Esophageal cancer is an uncontrolled growth of cells involving the esophagus. It is a tube-like structure that connects your throat with the stomach.
It’s a challenging disease often diagnosed at advanced stages, underscoring the need for awareness, early detection, and effective treatment strategies.
there are mainly two different types of cancers involving the esophagus
Squamous cell carcinoma: More prevalent globally, associated with smoking, alcohol, and dietary factors.
Adenocarcinoma: More common in the Western world, often linked to obesity, acid reflux, and Barrett’s esophagus.
In this article, we are going to shed light on the different aspects of esophageal cancer covering its causes, symptoms, diagnostic and treatment options, and finally survival rates in various stages of cancer.
Esophageal Cancer Causes and Risk Factors
Determining the exact cause for esophageal cancer is very challenging due to complex interplay of various factors involved in development of cancer. Esophageal cancer typically develops as a result of a combination of genetic, environmental, and lifestyle factors, rather than a single cause.
There are several key risk factors which contribute to development of cancer. They include
Smoking and Tobacco consumption: Tobacco use, particularly Cigarette smoking, is one of the strongest risk factor contributing to cancer development. The longer and heavier the smoking history, the higher the risk.
Alcohol: Heavy and prolonged alcohol consumption is another major risk factor. Its consumption is associated with multiplicative risk when combined with smoking.
Esophageal cancer increases with advancing age, men are more likely to develop disease than women. Obesity is associated with increased risk especially for adenocarcinoma type.
Gastroesophageal Reflux disease, in which there is acid reflux from stomach into the lower part of esophagus is associated with increased risk of adenocarcinoma of esophagus.
Certain Medical Conditions such as achalasia (difficulty swallowing due to esophageal muscle problems) and tylosis (a rare genetic condition) can also elevate the risk.
Environment: Prolonged exposure to certain environmental factors such as asbestos, chemicals, or radiation may increase the risk, although these exposures are less common causes.
Food: A diet low in fruits and vegetables and high in processed meats, fried foods, and saturated fats may contribute to esophageal cancer risk.
Genetic Susceptibility: While specific genetic mutations (e.g., in MMR genes for Lynch syndrome) increase risk, familial clustering suggests genetic predisposition in some cases.
Esophageal Cancer Symptoms
Esophageal cancer is remains difficult to diagnose in early symptoms because the symptoms are often absent or mild to resemble other digestive problems. As the disease progresses, the symptoms become more pronounced with requiring medical attention.
Here’s a list of symptoms indicating presence of esophageal cancer:
- Dysphagia (Difficulty Swallowing): Difficulty swallowing, especially with solid foods, progressing to difficulty with liquids as well.
- Unintended Weight Loss: Significant and unexplained weight loss, even without changes in diet or physical activity.
- Chest Pain or Pressure: Persistent pain or pressure behind the breastbone or in the back, worsening with swallowing or lying down.
- Chronic Heartburn or Indigestion: Persistent or worsening heartburn, indigestion, or discomfort in the chest or abdomen, not relieved by usual remedies.
- Hoarseness or Chronic Cough: Persistent changes in voice quality, hoarseness, or a chronic cough that persists over time.
- Regurgitation or Vomiting Blood: Episodes of regurgitating blood or vomiting blood (hematemesis), indicating potential bleeding in the digestive tract.
- Fatigue and Weakness: Persistent fatigue, weakness, and a decline in energy levels, often accompanied by other symptoms.
- Swelling or Lump: presence of swelling or mass in the neck region indicating spread of tumor from esophagus to the neck nodes
These signs and symptoms can occur in other benign disease of digestive tract such as GERD, Achalasia cardia etc. or in other cancers such as stomach cancer, cancer of throat. In case the symptoms persist or worsen, immediately seek medical attention to get yourself checked.
Esophageal cancer Diagnosis
Diagnosing esophageal cancer in early stages requires regular screening with endoscopies and other tests as the symptoms are not present. Your doctor may prescribe a battery of tests depending on your signs and symptoms to diagnose and further evaluate the stage of disease.
Here’s a list of test usually done for diagnosis and staging of esophageal cancer:
Endoscopy: A flexible tube with a camera (endoscope) is passed through the mouth into the esophagus to visualize the lining and collect tissue samples (biopsy) for examination under a microscope.
Biopsy: Tissue samples collected during endoscopy are analyzed by pathologists to confirm the presence of cancer cells, determine cancer type (adenocarcinoma or squamous cell carcinoma), and assess tumor aggressiveness. Biopsy can also be performed from lumps present in other locations such as Neck or axilla to confirm cancer.
Imaging Tests: Various imaging techniques help visualize the esophagus and surrounding structures to identify tumors and evaluate cancer spread.
- CT Scan: Provides detailed cross-sectional images of the chest and abdomen to assess tumor size, lymph node involvement, and potential metastasis (spread to distant organs).
- PET Scan: Uses a radioactive tracer to detect areas of increased metabolic activity, helping identify cancer spread beyond the esophagus.
Endoscopic Ultrasound (EUS): Combines endoscopy with ultrasound to assess tumor depth (T-stage) and involvement of nearby lymph nodes (N-stage).
Thoracoscopy or Laparoscopy: Minimally invasive surgical procedures to directly visualize the chest or abdomen for assessing tumor spread and determining surgical resectability.
Bronchoscopy: If there’s suspicion of tumor involvement in the airways, bronchoscopy helps evaluate and collect samples for analysis.
After diagnosing the cancer and evaluating the spread of cancer by imaging investigations, Stage of disease is calculated based on TNM staging system. This system evaluates Tumor size (T), lymph Node involvement (N), and distant Metastasis (M).\
Summary: Diagnostic tests such as endoscopy, biopsy, and imaging (CT, PET, EUS) are used to diagnose esophageal cancer by visualizing tumors, collecting tissue samples, and assessing cancer spread. Staging tests, including TNM staging and surgical procedures like thoracoscopy or laparoscopy, help determine the extent of cancer involvement for appropriate treatment planning.
Esophageal Cancer Treatment
Treatment for esophageal cancer depends on the stage of the disease at which it is detected. furthermore, physical health of the patient and other individual preference also play an important role in deciding the appropriate treatment modality for the patient. Multidisciplinary approach involving all concerned departments is beneficial to achieve the best results for a patient.
Surgery
Surgery plays a pivotal role, especially in early-stage esophageal cancer or cases where the tumor is localized and resectable. Procedures such as esophagectomy, where part or all of the esophagus is surgically removed, may be performed. Lymph node dissection is often part of the surgical process to assess and address potential cancer spread to nearby lymph nodes. Advanced surgical techniques, including minimally invasive approaches such as laparoscopy or robotic-assisted surgery, are utilized when appropriate, leading to faster recovery times and reduced postoperative complications.
Chemotherapy
Chemotherapy involves the use of powerful anti-cancer drugs to destroy cancer cells or slow down their growth. It is often used in combination with other treatments such as surgery or radiation therapy. Neoadjuvant chemotherapy is administered before surgery to shrink tumors, making them more manageable for surgical removal. Adjuvant chemotherapy follows surgery to eliminate any remaining cancer cells and reduce the risk of cancer recurrence. Chemotherapy regimens may include drugs like cisplatin, 5-fluorouracil (5-FU), paclitaxel, and docetaxel, tailored to each patient’s specific cancer type and overall health status.
Radiation Therapy
Radiation therapy utilizes high-energy radiation beams to target and destroy cancer cells. It can be delivered externally (external beam radiation) or internally (brachytherapy) depending on the tumor location and staging. Radiation therapy may be used as a primary treatment modality for localized tumors, in combination with chemotherapy (chemoradiation) to enhance treatment efficacy, or as adjuvant therapy after surgery to reduce the risk of cancer recurrence. Advanced techniques such as intensity-modulated radiation therapy (IMRT), Image guided RT (IGRT) and proton therapy offer precise tumor targeting while minimizing damage to surrounding healthy tissues.
Targeted Therapy
Targeted therapies specifically target cancer cells by interfering with specific molecular pathways involved in cancer growth and progression. For example, Her2-targeted therapy such as trastuzumab (Herceptin) is effective in HER2-positive esophageal cancers. EGFR inhibitors like cetuximab target the epidermal growth factor receptor pathway, and angiogenesis inhibitors such as bevacizumab block blood vessel formation in tumors. These targeted therapies are often used in combination with standard treatments and may be recommended based on genetic testing results or specific tumor characteristics.
Immunotherapy
Immunotherapy harnesses the body’s immune system to recognize and attack cancer cells. Checkpoint inhibitors such as pembrolizumab, nivolumab, and ipilimumab are designed to release the “brakes” on the immune system, allowing it to mount a stronger anti-cancer response. Immunotherapy has shown promising results, especially in advanced or metastatic esophageal cancers, and may be used as a standalone treatment or in combination with other modalities.
Palliative Care
Palliative care is an essential component of comprehensive cancer care, focusing on symptom management, pain relief, and improving quality of life for patients throughout their cancer journey. It addresses physical, emotional, and psychosocial aspects of care, providing support to patients and their families. Palliative care interventions may include pain medications, nutritional support, counseling services, and end-of-life planning, tailored to individual patient needs and preferences.
Esophageal Cancer Survival Rates
As in all cancers, survival depends on the stage of the patient, current health condition and the response to the treatment received. The overall 5-year survival rate for esophageal cancer across all stages is around 19%.
Survival Rates by Stage:
Localized Stage (Stage I): The 5-year survival rate for localized esophageal cancer, where the cancer is confined to the inner layers of the esophagus, is higher, ranging from about 47% to 63%, depending on the tumor subtype (adenocarcinoma or squamous cell carcinoma) and other factors.
Regional Stage (Stage II and III): Esophageal cancer that has spread to nearby lymph nodes or tissues (regional stage) has a lower 5-year survival rate, ranging from approximately 25% to 39%.
Distant Stage (Stage IV): When esophageal cancer has metastasized (spread) to distant organs such as the liver, lungs, or bones, the 5-year survival rate drops significantly to around 5% to 6%. Stage IV esophageal cancer is considered advanced and more challenging to treat.
It is important to note that these survival rates represent an average among the population studied and does not represent an individual patient’s survival rate. Various factors affect the survival apart from the stage, which include the health of the patient, type of treatment taken and response to that treatment. Thus, Early detection and intervention remain critical in improving survival rates and long-term prognosis for individuals diagnosed with esophageal cancer.
