Esophageal cancer

Esophageal cancer, though less talked about than other types of cancers, is a serious and potentially life-threatening condition that affects the food pipe connecting the mouth to the stomach. It is often diagnosed at a later stage due to subtle early symptoms, making awareness and early detection critical. This type of cancer can severely affect swallowing, nutrition, and overall quality of life. Understanding its symptoms, causes, and treatment options is vital for timely diagnosis and management.

With an increase in lifestyle-related risk factors such as tobacco and alcohol use, the incidence of esophageal cancer is on the rise. In this article, we explore every facet of this condition to help individuals and families better understand and manage it.

Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the oesophagus, the muscular tube that carries food and liquids from the throat to the stomach. The two main types of this cancer are squamous cell carcinoma and adenocarcinoma.

Squamous cell carcinoma usually develops in the upper or middle part of the oesophagus and is more commonly associated with tobacco and alcohol use. Adenocarcinoma often arises in the lower part of the oesophagus and is linked with conditions like gastroesophageal reflux disease (GERD) and Barrett’s oesophagus.

Globally, esophageal cancer ranks as the eighth most common cancer and the sixth leading cause of cancer-related deaths, according to the World Health Organisation (WHO).

In India, the burden is significant. According to a 2020 study published in the Indian Journal of Medical Research, the age-adjusted incidence rate for esophageal cancer in India ranges between 5 to 10 per 100,000 people. It is more prevalent in rural and tribal populations, particularly in regions such as the North-East and Central India, where dietary and environmental factors contribute significantly.

There are two primary types of esophageal cancer:

1. Squamous Cell Carcinoma

• Arises from the flat, thin cells lining the upper and middle oesophagus.
• More common in Asia and Africa.
• Strongly linked to tobacco, alcohol, and dietary deficiencies.

2. Adenocarcinoma

• Begins in glandular cells found at the lower part of the oesophagus.
• More common in Western countries.
• Associated with GERD and obesity.

Other Rare Types:

• Small cell carcinoma
• Sarcomas
• Lymphomas

These are rare but may present with similar symptoms and require unique treatment approaches.
 

Several factors contribute to the development of esophageal cancer. While the exact cause is not always known, common contributors include:

• Chronic acid reflux (GERD): Constant exposure to stomach acid can damage oesophageal lining.
• Barrett’s oesophagus: A condition where normal oesophageal cells are replaced by abnormal cells due to long-term reflux.
• Tobacco use: Smoking or chewing tobacco significantly increases the risk.
• Alcohol consumption: Heavy drinking irritates and damages the oesophageal lining.
• Poor nutrition: Deficiencies in vitamins like A, C, and minerals such as zinc.
• Obesity: Increases the risk, especially for adenocarcinoma.
• Human papillomavirus (HPV) infection (in rare cases).
   

Esophageal cancer symptoms may appear subtly at first and worsen over time. Common signs include:

• Difficulty swallowing (dysphagia) – often the first noticeable symptom.
• Unexplained weight loss – due to trouble eating.
• Chest or back pain
• Chronic cough or hoarseness
• Vomiting or regurgitation of food
• Heartburn or indigestion
• Fatigue and anaemia
• Persistent hiccups in advanced stages

It is crucial not to ignore these signs, especially if they persist for more than two weeks.

Early diagnosis is key to better outcomes. Diagnostic methods include:

1. Barium swallow X-ray: A special dye helps highlight abnormalities in the oesophagus.
2. Endoscopy: A thin tube with a camera examines the inner lining of the oesophagus.
3. Biopsy: Tissue sample collected during endoscopy for cancer testing.
4. CT scan or MRI: Used to determine if cancer has spread.
5. PET scan: Identifies cancer activity in the body.
6. Endoscopic ultrasound: Measures tumour size and involvement of nearby tissues.
   
    

The treatment depends on the cancer’s stage, type, and patient health. Common approaches include:

1. Surgery

• Esophagectomy: Removal of part or all of the oesophagus.
• Often followed by reconstruction using part of the stomach or colon.

2. Radiotherapy

• High-energy rays target and kill cancer cells.
• May be used before surgery (neoadjuvant) or after (adjuvant).

3. Chemotherapy

• Drugs used to kill cancer cells or stop their growth.
• Often combined with radiation (chemoradiation). You can opt for the best brands for thyroid hormonal pills such as Thyrox 88 mcg tablet on Dawaadost.

4. Targeted Therapy

• Targets specific molecules involved in cancer growth.
• Trastuzumab (for HER2-positive cases) is one such drug.

5. Immunotherapy

• Boosts the body’s natural defences to fight cancer.
• Used in advanced or recurrent cases.

While alternative therapies cannot replace conventional treatments, some patients use them to manage symptoms or side effects. These include:

• Acupuncture – may help with nausea or pain relief.
• Herbal supplements – only under medical supervision.
• Yoga and meditation – for stress and anxiety management.
• Nutritional therapy – helps patients maintain weight and strength.

Patients should always consult their oncologist before trying alternative methods.

The following factors increase the likelihood of developing esophageal cancer:

• Age: Most common in people over 60.
• Gender: More common in men than women.
• Smoking and alcohol: Strongly associated with squamous cell carcinoma.
• Diet low in fruits and vegetables
• Chronic GERD or Barrett’s oesophagus
• Obesity
• Family history of esophageal cancer
• Occupational exposure: To certain chemicals or dust

If left untreated, esophageal cancer can lead to:

• Obstruction of the oesophagus
• Severe malnutrition
• Internal bleeding
• Metastasis to liver, lungs, lymph nodes
• Fistulas between oesophagus and windpipe
• Severe pain and discomfort

Advanced cases may also affect breathing and heart function.

A cancer diagnosis can be overwhelming. Here are some practical ways to cope:

• Follow a soft or liquid diet to ease swallowing.
• Eat small, frequent meals to ensure nutrition.
• Attend all follow-up appointments and keep track of symptoms.
• Join support groups to share experiences.
• Prioritise rest and mental health – consider counselling or meditation.
• Stay active if possible, with light exercise.
• Work with a dietitian to manage eating challenges.
   

There are several myths surrounding this condition:

• Myth: Only smokers get esophageal cancer.
   Fact: Non-smokers with GERD or Barrett’s are also at risk.
• Myth: Heartburn is harmless.
   Fact: Chronic acid reflux can lead to cancer over time.
• Myth: It’s untreatable.
   Fact: Early-stage esophageal cancer is curable, and treatment can prolong life even in advanced cases.
• Myth: Surgery is the only treatment.
   Fact: Many cases are treated with a combination of therapies.
   

Seek medical help if you experience:

• Difficulty swallowing
• Unexplained weight loss
• Frequent heartburn or chest pain
• Chronic cough or hoarsenessEsophageal cancer is a serious disease, but with early diagnosis, proper treatment, and supportive care, patients can lead a meaningful life. Knowing the symptoms, risk factors, and available treatments empowers individuals to act promptly. Whether you are at risk, newly diagnosed, or caring for someone with esophageal cancer, information is your best ally.

By making lifestyle changes, staying informed, and reaching out for medical and emotional support, the journey through esophageal cancer becomes more manageable and hopeful.

Early intervention can dramatically improve outcomes.

• What type and stage of esophageal cancer do I have?
• What are my treatment options?
• What are the side effects of each treatment?
• How will treatment affect my ability to eat?
• Are clinical trials an option for me?
• What lifestyle changes should I make?

Being well-informed helps you make confident decisions.

Supporting a loved one includes:

• Listening without judgement
• Helping with daily tasks
• Attending medical appointments together
• Encouraging a healthy diet
• Respecting their choices about treatment
• Offering emotional support or helping find professional counselling
   

Sometimes, just being present is the most comforting gesture.

Esophageal cancer is a serious disease, but with early diagnosis, proper treatment, and supportive care, patients can lead a meaningful life. Knowing the symptoms, risk factors, and available treatments empowers individuals to act promptly. Whether you are at risk, newly diagnosed, or caring for someone with esophageal cancer, information is your best ally.

By making lifestyle changes, staying informed, and reaching out for medical and emotional support, the journey through esophageal cancer becomes more manageable and hopeful.