The esophagus, or foodpipe, is an important organ of the human digestive system. It is a 25 cm long, hollow, and muscular tube connecting the mouth and stomach.
When the cells present in the esophagus undergo undesirable DNA mutations and start dividing abnormally, a tumor is formed. This is referred to as esophageal cancer. Esophageal cancer, which is sometimes referred to as esophageal carcinoma cancer, may not show any symptoms in the early stages and is often diagnosed in the advanced stages. Esophageal carcinoma risk is found to be high among individuals who are aged 45 and above. However, it can be seen in all age groups.
Esophageal carcinoma is one of the most common cancers in India. It is also found to be a leading cause of cancer-related deaths in the country.
The 5-year survival rates for esophageal carcinoma are relatively promising if the cancer is caught in the early stages.
Esophageal cancer has a slow growth rate, and patients may not experience any symptoms in the early stages. An esophageal cancer tumor primarily arises in the inner lining of the esophagus. Gradually, it starts spreading outward to different layers of the esophagus, to the lymph nodes and nearby organs, and eventually, to the distant organs in the body.
Patients with esophageal carcinoma often have swallowing difficulties, vomiting, chest pain, coughing blood, chest burn, indigestion, and weight loss.
It is important to note that once the disease starts presenting symptoms, it progresses rather quickly. Therefore, it is important to not ignore any symptoms, and immediately see a doctor when these symptoms are observed.
Based on the type of cell from which they arise, the following are the common esophageal cancer types:
Squamous cell carcinoma is the most common type of esophageal carcinoma worldwide. It is also the most common esophageal carcinoma type in India.
Squamous cell carcinoma, or squamous cell esophageal cancer, forms in the thin and flat cells that comprise the inner lining of the esophagus. This is one of the types of esophageal tumors usually seen in the upper and middle portions of the esophagus.
Adenocarcinoma is also one of the most common esophageal cancer types, and it arises from the mucus-producing gland cells. Adenocarcinoma is more commonly found in the lower part of the esophagus.
Small cell carcinoma is a rare type of esophageal carcinoma, wherein the cancer arises from the neuroendocrine cells that are responsible for the production of hormones. Small cell carcinoma has a relatively poor prognosis.
Once the diagnosis of esophageal carcinoma is confirmed, the specialists perform esophageal cancer staging. This involves evaluating the extent of the disease’s spread and categorizing it under the respective stage. Stages 1 and 2 refer to the early-stage esophageal cancers, and stages 3 and 4 refer to the advanced-stage cancers.
Esophageal carcinoma staging is an important step of esophageal carcinoma management as it helps specialists devise personalized treatment plans that are going to positively impact the disease’s prognosis. Also, the staging parameters are different for different types of esophageal tumors. The following are the different oesophageal cancer stages:
Stage 1 esophageal cancer, or early-stage esophageal cancer, is where the cancer is on the top layer of the inner lining of the esophagus. The esophageal cancer tumor, in this stage, is localized and has not spread to the lymph nodes or nearby tissues.
In stage 2, the cancer has spread to the outer layer of the esophagus. The disease may or may not have spread to 1-2 lymph nodes nearby.
In stage 3, the cancer has spread to the surrounding tissues outside of the esophagus or to the lymph nodes. However, distant organs are not involved in this stage.
Stage 4 esophageal cancer is where the disease has spread to multiple regional and distant lymph nodes and organs.
In many cases, esophageal cancer does not show any symptoms in the early stages, and the symptoms that it does show are often ignored because they overlap with those of other less serious GI conditions.
For early detection of esophageal cancer, one needs to opt for regular health checkups, be mindful of different signs and symptoms of esophageal cancer, and see a doctor when persistent symptoms are experienced.
Anyone can get esophageal cancer. However, certain individuals have a higher risk of developing this cancer type, and such individuals are called “high-risk individuals.” Those who consume tobacco and alcohol, those who are obese, and those with conditions like Barrett’s esophagus and chronic acid reflux have a higher risk of developing esophageal cancer. Also, men have a higher chance of developing this condition than women.
Esophageal cancer symptoms can vary from patient to patient. The following are the important symptoms of esophageal carcinoma:
Vomiting is one of the most commonly seen esophageal cancer symptoms. Patients with esophageal cancer also have difficulty swallowing. When the food gets lodged in the food pipe, vomiting occurs as a reflex.
Also, bleeding in the esophagus can cause the patient to cough up blood.
Those suspected of having esophageal carcinoma often experience sensations of pain, pressure, and burning in the chest. As the esophageal tumor grows, it exerts pressure on the nerves in the chest region, which leads to pain and burning sensations in the chest.
Due to the growth of esophageal tumors, patients may have swallowing difficulties, which may lead to vomiting too.
Unintended weight loss is also one of the signs of esophageal cancer. Swallowing difficulties, vomiting, and decreased appetite may contribute to unintentional weight loss. It is often one of the esophageal cancer stage 4 symptoms.
Indigestion is also one of the most important symptoms of esophageal carcinoma. Indigestion is caused when the tumor growing in the esophagus blocks the passage of food, causes irritation and inflammation, and produces hormones that affect digestion. Heartburn is another important symptom of esophageal cancer.
When the tumor grows in the upper part of the esophagus, it may exert pressure on the vocal cord and lead to a change in voice. Coughing may present as one of the esophageal cancer symptoms. Not ignoring symptoms like hoarseness and coughing, especially if they are persistent, and promptly seeing a doctor can positively impact treatment outcomes.
The exact cause of esophageal cancer is yet to be known. From studies carried out over the years, we have understood that certain DNA mutations can cause the cells in the esophagus to divide uncontrollably and form a tumor. That said, it has also been understood that certain factors can increase the risk of mutations that can lead to esophageal cancer, and these factors may be called risk factors or possible causes of esophageal cancer.
Tobacco consumption is identified as one of the possible causes of esophageal cancer. Harmful carcinogens present in tobacco can affect the immune system and increase the risk of acid reflux, which may increase the risk of esophageal cancer.
Alcohol consumption is also one of the possible causes of esophageal cancer. Alcohol can cause esophageal cells to more readily absorb carcinogens. It also produces certain compounds that can lead to DNA mutations that increase the risk of esophageal cancer.
Obesity is also identified as one of the possible esophageal carcinoma causes. This is because obese individuals are prone to chronic acid reflux, which, in turn, contributes to the increased risk of esophageal cancer.
Barrett’s esophagus is a condition wherein the tissues present in the lower portion of the esophagus become similar to those of the stomach and the intestine due to their frequent exposure to stomach acid. Those with Barrett’s esophagus and chronic acid reflux have a higher risk of esophageal cancer.
Those with HPV infections also have an increased risk of developing esophageal cancer. Chronic HPV is known to cause oropharyngeal cancers, which can spread to the esophagus.
Those who have been diagnosed with cancer in the past are also at a higher risk of developing esophageal cancer.
Other possible causes of esophageal cancer include a poor diet, physical inactivity, certain conditions like achalasia and tylosis, and esophagus injuries.
Persistent symptoms that indicate esophageal cancer should not be ignored and should be brought to a physician’s attention immediately. Multiple tests are recommended to diagnose and stage the disease accurately. Once the disease is staged, the expert team employs a multidisciplinary approach to thoroughly study the case, understand the individual patient parameters, and devise a personalized care plan.
The doctor will initially perform a physical examination and medical history assessment to understand the cause of the symptoms and see if the patient has a family history of esophageal cancer or has underlying medical conditions. Doctors will recommend additional tests if the observations from the physical examination hint at the possibility of esophageal cancer. The following are the different tests recommended for esophageal cancer diagnosis:
A barium swallow is a form of X-ray test wherein the patient swallows a white-chalky liquid containing barium sulfate. Barium sulfate coats the structures of the esophagus and appears white on X-rays. This test helps specialists look for various esophagus-related abnormalities, such as strictures, tumors, and other anomalies.
A computed tomography (CT) scan is an imaging method that uses X-rays to create more detailed, cross-sectional images. It is recommended during an esophageal cancer diagnosis to determine the size, location, and extent of the disease’s spread. This information helps the specialists stage the disease accurately and devise the most effective treatment plan.
Esophagogastroduodenoscopy (EGD), or upper endoscopy, is a diagnostic procedure that involves inserting an elongated, flexible tube that carries a light source and a camera through the mouth to examine the regions of the esophagus for any abnormalities. At times, biopsy samples may also be collected during this procedure with the help of specialized tools.
As the name says, esophageal endoscopic ultrasound combines an endoscopy with an ultrasound scan to obtain detailed images of the esophagus, along with the nearby tissues and lymph nodes.
An endoscope along with an ultrasound probe is inserted through the mouth to examine the esophageal region. This dual endoscope allows specialists to directly visualize the organ and create real-time, detailed images through the sound waves emitted by the probe. This test helps with esophageal carcinoma diagnosis by helping specialists determine the extent of tumor invasion and the possibility of lymph node involvement and by facilitating guided biopsies.
A biopsy is recommended for the confirmatory esophageal cancer diagnosis. During this procedure, a small sample of the esophageal tissue is removed. This tissue sample is later examined for the presence of cancer cells. The biopsy sample, in most cases, is collected during an endoscopy.
An endoscopy involves inserting a thin, flexible, and elongated tube through the mouth to examine the interior of the esophagus. As a test for esophageal cancer, endoscopy facilitates direct visualization and biopsy sample collection.
Once the esophageal cancer diagnosis is confirmed and staging is done, an individualized treatment plan is devised based on several parameters, such as the type of esophageal cancer, its stage, its grade, the exact location of the tumor, the patient’s age, the patient’s overall health status, and lastly, their preferences. Surgery, radiation therapy, chemotherapy, and targeted therapy are the different treatment options available for esophageal cancer
Surgery is often the first line of esophageal cancer treatment. Depending on the stage of the disease, specialists recommend different esophageal cancer surgery types. Esophagectomy refers to the partial or complete removal of the esophagus, depending on the disease’s stage. This esophageal cancer surgery may be open or minimally invasive.
Lymphadenectomy may also be recommended, wherein the lymph nodes close to the tumor are removed to prevent the disease from metastasizing.
In the case of a partial esophagectomy, the remaining esophagus is connected back to the stomach. If the esophagus is removed completely, the surgeon may reconstruct the esophagus from the small intestine and then insert it between the mouth and the stomach.
Radiation treatment for esophageal cancer involves targeting and destroying cancer cells using high-energy radiation beams, such as X-rays. Radiotherapy for esophageal cancer is often administered along with other treatments for more effective management of the disease.
Radiation therapy for esophageal cancer helps shrink the tumor, destroy residual cancer cells, and ease symptoms in the advanced stages.
Over the years, radiation therapy has become more precise, and today, due to modern technologies, we can target tumors more accurately and reduce side effects for patients.
Chemotherapy is one of the most important treatments recommended for esophageal cancer. Esophageal chemotherapy involves the use of powerful drugs that disrupt the growth of fast-growing cells in the body. Chemotherapy for esophageal cancer may be recommended before the surgery (neoadjuvant chemotherapy) to shrink the tumor size or after the surgery (adjuvant chemotherapy) to destroy the residual cancer cells.
Endoscopic mucosal resection (EMR) is recommended for early-stage esophageal cancers. This is a minimally invasive procedure wherein an endoscope with specialized surgical tools is sent to the esophagus through the mouth. These tools carefully remove the cancerous or precancerous tissue from the inner lining of the esophagus.
Endoscopic submucosal dissection (ESD) is a minimally invasive procedure recommended for early-stage esophageal cancers. Just like endoscopic mucosal resection, this is also an endoscopic procedure; however, it is recommended for larger lesions that have a higher likelihood of developing into aggressive cancer. ESD is recommended when the lesions cannot be removed through EMR or have recurred after EMR.
Also referred to as light-activated cancer cell destruction, photodynamic therapy (PDT) is also recommended as one of the esophageal cancer treatments. This procedure involves administering a photosensitizing agent into the body, which tends to accumulate in cancer cells. This photosensitizing agent is activated by exposure to light. Once activated, this agent releases oxygen radicals, which destroy the cancer cells.
This treatment is often recommended for Barrett’s esophagus, early-stage esophageal cancer, and advanced-stage esophageal cancers. In patients with stage 4 esophageal cancer, PDT helps alleviate symptoms, such as swallowing difficulties, and improve the quality of life.
This esophageal cancer therapy uses powerful beams of light to destroy cancer cells through heat. It is often administered as a part of palliative care and helps address complications such as obstruction or superficial lesions. This treatment procedure may not destroy all cancer cells, but it is effective in alleviating advanced-stage symptoms.
Targeted therapy is a personalized esophageal cancer treatment approach. Drugs administered as a part of this treatment approach target specific biomolecules and cellular pathways that are associated with cancer cells. Targeted therapy treats esophageal cancer by blocking the molecules and pathways responsible for cancer growth. These targets associated with cancer cells are identified through molecular profiling, and based on these, a treatment plan, including specific targeted therapy drugs, is devised.
Immunotherapy involves stimulating the body’s immune system to identify and attack cancer cells throughout the body. Many studies have identified that certain checkpoint inhibitors can help block those proteins that block the immune response and help the body attack and destroy cancer cells. This new treatment for esophageal cancer is highly precise, safer, and more effective.
As one of the best cancer hospitals in India, HCG is equipped with all major diagnostic and treatment facilities for the effective management of esophageal cancer. Our experts are globally trained and have vast experience in managing simple to complex esophageal cancer cases successfully through a patient-centric and personalized approach. This approach will not only help us improve the survival rates of our patients but also their quality of life.
The risk of esophageal cancer is relatively high among those who consume tobacco and alcohol. Those with chronic acid reflux also have a higher chance of developing esophageal cancer. Having a detailed understanding of various esophageal carcinoma risk factors and measures for the possible prevention of esophageal cancer can help reduce the overall risk of esophageal cancer
Certain lifestyle-related and non-lifestyle-related factors may impact the risk of esophageal cancer. Lifestyle-related risk factors are modifiable. In other words, it is possible to reduce one’s esophageal cancer risk by making certain lifestyle modifications.
Increasing age is one of the most important esophageal cancer risk factors. The risk of esophageal cancer is found to be high among individuals between the ages of 45 and 70.
Men have a higher tendency to be diagnosed with esophageal cancer than women. This could probably be because of the higher incidence of tobacco and alcohol consumption, obesity, and heartburn in men.
Smoking and alcohol consumption are identified as important esophageal cancer risk factors. The carcinogens, or harmful components, present in tobacco affect the functioning of the lower esophageal sphincter, which prevents acid reflux from the stomach to the esophagus. Smokers are found to have a 2-fold higher risk of developing esophageal cancer than non-smokers. All these aspects make tobacco consumption the most common risk factor for esophageal cancer.
Obesity causes chronic heartburn, which is one of the esophageal cancer risk factors. Obesity may also lead to inflammation and hormonal imbalances in the body, which may increase the risk of esophageal cancer.
Having certain vitamin deficiencies can increase one’s risk of esophageal cancer. Deficiencies of vitamin A, vitamin B (B1, B3, B6, and B9), vitamin C, vitamin D, and vitamin E, along with selenium, are found to increase the risk of esophageal cancer.
Barrett’s esophagus is one of the esophageal adenocarcinoma risk factors. Barrett’s esophagus is a medical condition wherein the cellular lining of the esophagus becomes similar to that of the stomach and intestine. In those with Barrett’s esophagus, the lower esophageal sphincter fails to function normally, which leads to chronic acid reflux. The stomach acid that refluxes into the esophagus gradually damages the esophageal lining, causes inflammation, and increases the risk of esophageal cancer.
Barrett’s esophagus may increase one’s esophageal cancer risk; however, not everyone with this condition will develop cancer.
There is no proven way to prevent esophageal cancer. However, adopting certain preventive measures can help reduce esophageal cancer risk. The following are some of the important esophageal cancer prevention measures:
Refraining from tobacco and alcohol consumption is one of the most important esophageal cancer prevention measures.
Both tobacco and alcohol are harmful carcinogens that may damage the esophageal lining, cause inflammation, lead to chronic acid reflux, and thereby increase the risk of esophageal cancer. Studies have reported that quitting the consumption of tobacco and alcohol can significantly reduce one’s esophageal cancer risk.
Exercising regularly will help maintain optimum body weight. Exercise plays a pivotal role in promoting overall health and possibly preventing GERD, lowering the levels of hormones and growth factors that are responsible for cancer growth, reducing inflammation, and releasing myokines, which help the immune system identify and attack cancer cells.
Esophageal cancer may not always cause symptoms in the early stages. Therefore, it is necessary to opt for regular health checkups and be mindful of different esophageal cancer symptoms, especially those that overlap with symptoms of other health problems. This helps reduce the risk of esophageal cancer.
Obesity is one of the biggest esophageal cancer risk factors, and therefore, it is important to maintain a healthy weight. Opting for a balanced diet that is free of processed foods and regular exercise can support healthy weight management, which will eventually aid in possible esophageal cancer prevention.
Consuming a diet rich in fruits and vegetables has been found to reduce the risk of esophageal cancer. A plant-based diet has an anticarcinogenic effect on the body.
Esophageal cancer is one of the most common cancers in India. Despite being one of the slow-growing cancers, it progresses rather quickly once the symptoms become apparent. Different esophageal cancer types affect different parts of the esophagus. Opting for regular health checkups and not ignoring symptoms like swallowing difficulties, heartburn, chest pain, vomiting, indigestion, etc., can aid in the early detection and timely treatment of esophageal carcinoma.
