Improving Outcomes in Esophageal Cancer

Esophageal Cancer is a disease in which malignant (cancer) cell forms in tissues of the esophagus. Cancer of the esophagus (food pipe) usually starts in the innermost layer of the esophagus known as the mucosa layer and then grows outward through the submucosa and the middle layer.

ESOPHAGEAL CANCER

There are two main types:


  1. Squamous Cell Carcinoma: This type of cancer can occur anywhere along the esophagus. It grows in the cells that form the top layer of the lining of the esophagus, known as squamous cells.

  2. Adenocarcinoma: Here, gland cells have replaced an area of squamous cells, which occurs mainly in the lower part of the esophagus. Adenocarcinomas now account for one-third to one-half of all esophageal cancers.

RISK FACTORS:


Though, the exact cause of esophageal cancer is not known, there are several risk factors for this disease.


Older Age: Esophageal cancer most often occurs in people of 60 years and above, therefore the risk increases with age.

Gender: Men are three times more likely to develop esophageal cancer than women.

Tobacco & Alcohol use: Smoking or chewing tobacco and heavy drinking can increase the risk of esophageal cancer.

Obesity: Obesity and overeating can also increase the risk of esophageal cancer.

GERD: Those who suffer from long term Gastroesophageal reflux disease and heartburn have an increased risk in developing esophageal cancer.

Previous Cancers: Previous cancer history involving the lungs, mouth or throat can increase one’s risk to developing esophageal cancer.

Ethnicity: Squamous cell esophageal cancer is more likely to occur in African Americans and Asians whereas Adenocarcinoma is more likely in Caucasians.

Barret’s Esophagus: Barrett’s oesophagus is a change in the cells at the lower end of the oesophagus that occurs from chronic untreated acid reflux which alleviates the risk of esophageal cancer.

Chemical Exposures: people exposed to certain chemicals over a period of time can develop esophageal cancer in the future.

Human Papilloma Virus (HPV): HPV infection carries an increased risk of developing esophageal cancer.

Tylosis: Tylosis is a rare, inherited disorder in which excess skin grows on the palms of the hands and the soles of the feet. This could also be linked to developing esophageal cancer.

Achalasia: Achalasia is an uncommon disease that causes difficulty swallowing and could be linked with esophageal cancer.


SYMPTOMS:


These are some of the common symptoms for esophageal cancer:


· Unexplained weight loss

· Difficulty swallowing

· Heartburn

· Regurgitation of undigested food

· Hoarse voice

· Vomiting blood

· Persistent cough

· Pain between shoulder blades


How Can We Improve Outcomes For Esophageal Cancer ?


Esophageal Cancer can be one of the most challenging conditions to treat due to its location occupying the posterior part of the chest cavity and upper part of the abdominal cavity. The key factor in determining good prognosis is to detect the cancer in an early stage. This is done by means of regular screening gastroscopy. Since, early cancer may not produce symptoms, those with high risk of developing esophageal cancer must screen themselves regularly.


When esophageal cancer is detected early then it can be resected either endoscopically(Endoscopic Submucosal Dissection also called ESD) or with other minimal access techniques such as Laparoscopic surgery and Robotic surgery.


Robotic esophagectomy results in less pain, shorter hospital stay, lower rate of complications such as pneumonia and faster return to normal activity. It also enables the surgeon to visualise better and perform the surgery with finer techniques and minimal blood loss.


Robotic surgery

Advances in perioperative management strategies have improved early morbidity and mortality. When the cancer is detected in a slightly advanced stage then a combination of treatment strategies may be employed . Neoadjuvant chemotherapy or chemo-radiotherapy may be an option to decrease the size of the tumour before performing surgery. This has shown to improve outcomes in many cases. Nowadays, Immunotherapy has shown to provide excellent results in treating patients with advance esophageal cancer. In advance stages, the best outcomes can be achieved with multimodality combination treatment consisting of surgery, chemotherapy, radiotherapy and immunotherapy and this is best done with a good team of doctors consisting of a surgeon, medical oncologist and radiotherapist.

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