Esophageal Cancer

The esophagus is an important part of our daily life. From swallowing to digestion and even protecting the airway, we highly rely on our esophagus. The esophagus also plays a role in protecting our upper digestive tract from acid reflux. Esophageal cancer is a cancer affecting the esophagus, the tube that carries our food to the stomach. The disease is often overlooked because symptoms are mild, but it can get much worse if it is not detected early. Cancer in the esophagus can also affect your eating habits as it can cause difficulty in swallowing. Things like age, lifestyle and medical factors play a major role in this disease. 

What Is Esophageal Cancer?

Esophageal cancer occurs when the cells in the esophagus lining start growing uncontrollably, which then causes abnormal cells to form a tumor. The formation of the abnormal cells and tumor can then cause a spread leading to the lymph node, or other organs like the lungs and liver. Even people with no obvious risks and those maintaining a healthy lifestyle can get affected by this disease as it develops due to changes in the cell.

Types of Esophageal Cancer

Squamous Cell Carcinoma

Squamous Cell Carcinoma, is one of the two most common forms of esophageal cancer. This forms in the flat cells lining the esophagus. SCC forms in the upper/middle section of the esophagus, and it may grow slowly at first but can spread if untreated. Common causes of this type of cancer include smoking, alcohol use and exposure to dietary carcinogens. 

Adenocarcinoma

Unlike SCC, adenocarcinoma usually occurs in the lower esophagus near the intestine. This type of esophageal cancer is linked to acid reflux and other diseases like GERD and Barrett’s esophagus can increase the risk of you being diagnosed with the disease. This type of esophageal cancer tends to spread more quickly than other diseases.

Causes and Risk Factors

There are several causes and risks that can lead to esophageal cancer: 

• Smoking: Tobacco chemicals damage DNA in esophageal cells.
• Alcohol Consumption: Can cause chronic irritation and increases risk of esophageal cancer when combined with smoking.
• Acid Reflux (GERD): Chronic acid reflux can cause repeated inflammation and cell changes over time. 
• Dietary habits: Hot, pickled, or smoked foods and their carcinogenic effects put people further in risk of getting esophageal cancer. 
• Lifestyle and Genetics: Inactivity, poor diet and an unhealthy lifestyle can further put an individual at risk. Additionally, inherited risk factors also play a part.

Symptoms of Esophageal Cancer

Early symptoms are usually minimal, as in the early stage the tumor may not block the esophagus itself. However, as conditions worsen, individuals may have difficulties swallowing solid or even liquid based food. Further symptoms include pain and discomfort, especially when swallowing and even chest pains. Weight loss is another symptom, as the condition may cause individuals to reduce their food intake and also due to the metabolism being affected by the cancer. On top of having difficulty swallowing, individuals may also start coughing a lot more which can also lead to hoarseness. This happens due to the irritation or pressure on nearby structures. Lastly, another symptom to look out for is having a sensation of food getting stuck in your throat or chest area. 

(Disclaimer: Symptoms vary for each individual, consult a healthcare professional if you have any of the symptoms listed above.)

Stages of Esophageal Cancer

• Stage 0: Abnormal cells are confined to the surface lining of the esophagus.
• Stage I: Cancer has grown into deeper layers but has not reached lymph nodes.
• Stage II: The tumor extends further into the esophagus and may affect nearby lymph nodes.
• Stage III: Cancer spreads into surrounding tissues and multiple lymph nodes.
• Stage IV: Cancer has spread to distant organs such as the liver, lungs, or bones

Diagnosis of Esophageal Cancer

Endoscopy

In order to find the exact location and extent of the abnormal tissue in the esophagus, doctors insert a thin, flexible tube with a camera and a light into the individual's mouth. This allows doctors to directly view the inner lining of the esophagus. By performing endoscopy, doctors will be able identify abnormalities such as tumors, ulcers, inflammation or narrowing. This procedure is often accompanied with a mild sedation for the patient's comfort. 

Biopsy

This procedure is performed during endoscopy, if any abnormal tissues are detected. Small tissue samples are taken from suspicious areas, the samples are examined under a microscope by specialists. This examination allows doctors to confirm whether cancer cells are present, the specific type of esophageal cancer and the aggressiveness of the cancer.

Imaging Tests

Image testing usually includes CT Scans, PET scans, and sometimes MRI scans. These imaging tests create a detailed image of the esophagus and surrounding organs. The test also shows the size of the tumor and depth of invasion. Doctors can also use these tools to further see if the tumor has spread to surrounding areas like the lymph nodes or even distant organs like the liver and lungs. Imaging tests play a major role in coming up with a treatment plan, as they reveal the stage of the cancer. 

Treatment Options

Surgery (Esophagectomy) 

Surgery is most effective in the early-stage of cancer, this procedure involves a removal of part of or the whole esophagus itself. This usually comes with dietary changes and a lengthy healing time. 

Chemotherapy

Chemotherapy is a drug that kills cancer cells throughout the body. The drug travels through one's bloodstream, thus allowing it to treat cancer cells in the esophagus and throughout the body. The procedure also helps slow the growth of cancer cells, shrinks tumors and reduces the risk of spread. Chemotherapy can also target cancer cells that are too small to be seen on imaging tests.

Chemotherapy is often given before surgery, known as neoadjuvant therapy, to shrink the tumor and improve the effectiveness of surgical treatment. In some cases, it may also be administered after surgery, referred to as adjuvant therapy, to destroy any remaining cancer cells and reduce the risk of recurrence. Chemotherapy is frequently combined with radiation therapy to enhance its cancer-killing effects and improve overall treatment outcomes. The timing and approach of chemotherapy depend on several factors, including the stage of the cancer, the location of the tumor, and the patient’s overall health.

Side effects of chemotherapy include:

• Fatigue, nausea, vomiting and temporary hair loss.
• Reduced appetite or increased chances of infections.
• Most effects are temporary and can be managed with medications and monitoring.

(Disclaimer: Side effects vary depending on drug type and dosage

Radiation Therapy and Palliative Care

• Uses high-energy, targeted radiation beams to destroy cancer cells and stop their growth
   
• Can be given before surgery to shrink tumors and improve surgical outcomes
   
• May be used after surgery to eliminate remaining cancer cells and lower the risk of recurrence
   
• Often combined with chemotherapy to enhance overall treatment effectiveness
   
• Common temporary side effects include throat irritation, swallowing discomfort, fatigue, and skin irritation, which usually improve after treatment
   
• Focuses on symptom relief and quality of life, especially when a cure is not possible
   
• Aims to provide comfort rather than curative treatment
   
• Helps manage pain, swallowing difficulties, and other cancer-related symptoms
   
• Includes pain control, nutritional support, and emotional or psychological care
   
• Supports both patients and their families throughout the course of the illness

Treating Esophageal Cancer at Vibhavadi Hospital

Vibhavadi Hospital has a team of experienced doctors and healthcare professionals that can diagnose, treat and help with recovery when it comes to esophageal cancer. It is important to detect your symptoms early, as treating a cancer at an earlier stage is easier than treating it at a later stage. Therefore, it is important to visit the doctor if you start seeing any symptoms even if they are mild.