suitable For Surgery: 

• A combination of definitive chemotherapy and radiation therapy may be advocated.

Metastatic Cases (spread beyond the oesophagus to the other organs of the body):

• Chemotherapy or immunotherapy may be used to manage the disease.
• Stenting: placing a hollow metal tube in the oesophagus to alleviate swallowing difficulties and improve quality of life.

It is important to seek medical advice if you experience persistent difficulty swallowing, unexplained weight loss, frequent vomiting after meals, or changes in voice. Early consultation increases the chances of timely diagnosis and better treatment outcomes.

While oesophageal cancer is not always preventable, addressing specific risk factors can lower the chances of developing this condition:

• Avoid smoking and tobacco consumption in any form.
• Avoid or limit alcohol consumption.
• Manage GERD (hyperacidity) with appropriate lifestyle changes and treatment.
• Follow a healthy and balanced diet.

If symptoms arise, consult a thoracic surgeon or a medical/radiation oncologist.

The specialist will recommend a treatment plan best suited for you based on your age, medical fitness, and the stage of the disease.