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Oesophageal cancer

Overview

Oesophageal cancer refers to a cancerous tissue (tumour) that has its origins in the lining of the oesophagus but can spread deeper and upwards or downwards along the food pipe. This rare entity is often diagnosed at an advanced stage as patients do not realise that they are affected until the tumour is big and obstructs the oesophageal lumen.

Oesophageal cancers are of the following three types:

  • Adenocarcinomas: They originate from glandular cells, which are located in the lower part of the food pipe, i.e., near the stomach.
  • Squamous cell carcinomas: They originate from the squamous cells that line the upper and middle parts of the food pipe.
  • Other rare types of oesophageal cancers: Though most oesophageal cancers are adenosarcomas or squamous cell sarcomas, other rarer types exist.
    • Small cell cancers: The origins of this cancer are not clear.
    • Soft tissue sarcomas: These originate from cells of tissues that support and protect organs.
    • Poorly differentiated neuroendocrine cancers: These originate from cells of the neuroendocrine system.

  • Gastroesophageal reflux disease (GERD)
  • Acid reflux
  • Obesity and overweight
  • Smoking and drinking
  • Vegetable & fruit-poor diets
  • Age
  • Achalasia
  • Chronic irritation or injury to the oesophagus

Oesophageal cancer may be asymptomatic (no noticeable symptoms) initially; however, with disease progression, symptoms may appear. These symptoms include:

  • Dysphagia (difficulty swallowing
  • Unexplained weight loss
  • Chest pain
  • Regurgitation of food
  • Hoarseness
  • Chronic cough
  • Indigestion or heartburn
  • Vomiting or coughing up blood (in more advanced stages)

  • Endoscopy: This method involves visualising the interior of the oesophagus and possibly suspicious using a camera attached to a very fine, flexible tube.
  • Endoscopic ultrasound: This technique helps determine tumour size and evaluate tumour metastasis, i.e., spread to nearby tissues or lymph nodes.
  • Imaging tests: CT, MRI, or PET are used to assess cancer spread (metastasis).
  • Biopsy: This technique is used to detect cancer cells in the oesophageal tissue.

  • Surgical approach: In some cases, removing the tumour through surgery is an option. This may involve partial or total removal of the oesophagus (esophagectomy).
  • Endoscopic therapy: For early-stage cancers, techniques like laser therapy or photodynamic therapy may be used to eliminate cancer cells.
  • Radiation therapy: This modality involving high-energy irradiation either alone or in conjunction with chemotherapy can be used to target and kill abnormally growing cells (tumour cells).
  • Chemotherapy: This modality generally used in combination with other treatments eliminates cancer cells and restricts their growth.
  • Targeted therapy: This strategy involves using drugs e.g., trastuzumab (HER2 inhibitor), bevacizumab (VEGF inhibitor), and EGFR inhibitors that target key molecules driving cancer cell growth and survival. It offers new options for managing advanced or metastatic disease.
  • Immunotherapy: Checkpoint inhibitors like pembrolizumab and nivolumab have emerged as important treatment options for individuals with advanced oesophageal cancer, especially those with high PD-L1 expression.

Consult a medical professional if you have difficulty swallowing, unexplained weight loss, or other persistent symptoms like long-standing acidity and heartburn.

  • Avoiding smoking and excessive alcohol use.
  • Maintaining optimal weight and having a balanced diet.
  • Orderly screening of high-risk individuals, especially those having chronic GERD or a history of oesophageal conditions.
  • Managing GERD symptoms and Barrett’s oesophagus (if present).
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