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Oesophageal Cancer

Overview

Oesophageal cancer develops when abnormal cells in the lining of the oesophagus grow and multiply uncontrollably, leading to the formation of a tumour.

The most common subtypes of oesophageal cancer are:

  • Adenocarcinoma: typically occurs in the lower third of the oesophagus
  • Squamous cell carcinoma: Most often found in the middle and upper third of the oesophagus

Management strategies for both subtypes differ slightly based on specific pathology. 

  • Smoking
  • Alcohol consumption
  • GERD (Gastroesophageal Reflux Disease)
  • Barrett's oesophagus
  • Chewing tobacco, although less risky than smoking for oesophageal cancer, can still increase the risk by causing hyperacidity due to its irritant properties.

Early stages: 

  • Refractory hyperacidity
  • Difficulty swallowing solids or liquids, with food often feeling stuck in the oesophagus

Advanced stages:

  • Unexplained weight loss
  • Frequent vomiting after eating 
  • Pain in the chest or back
  • Hoarseness or change in voice

  • Upper Gastrointestinal (GI) endoscopy
  • Endoscopic ultrasonography (EUS)
  • Biopsy
  • Imaging tests, including CT and PET-CT scans
  • Barium swallow, although commonly used in the past, is now sparingly used for diagnosing oesophageal carcinoma.

Very Early Stages:

  • Endoscopic Mucosal Resection (EMR) or Endoscopic Submucosal Dissection (ESD)
  • Surgical removal of the oesophagus may be recommended, using conventional, video-assisted thoracoscopic surgery (VATS), or robotic approaches

Locally Advanced Cases:

  • For squamous cell carcinoma, treatment typically involves a combination of chemotherapy and radiotherapy in smaller doses, followed by surgery.
  • For adenocarcinoma, the sequence may involve administering chemotherapy first, followed by surgery, and subsequent chemotherapy as a follow-up.

Locally Advanced Cases Not Suitable For Surgery: 

  • A combination of definitive chemotherapy and radiation therapy maybe advocated

Cases with Metastatic Disease (spread beyond the oesophagus to the other organs of the body):

  • Chemotherapy or immunotherapy maybe used to manage the disease
  • Stenting can be performed to alleviate swallowing difficulties and improve quality of like

  • Avoid smoking and tobacco consumption in any form
  • Avoid or limit alcohol consumption
  • Manage GERD (hyperacidity)
  • Follow a healthy and balanced diet

Outcomes depend on the stage at diagnosis, overall health, and the chosen treatment approach.

If symptoms arise, consult a thoracic surgeon or a medical/radiation oncologist.

The specialist will recommend a treatment plan best suited for you based on your age, medical fitness, and the stage of the disease.

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