Cancer can affect any part of the body and remain silent until later stages. However, if detected early on, cancer can be successfully cured. Esophageal cancer continues to be one of the deadliest forms of cancer, and one of the most complicated cancers to treat.
A cancer hospital like Max Healthcare is equipped with modern technology and has a panel of specialist including the best oncologist in India. Read on to find out the types of esophageal cancer, associated risk factors, symptoms, and diagnosis.
Esophageal cancer is primarily of two types viz. Adenocarcinoma and Squamous Cell Carcinoma.
The type of esophageal cancer tells you the kind of cell where the cancer started.
- Adenocarcinoma
Adenocarcinoma is the most common form of esophageal cancer accounting for more than 50 percent of all new cases. It starts out in glandular cells, which are not normally present in the lining of the esophagus. These cells can grow there due to a condition called Barrett’s esophagus which increases a person’s chance of developing esophageal cancer. Adenocarcinoma occurs mainly at the lower end of the esophagus and the upper part of the stomach, known as the gastroesophageal junction or the GE junction.
- Squamous Cell Carcinoma
The second most common form of esophageal cancer is squamous cell carcinoma. This type of cancer begins when squamous cells, thin flat cells that line the inside of the esophagus, mutate and begin to grow uncontrollably. Squamous cell carcinoma of the esophagus is strongly linked with smoking and the consumption of excessive amounts of alcohol.
- Undifferentiated Cancers
Undifferentiated cancers are the ones that are not yet identified by the oncologist. It usually happens when cells are not mature enough to be specialized in the two categories mentioned above. Specialization of cells is called differentiation in medical terminology, and the primitive cancer cells are known as undifferentiated types of cancer.
- Rare Cancers
Other rare cancers can develop in the esophagus such as:
- Melanoma
- Lymphoma
- Sarcoma
- Gastroesophageal Reflux Disease and Esophageal Cancer
Normally, a sphincter muscle at the end of the esophagus opens to allow food to enter the stomach and closes to prevent harmful digestive acids from bubbling back up into the esophagus. When this sphincter muscle does not function normally, however, it can lead to a condition known as GERD. Studies have shown that having severe GERD over the course of many years increases the chance of developing gastroesophageal adenocarcinoma.
Cancer can develop anywhere along the length of the esophagus. Anything that raises the risk of getting cancer is called a risk factor. Having a risk factor does not mean a person will get cancer, similarly not having risk factors does not mean you are safe from cancer.
- Esophageal Cancer – Risk Factors
- Age
Esophageal cancer is most often diagnosed in people over age 50.
- Tobacco and Use of Alcohol
Use of tobacco in any form can increase your risk of developing esophageal cancer — particularly squamous cell carcinoma. The more you smoke and the longer you smoke, the greater your risk of esophageal cancer.
- Barrett’s Esophagus
Caused by long-term reflux of acid from the stomach into the esophagus, Barrett’s esophagus increases the risk of esophageal adenocarcinoma.
- Race
Squamous cell cancer of the esophagus is more common among blacks than whites. Adenocarcinoma is more common in white men than men of other race
- Obesity
Being overweight is a risk factor for esophageal adenocarcinoma.
- Vitamin Deficiencies
Some studies have linked esophageal cancer with deficiencies in beta carotene, vitamin E, selenium, or iron.
- Gender
Esophageal cancer is more common in men than in women, but the gender gap is narrowing.
Esophagael cancer has some signs that can help in identifying the root cause.
- Symptoms
In many cases, esophageal cancer is diagnosed after a person begins to experience symptoms. Some of the most common symptoms of esophageal cancer include:
- Difficulty swallowing. As the tumor grows, it can narrow the tube through which food and liquids move to the stomach.
- Pain or discomfort in the chest. Some people with esophageal cancer feel pressure or a burning sensation.
- Weight loss and lack of appetite. As swallowing becomes more difficult, many people begin to eat less, leading to involuntary weight loss.
- Other symptoms. Some patients with esophageal cancer experience other symptoms such as hoarseness, a persistent cough, hiccups, pneumonia, bone pain, and bleeding in the esophagus.
Because many of these symptoms are also associated with other medical conditions, having any of them does not necessarily mean that you have esophageal cancer. If you experience any of these symptoms, speak with your doctor. The earlier you are evaluated, the better the chance of detecting esophageal cancer at an earlier stage, when treatment can be more effective.
- Diagnosis and Treatment at Max Cancer Centre Shalimar Bagh
A team of dedicated surgical oncologists, medical oncologists, radiation oncologists, gastroenterologists, radiologists, and pathologists work together closely to develop every patient’s treatment plan. We meet regularly to discuss individual patients and the latest advances in treatment.This team approach is particularly important in the treatment of esophageal cancer because it is often best managed using a multidisciplinary approach. Having representatives of many different disciplines involved in your care ensures that all possible approaches to your treatment will be considered and that your care will be well coordinated and personalized to your specific needs.
- Diagnosis and Staging
Getting an accurate diagnosis is the first step toward getting the best cancer care.
- Endoscopy
- Biopsy
Staging the tumor requires performing one or more possible studies, including:
- CT scans of the chest and upper gastrointestinal tract
- A combined PET/CT scan, which allows doctors to measure and analyze the location of tumors more accurately. This technology can also help track how the tumor responds to treatment as your care progresses.
- Endoscopic ultrasound, a procedure that uses an endoscope with a small ultrasound probe at its tip. The device can measure how thick the tumor is and see whether it has invaded the wall of the esophagus. The test can also help your doctors to determine whether cancer cells are in the lymph nodes.
- Bronchoscopy, an endoscopy procedure, to evaluate cancer involvement of the trachea (windpipe) or main bronchi (airways)
- Interventional radiology or surgical biopsies if suspicious areas are identified outside the esophagus Using results from your staging studies, your doctors will classify cancer into one of four stages. The stage indicates how large the tumor has grown and how widely it has spread in the body.
- TREATMENT
- Surgery
Surgery is an important part of treatment for many people with esophageal cancer. In the procedure called an esophagectomy, the goal is to remove all of the tumors in order to prevent its regrowth and spread. It is the primary modality of treatment in most cases of esophageal cancer.Surgery is an important part of treatment for many people with esophageal cancer. In the procedure called an esophagectomy, the goal is to remove all of the tumor in order to prevent its regrowth and spread.Studies have shown that cancer centers that perform more surgeries deliver better results for patients, including better survival rates than those with less experience.We have among the lowest rates of complications following esophageal surgery in the country.Our thoracic surgeons are experts in performing complex esophageal surgery, including advanced minimally invasive techniques and robotic surgery. These approaches have been shown to lead to faster recovery after surgery than traditional open surgical approaches. Because surgical oncologists at Max Cancer Centre, Shalimar Bagh work as part of a multidisciplinary team, we are also very careful to recommend surgery only as part of a comprehensive treatment plan that will offer you the best results.
- When Surgery Is Performed
Whether your doctors recommend surgery as the initial treatment for your esophageal cancer depends on several important factors, including:
- Whether the cancer is adenocarcinoma or squamous cell carcinoma. Squamous cell carcinoma does not always require surgery. It can sometimes be managed with chemotherapy and radiation therapy alone.
- The size of the tumor
- How deeply the cancer has invaded the layers of tissue in the wall of the esophagus
- Whether the cancer has spread to the lymph nodes
- Your overall health
In some cases, limited precancerous changes or very early stage tumors may be treated with a simple endoscopy and removal of the diseased inner lining of the esophagus — a technique called endoscopic mucosal resection (EMR). Radiofrequency ablation (RFA), an endoscopic procedure used to treat remaining areas of disease including Barrett’s esophagus, may also be used. If successful, surgery may be avoided in these cases.
Surgery is the best treatment option for more-advanced tumors, or early tumors and precancerous changes in the lining of the esophagus that cannot be treated with endoscopic techniques.
For most patients — because the diagnosis of esophageal cancer usually happens only once it has reached an advanced stage — surgery is not the first treatment given. In many cases, patients first receive a combination of chemotherapy and radiation therapy to shrink the tumor and to increase the likelihood that any remaining cancerous tissue will be completely removed during a later surgery.
- Esophagectomy
During surgery for esophageal cancer, the thoracic surgeon removes the tumor along with part of the normal esophagus, as well as a margin of tissue around the cancer and nearby lymph nodes to which cancer cells may have spread. This procedure is called an esophagectomy. Once these tissues are removed, the stomach is reattached to the remaining part of normal esophagus. In some cases, the colon or small intestine is used instead of the stomach to complete the connection.
Esophagectomy can be performed using open surgical methods or minimally invasive techniques. Your surgeon will carefully consider the appropriate approach for you.
- Minimally Invasive Robotic Surgery
Many operations for esophageal cancer at Max Cancer Centre can now be performed using minimally invasive approaches, including robotic-assisted approaches. Minimally invasive surgery is a set of techniques that use small incisions to enter the body, limiting the amount of healthy tissue that is affected during an operation. Minimally invasive approaches are not effective for all patients with esophageal cancer, but when appropriate these techniques may offer a variety of benefits, including:
- Shorter hospitalization
- Less pain
- Decreased complications, particularly in older patients
Our surgeons are leaders in performing robotic-assisted surgery. Our team of thoracic surgeons is increasingly integrating robotic assistance into esophageal surgery, including complex esophageal cancer operations. This sophisticated surgical tool offers finer precision than is possible with other minimally invasive techniques.
- Chemotherapy
Most people with esophageal cancer get chemotherapy. It may be used alone or with radiation therapy.
The side effects depend mainly on the drugs given and amount of chemotherapy that you get. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
- Blood cells: When drugs lower the levels of healthy blood cells, you’re more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. They may also give you medicines that help your body to make new blood cells.
- Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
- Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.
Other possible side effects include a skin rash, joint pain, tingling or numbness in your hands and feet, hearing problems.
- Targeted Therapy
People with esophageal cancer that has spread may receive a type of treatment called targeted therapy. This treatment can block the growth and spread of esophageal cancer cells.
Targeted therapy for cancer of the esophagus is usually given intravenously.
During treatment, your health care team will watch you for side effects. You may get diarrhea, belly pain, heartburn, joint pain, tingling arms and legs, or heart problems. Most side effects usually go away after treatment ends.
- Radiation Therapy
Radiation therapy for esophageal cancer is the use of high-energy beams to shrink or eliminate tumors
- When Radiation Therapy Is Used
While it is not common to treat esophageal cancer with radiation therapy alone, this type of treatment plays an important role in combination with chemotherapy and surgery. Often, patients begin treatment for esophageal cancer by receiving four to six weeks of radiation therapy in combination with chemotherapy. This combination treatment is sometimes called chemoradiation.
In some cases, particularly in patients with squamous cell carcinoma, chemoradiation is the primary therapy and surgery is used only if the tumor does not have a complete response to the chemoradiation. In other cases, chemoradiation is performed to shrink the tumor before surgery.
In addition, radiation therapy can be used as a palliative treatment. In this situation, the therapy is not intended to cure the cancer, but to relieve pain and discomfort that cancer can cause. For example, radiation therapy can shrink a tumor to improve swallowing or eliminate metastases in other parts of the body.
- Types of Radiation Therapy
- Intensity-Modulated Radiation Therapy
Intensity-modulated radiation therapy (IMRT) is a type of external-beam radiation therapy that targets tumors more accurately than conventional radiation therapy. Using computer software and three-dimensional images from CT scans, the radiation oncologist is able to focus several small radiation beams of varying intensity on and around the tumor. This results in highly targeted treatment, with high doses trained directly on cancerous areas, sparing surrounding organs.
- Image-Guided Radiation Therapy
Image-guided radiation therapy (IGRT) uses real-time imaging to mold radiation beams to the contours of your tumor. In IGRT, imaging methods such as CT, ultrasound, or other guidance systems are performed during each radiation treatment in order to deliver more-precise doses. This technique addresses the problem of the esophagus moving slightly during or between treatments as a result of physical activity, respiration, and other bodily functions.
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