Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from the throat to the stomach. Esophageal cancer usually begins in the cells that line the inside of the esophagus and can occur anywhere along the esophagus. This cancer type is more commonly found in men in comparison to women.
Esophageal cancer is the sixth most common cancer across the world. Adenocarcinoma is one of the types of Esophageal cancer which has a high incidence rate. In some regions, higher rates of Esophageal cancer cases may be attributed to consumption of tobacco and alcohol use or particular dietary habits and obesity.
- Difficulty in swallowing (liquids/semisolids or solids)
- Back Ache
- Change of Voice
- Weight loss and fatigue
- Esophageal Cancer usually occurs when cells in the esophagus develop mutations in their DNA. These mutations make cells grow and divide out of control. These mutated cells form a tumor in the esophagus that can then grow and invade into nearby structures and spread to other parts of the body. There are two types of Esophageal Cancers called the Adenocarcinoma and the Squamous Cell Carcinoma
- Gastro-Esophageal Reflux Disease (GERD)
Squamous cell carcinoma
- Prior Gastrectomy
- HPV infection
- Consumption of Tobacco and Alcohol
- Red Meat
- Low selenium, Zinc deficiency
- Consumption of Arcanut, Betel quid
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
Chemotherapy is a medical treatment used to kill cancer cells. Chemotherapy is typically administered before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy for various complicated cases. In people with advanced tumors which may have spread to other organs beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.
Surgery to remove your esophagus can be performed as an open procedure using large incisions or with special surgical tools inserted through several small incisions in your skin (laparoscopically). How your surgery is performed depends on your individual situation and your surgeon’s particular approach to managing it. This is the primary curative modality for both esopgeal & GE junction carcinoma that have invaded through esopheal wall/are node positive.
With the advancements in technologies, Robotic surgeries are also recommended for esophageal cancer treatment which results in
- Shorter hospital stay
- Less blood loss
- Less pain
- Lesser incidence of complications ( infection, ileus )
- Faster return to normal activities
Radiation therapy is most often combined with chemotherapy for cases with esophageal cancer. Radiation therapy is typically done before surgery, or occasionally after surgery, it is also used to relieve complications of advanced esophageal cancer. Modern Radiation Therapy techniques (3D-CRT, IMRT) are associated with favorable toxicity profile than those associated with lower energy unit used earlier.