Oesophageal Cancer

Symptoms

The symptoms associated with oesophageal cancer are very much similar to that of other more-common conditions. Difficulty swallowing is one of the most common symptoms associated with oesophageal cancer.

Other symptoms include:

Persistent indigestion or heartburn

Unexplained weight loss

Pain in the throat or behind the breastbone

Feeling or being sick

A cough that does not get better

A hoarse voice

Appetite loss and weight loss

Vomiting

Backache

If anyone witnesses any of these symptoms for more than 2 weeks, it must not be ignored.

Causes

Oesophageal cancer usually occurs when cells in the oesophagus develop mutations in their DNA. These mutations make cells grow and divide out of control. These mutated cells form a tumour in the oesophagus. This tumour grows and the cancerous cells start to invade nearby tissues and structures and later spread to other parts of the body.

Although the actual cause for oesophageal cancer is unknown. Several risk factors trigger the development of oesophageal cancer.

Obesity: Being overweight or obese is associated with an increased risk of oesophageal cancer.

Gastro-Oesophageal Reflux Disease (GERD): Chronic GERD is linked with a higher risk of developing cancer in the oesophagus.

Prior Gastrectomy: Gastrectomy increases the subsequent risk of developing oesophageal cancer.

HPV infection: Infection with high-risk human papillomavirus (HPV) is one of the risk factors for the cancer of the oesophagus.

Consumption of Tobacco and Alcohol: Consumption of tobacco and alcohol increases the oesophageal cancer risk.

Red Meat: Red meat or processed meat consumption increases one’s chances to develop oesophageal cancer.

Deficiencies of Zinc and Selenium: another risk factor for the cancer of the oesophagus is the reduced serum contents of zinc and selenium.

Consumption of Areca Nut and Betel Quid: Studies have shown that consumption of areca nut is linked to diagnosis at a younger age, poor chemoradiation response and shorter overall survival rate.

Diagnosis

Endoscopy + Biopsy (90% + predictive value)

EUS – preferred method for loco regional staging

Flexible laryngoscopy- for cervical esophageal SCC

FDG PET- noninvasive staging modality, more sensitive than CECT/EUS for distant metastasis, decreases 5-20% patients undergoing needless surgeries

Treatment

The primary treatment modalities used to treat oesophageal cancer include chemotherapy, surgery and radiation therapy.

Chemotherapy: Chemotherapy uses potent drugs to destroy cancer cells. Chemotherapy is typically administered before (neoadjuvant) or after (adjuvant) surgery in people with oesophageal cancer. Chemotherapy can also be combined with radiation therapy for complicated cases. In people with advanced tumours, which may have spread to other organs beyond the oesophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by cancer.

Surgery: Surgery to remove the oesophagus can be performed as an open procedure using large incisions or with special surgical tools inserted through several small incisions in the skin (laparoscopically). The surgical pathway used depends on the severity of cancer. This is the primary curative modality for both oesophageal & GE junction carcinomas that have invaded through the oesophageal wall or are node-positive. With the advent of robotic surgeries, treatments for oesophageal cancers now report:

Shorter hospital stay

Less blood loss

Less pain

Lesser incidence of complications (infection, ileus)

Faster return to normal activities

Radiation Therapy: Radiation therapy is often combined with chemotherapy oesophageal cancer cases. Radiation therapy is typically given before surgery, or occasionally after surgery; it is also used to relieve complications of advanced oesophageal cancer. Modern radiation therapy techniques (3D-CRT, IMRT) are associated with a favourable toxicity profile than those associated with lower energy units used earlier.