Esophageal cancer

Esophagus

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The esophagus is a 10-inch-long muscular tube that connects the throat to the stomach. When you swallow, the esophagus contracts, pushing food down into the stomach.

Esophageal Cancer

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Esophageal cancer occurs when cells in the esophagus begin to grow uncontrollably, forming a tumor. This tumor can be cancerous (malignant) or non-cancerous (benign). The cancer generally starts in the innermost layer of the esophagus and can grow outward.

The two main types of esophageal cancer are:

• Squamous Cell Carcinoma: This cancer starts in the squamous cells that line the esophagus. It is more common in the upper and middle parts of the esophagus.
• Adenocarcinoma: This cancer develops in the glandular tissue near the lower part of the esophagus where it connects to the stomach.

Other rare forms of esophageal cancer include small cell neuroendocrine cancer, lymphoma, and sarcoma.

Statistics

In India, 63,180 new cases of esophageal cancer are detected annually, making it the 5th most common cancer. It is also ranked 5th in cancer-related mortality, with 58,342 deaths each year.

Survival Rate

In the United States, the 5-year survival rate for localized esophageal cancer is 47%. If the cancer spreads to nearby organs or lymph nodes, the survival rate drops to 26%, and if it spreads to distant organs, it falls to 6%.

Risk Factors

Several factors can increase the risk of developing esophageal cancer, including:

• Age: People aged between 45 and 70 are at higher risk.
• Gender: Men are 3 to 4 times more likely to develop esophageal cancer than women.
• Smoking: Tobacco use significantly raises the risk of esophageal cancer.
• Alcohol: Regular alcohol consumption increases the risk, especially when combined with smoking.
• Barrett’s Esophagus: People with chronic GERD (gastroesophageal reflux disease) may develop Barrett’s esophagus, which increases the likelihood of adenocarcinoma.
• Diet: A diet low in fruits and vegetables is associated with a higher risk of esophageal cancer.
• Obesity: Obesity increases the risk of developing adenocarcinoma in the esophagus.

Symptoms

Symptoms of esophageal cancer may include:

• Pain or difficulty swallowing food
• Chest pain or discomfort
• Vomiting
• Food getting stuck in the esophagus
• Unexplained weight loss
• Cough or hoarseness

Diagnosis

Tests and procedures used to diagnose esophageal cancer include:

• Barium Swallow: The patient drinks a barium solution, and X-rays are taken to identify abnormalities in the esophagus.
• Endoscopy: A thin, lighted tube is inserted through the mouth or nose to examine the esophagus. Biopsies may be taken during the procedure.
• Bronchoscopy: Used to determine if the cancer has spread to the airway in the upper esophagus.
• Biopsy: A sample of tissue is removed for microscopic examination to confirm the presence of cancer cells.
• Endoscopic Ultrasound: Provides detailed images of the esophagus and surrounding tissues.
• CT Scan, MRI, and PET CT: Used to determine the extent of cancer spread.

Treatment

1. Surgery: Esophagectomy is the primary surgery used to remove part of the esophagus affected by cancer. The remaining healthy portion of the esophagus is then connected to the stomach. In some cases, surgery is performed to relieve symptoms rather than cure the cancer, known as palliative surgery.
2. Endoscopic Therapy: Various endoscopic procedures can be used to treat symptoms, including dilation (widening the esophagus), stent placement, electrocoagulation (using electrical current to destroy cancer cells), and cryotherapy (freezing cancer cells).
3. Radiation Therapy: High-energy radiation is used to destroy cancer cells. External beam radiation therapy is delivered from outside the body, while brachytherapy delivers radiation directly inside the esophagus. Side effects may include fatigue, pain while swallowing, skin irritation, nausea, and diarrhea.
4. Chemotherapy: Chemotherapy uses drugs to kill cancer cells. Side effects vary depending on the specific drug but may include fatigue, nausea, vomiting, infections, hair loss, and diarrhea.
5. Targeted Therapy: Drugs like trastuzumab (Herceptin) and ramucirumab (Cyramza) are used to target specific genes or proteins that contribute to cancer growth.
6. Immunotherapy: Drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) help the body’s immune system fight the cancer.

Follow-up Care

After treatment, regular follow-up care is essential to monitor for recurrence or side effects. Follow-up includes physical exams, blood tests, and imaging studies.

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