Esophageal cancer
Food pipe (esophagus) cancer

Esophagus, is a hollow muscular tube (the food pipe) that runs between your throat and the stomach. It carries the food you swallow from mouth to your stomach through movements known as peristalsis. The wall of the esophagus is made of several layers of tissue.

In esophageal cancer, a malignant tumor forms in the inner lining of the esophagus and then it advances and spreads. It is found more commonly in men than women.

You might be surprised to know that esophageal cancer is the sixth most common cause behind cancer deaths globally.

Types of esophagus cancer

Esophageal cancer can be divided into subtypes based on microscopic examination (histopathology) and location of tumor in the esophagus.

• Histopathology: Adenocarcinoma and squamous cell carcinoma
• Location: Upper, mid and lower esophageal cancer

Risk factors for Esophageal Cancer

Any factor causing long term chronic irritation to the mucous lining of esophagus is thought to induce cancerous changes in the cells.

These factors include:

• Smoking
• Gastroesophageal reflux disease (GERD)
• Obesity
• Alcohol intake
• Drinking very hot liquids

Symptoms of Esophageal Cancer

These cancers like most other gastrointestinal cancers are asymptomatic in initial stages.

The symptoms when occur would include:

• Difficulty in swallowing (Dysphagia)

• Unintentional weight loss

• Chest pain

• Worsening indigestion or heartburn

Diagnosis of Esophageal Cancer

Diagnosis of esophageal cancer is established by doing an endoscopy. Endoscopy is a procedure in which a flexible thin tube with camera is passed and esophagus is seen from inside. If any abnormality is seen then a small sample from it is obtained called as biopsy and examined under microscope confirming the diagnosis.

Determining extent of disease (staging)

Depending upon the suspected extent of disease some of the following investigations will be done to determine the exact stage.

• Endoscopic ultrasound (EUS)
• Computed tomography (CT) scan
• Positron emission tomography (PET) scan
• Bronchoscopy

Following this work-up a stage will be assigned to the tumor, which spans from I to IV.

Treatment of Esophageal Cancer

Treatment will depend upon stage of tumor and fitness of patient to undergo major surgical procedure. Treatment can be broadly categorised into curative and palliative.

Palliative treatment is designed to relieve symptoms, and improve quality of life. Palliative treatment is considered when tumor is too advanced or disseminated. A patient unfit for major surgery is also treated with palliative intent. Difficulty in swallowing (dysphagia) is treated by inserting esophageal stent. Chemotherapy can provide symptomatic relief along with prolonging life.

Curative treatment aims to eradicate the disease. To obtain best results for advanced tumors chemotherapy, radiotherapy and surgery are combined in an approach called multimodal treatment.

Chemotherapy is use of special drugs to kill cancer cells. Radiotherapy is use of high-powered X-ray beams to kill cancer cells.

Surgery for Esophageal Cancer

Surgery involves esophagectomy, which is a procedure of removing part or most of the esophagus along with lymph nodes and reconstructing the same using another part of gastrointestinal tract, most commonly stomach.

Currently the standard of care is administration of chemotherapy or chemoradiotherapy first called neoadjuvant treatment, followed by surgery.

There are two ways to do a esophagectomy:

• Open, and
• Laparoscopic (thoracoscopic) or Robotic

In open surgery, a long incision is required over the chest and abdomen to do the surgery.

Minimally invasive surgery for esophageal cancer

The laparoscopic and thoracoscopic approach or robotic approach uses minimally invasive techniques to do the same surgery with tiny incisions. This entails the insertion of special long thin surgical tools through these small holes. In robotic surgery, there is a robotic interface between the patient and the surgeon. Minimally invasive surgery results in faster recovery and reduced pain compared to conventional open surgery. This requires expertise. Make sure your surgeon is skilled and has done many of these operations.

Robotic surgery for esophageal cancer

Robotic surgery combines the skill and expertise of a surgeon with the vision, precision, and flexibility of robotic technology. The robotic system features a 3D high-definition camera system for clear and enhanced vision with depth perception. It comprises a surgical console, where the surgeon sits, and robotic arms equipped with surgical instruments. The tiny wristed instruments can bend and rotate in ways the human hand cannot, allowing the surgeon to operate in tight spaces.

During robotic surgery, the surgeon makes minor cuts in the abdomen and inserts special tubes called ports. The robotic arms are connected to these ports, and the instruments mounted on these robotic arms go through the ports to do the surgery. A slender camera is also inserted through one port to show the surgeon a clear view of the inside. The surgeon controls the robotic arms from a console nearby, and an assistant helps by changing the instruments and aiding as needed.

Prognosis (survival rate) of Esophageal Cancer

According to the SEER data, the percentages of people who live for at least five years after being diagnosed with esophageal cancer is 48.8% for localized cancer to the esophagus, 27.7% for cancer that has spread regionally, and 5.6% with distant cancer spread.

Stay Alert! Stay Healthy!
Wish you a speedy recovery!