Oesophageal cancer is a type of cancer affecting the oesophagus (gullet) - the long tube that carries food from the throat to the stomach. It starts in the inner layer (the mucosa) and grows outward (through the submucosa and the muscle layer).
What causes oesophageal cancer?
Some risk factors may cause oesophageal cancer by damaging the DNA in cells that line the inside of the oesophagus. Long-term irritation of the lining of the oesophagus, as happens with reflux, Barrett's oesophagus, achalasia, Plummer-Vinson syndrome, or scarring from swallowing lye, may also lead to DNA damage. The DNA of oesophageal cancer cells often shows changes in many different genes.
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Here, you will find information about signs and symptoms, causes and risk factors, types, diagnosis, staging and prevention about oesophageal cancer.
Most esophageal cancers do not cause symptoms until they have reached an advanced stage, when they are harder to treat. Some signs and symptoms of oesophageal cancer are:
Trouble swallowing: The most common symptom of oesophageal cancer is a problem swallowing, with a feeling like the food is stuck in the throat or chest, or even choking on food. The medical term for trouble swallowing is dysphagia. This is often mild when it starts, and then gets worse over time as the opening inside the esophagus gets smaller.
Chest pain: Sometimes, people have pain or discomfort in the middle part of their chest. Some people get a feeling of pressure or burning in the chest. Swallowing may become painful if the cancer is large enough to limit the passage of food through the esophagus. Pain may be felt a few seconds after swallowing, as food or liquid reaches the tumor and has trouble getting past it.
Weight loss: About half of people with oesophageal cancer lose weight (without trying to). This happens because their swallowing problems keep them from eating enough to maintain their weight. Other factors include a decreased appetite and an increase in metabolism from the cancer.
Other symptoms: Other possible symptoms of the oesophageal cancer can include: Hoarseness, Chronic cough, Vomiting, Hiccups, Bone pain, Bleeding into the esophagus.
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A risk factor is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. Several factors that can affect your risk of oesophageal cancer are:
Age: The chance of getting oesophageal cancer increases with age.
Gender: Men are more likely than women to get oesophageal cancer.
Gastroesophageal reflux disease: The stomach normally makes strong acid and enzymes to help digest food. In some people, acid can escape from the stomach up into the lower part of the oesophagus. The medical term for this is gastroesophageal reflux disease (GERD), or just reflux.
Barrett's oesophagus: If reflux of stomach acid into the lower esophagus goes on for a long time, it can damage the inner lining of the oesophagus. This causes the squamous cells that normally line the esophagus to be replaced with gland cells. These gland cells usually look like the cells that line the stomach and the small intestine, and are more resistant to stomach acid. This condition is known as Barrett's (or Barrett) oesophagus.
Tobacco and alcohol: The use of tobacco products, including cigarettes, cigars, pipes, and chewing tobacco, is a major risk factor for oesophageal cancer. The more a person uses tobacco and the longer it is used, the higher the cancer risk. Drinking alcohol also increases the risk of esophageal cancer. The more alcohol someone drinks, the higher their chance of getting esophageal cancer. Alcohol affects the risk of the squamous cell type more than the risk of adenocarcinoma. Combining smoking and drinking alcohol raises the risk of oesophageal cancer much more than using either alone.
Obesity: People who are overweight or obese (very overweight) have a higher chance of getting adenocarcinoma of the oesophagus.
Diet: Certain substances in the diet may increase oesophageal cancer risk. A diet high in processed meat may increase the chance of developing oesophageal cancer.
Achalasia: In this condition, the muscle at the lower end of the oesophagus (the lower oesophageal sphincter) does not relax properly. Food and liquid that are swallowed have trouble passing into the stomach and tend to collect in the lower esophagus, which becomes stretched out (dilated) over time.
Tylosis: This is a rare, inherited disease that causes excess growth of the top layer of skin on the palms of the hands and soles of the feet. People with this condition also develop small growths (papillomas) in the esophagus and have a very high risk of getting squamous cell cancer of the oesophagus.
Plummer-Vinson syndrome: People with this rare syndrome (also called Paterson-Kelly syndrome) have webs in the upper part of the esophagus, typically along with anemia (low red blood cell counts) due to low iron levels, tongue irritation (glossitis), brittle fingernails, and sometimes a large thyroid gland or spleen.
Workplace exposures: Exposure to chemical fumes in certain workplaces may lead to an increased risk of esophageal cancer.
Human papilloma virus (HPV) infection: HPV is a group of viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma (or wart). Infection with certain types of HPV is linked to a number of cancers, including throat cancer, anal cancer, and cervical cancer.
Different type of oesophageal cancer are:
Squamous cell carcinoma: The oesophagus is normally lined with squamous cells. Cancer starting in these cells is called squamous cell carcinoma. This type of cancer can occur anywhere along the oesophagus, but is most common in the portion of the oesophagus located in the neck region and in the upper two-thirds of the chest cavity.
Adenocarcinoma: Cancers that start in gland cells (cells that make mucus) are called adenocarcinomas. This type of cancer usually occurs in the distal (lower third) part of the oesophagus. Before an adenocarcinoma can develop, gland cells must replace an area of squamous cells, which is what happens in Barrett's esophagus. This occurs mainly in the lower oesophagus, which is where most adenocarcinomas start.
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If oesophageal cancer is suspected, exams and tests will be needed to confirm the diagnosis. If cancer is found, further tests will be done to help determine the extent (stage) of the cancer.
Medical history and physical exam: If you have symptoms that might be caused by esophageal cancer, you will be asked about your medical history to check for possible risk factors and to learn more about your symptoms. You will be examined to look for possible signs of oesophageal cancer and other health problems.
Imaging tests to look for oesophageal cancer: Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests might be done for many reasons, such as: to help find a suspicious area that might be cancer, to learn if and how far cancer has spread, to help determine if the treatment is working, to look for possible signs of cancer coming back after treatment. Imaging tests like: Barium swallow, Computed tomography (CT or CAT) scan, Magnetic resonance imaging (MRI) scan, Positron emission tomography (PET) scan are used during diagnosis.
Endoscopy: An endoscope is a flexible, narrow tube with a tiny video camera and light on the end that is used to look inside the body. Tests that use endoscopes can help diagnose oesophageal cancer or determine the extent of its spread. Upper endoscopy, Endoscopic ultrasound, Bronchoscopy, Thoracoscopy and laparoscopy, Lab tests of biopsy samples are used.
Blood tests: Certain blood tests to help determine if you have oesophageal cancer. Complete blood count (CBC): This test measures the different types of cells in your blood. It can show if you have anemia (too few red blood cells). Some people with oesophageal cancer become anemic because the tumor has been bleeding.
Liver enzymes: You may also have a blood test to check your liver function, because esophageal cancer can spread to the liver.
After someone is diagnosed with oesophageal cancer, it is necessary to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it.
Most oesophageal cancers start in the innermost lining of the esophagus (the epithelium) and then grow into deeper layers over time.
How is the stage determined?
The staging system most often used for esophageal cancer is the TNM system, which is based on 3 key pieces of information:
The extent (size) of the tumor (T): How far has the cancer grown into the wall of the oesophagus? Has the cancer reached nearby structures or organs?
The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
The spread (metastasis) to distant sites (M): Has the cancer spread to distant lymph nodes or distant organs such as the lungs or liver?
CAN-C is a specialist centre for oesophageal cancer treatment in Bangalore.
Not all esophageal cancers can be prevented, but the risk of developing this disease can be greatly reduced by avoiding certain risk factors:
Avoiding tobacco and alcohol: Each of these factors alone increases the risk of oesophageal cancer many times, and the risk is even greater if they are combined. Avoiding tobacco and alcohol is one of the best ways of limiting your risk of esophageal cancer.
Watching your diet and body weight: Eating a healthy diet and staying at a healthy weight are also important. A diet rich in fruits and vegetables may help protect against oesophageal cancer. Obesity has been linked with oesophageal cancer, particularly the adenocarcinoma type, so staying at a healthy weight may also help limit the risk of this disease.
If you've been diagnosed with oesophageal cancer, it's important that you think carefully about each of your treatment choices. You will want to weigh the benefits of each treatment option against the possible risks and side effects. The most important factor in planning treatment for oesophageal cancer is the stage of the disease. Your treatment will also depend on your age, medical history and general health. Oesophageal cancer can be treated with surgery, chemotherapy, or radiotherapy. These may be used alone or in combination.
Surgery can be used to try to remove the cancer and some of the normal surrounding tissue. In some cases, it might be combined with other treatments, such as chemotherapy and/or radiation therapy.
1. Oesophagectomy: Surgery to remove some or most of the oesophagus is called an oesophagectomy. Often a small part of the stomach is removed as well. The upper part of the oesophagus is then connected to the remaining part of the stomach. Part of the stomach is pulled up into the chest or neck to become the new oesophagus. How much of the esophagus is removed depends upon the stage of the tumor and where it's located: if the cancer is in the lower part of the esophagus (near the stomach) or if the tumor is in the upper or middle part of the esophagus.
Open Oesophagectomy: In the standard, open technique, the surgeon operates through one or more large incisions (cuts) in the neck, chest, or abdomen (belly). Many different approaches can be used to remove part of the oesophagus.
Minimally invasive esophagectomy: For some early (small) cancers, the oesophagus can be removed through several small incisions instead of large incisions.
Lymph node removal: For either type of oesophagectomy, nearby lymph nodes are also removed during the operation as well. These are then checked in the lab to see if they contain cancer cells.
2. Surgery for palliative care: Sometimes minor types of surgery are used to help prevent or relieve problems caused by the oesophageal cancer, instead of trying to cure it. For example, minor surgery can be used to place a feeding tube directly into the stomach or small intestine in people who need help getting enough nutrition.
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Radiation therapy uses high-energy rays (such as x-rays) or particles to destroy cancer cells. It is often combined with other types of treatment, such as chemotherapy (chemo) and/or surgery, to treat esophageal cancer. Chemotherapy can make radiation therapy more effective against some oesophageal cancers. Using these 2 treatments together is called chemoradiation or chemoradiotherapy.
Radiation therapy may be used:
1. As part of the main treatment of oesophageal cancer in some patients, typically along with chemo (known as chemoradiation). This is often used for people who can't have surgery due to poor health or for people who don't want surgery.
2. Before surgery (and along with chemo when possible), to try to shrink the cancer and make it easier to remove (called neoadjuvant treatment).
3. After surgery (and along with chemo when possible), to try to kill any areas of cancer cells that may have been left behind but are too small to see. This is known as adjuvant therapy.
4. To ease the symptoms of advanced oesophageal cancer such as pain, bleeding, or trouble swallowing. This is called palliative therapy. There are 2 main types of radiation therapy used to treato esophageal cancer.
1. External-beam radiation therapy: This is the type of radiation therapy used most often for people with oesophageal cancer. The radiation is focused on the cancer from a machine outside the body. It is much like getting an x-ray, but the radiation is more intense. How often and how long the radiation treatments are delivered depends on the reason the radiation is being given and other factors.
2. Internal radiation therapy (brachytherapy): For this type of treatment, passing an endoscope (a long, flexible tube) down the throat to place radioactive material very close to the cancer. The radiation travels only a short distance, so it reaches the tumor but has little effect on nearby normal tissues. The radioactive source is then removed a short time later. Brachytherapy can be given 2 ways: High-dose rate (HDR) brachytherapy, Low-dose rate (LDR) brachytherapy.
Brachytherapy is most often used with more advanced oesophageal cancers to shrink tumors so a patient can swallow more easily. This technique cannot be used to treat a very large area, so it is better used as a way to relieve symptoms (and not to try to cure the cancer).
Chemotherapy (chemo) is treatment with anti-cancer drugs.
How is chemotherapy given?
The main way chemo is given for oesophageal cancer is called systemic chemotherapy. The drugs are injected into your vein or you take them by mouth. These drugs enter your bloodstream and reach most areas of your body.
Chemo may be used at different times during treatment for oesophageal cancer.
1. Adjuvant chemo: Chemo can be given after surgery. The goal is to kill any cancer cells that may have been left behind during surgery because they were too small to see, as well as cancer cells that might have escaped from the main tumor and settled in other parts of the body (but are too small to see on imaging tests).
2. Neoadjuvant chemo: For some cancers, chemo is given (often with radiation) before surgery to try to shrink the cancer and make surgery easier.
3. Chemo for advanced cancers: For cancers that have spread to other organs, such as the liver, chemo can also be used to help shrink tumors and relieve symptoms. Although it is not likely to cure the cancer, it often helps people live longer.
Chemo by itself rarely cures oesophageal cancer. It is often given together with radiation therapy (called chemoradiation or chemoradiotherapy). Chemoradiation is often used before surgery. This can lower the chance of the cancer coming back and help people live longer than using surgery alone.
Some common drugs and drug combinations used to treat oesophageal cancer include:
1. Carboplatin and paclitaxel (Taxol) (which may be combined with radiation)
2. Cisplatin and 5-fluorouracil (5-FU) (often combined with radiation)
3. ECF: epirubicin (Ellence), cisplatin, and 5-FU (especially for gastroesophageal junction tumors)
4. DCF: docetaxel (Taxotere), cisplatin, and 5-FU
5. Cisplatin with capecitabine (Xeloda)
6. Oxaliplatin and either 5-FU or capecitabine
7. Irinotecan (Camptosar)
8. Trifluridine and tipiracil (Lonsurf), a combination drug in pill form
For some oesophageal cancers, chemo may be used along with the targeted drug trastuzumab (Herceptin) or ramucirumab (Cyramza).
In Bangalore, we are the specialist centre to provide the best treatment of oesophageal cancer.
Targeted drugs work differently from standard chemotherapy drugs. They sometimes work when standard chemo drugs don't. They can be used either along with chemo or by themselves if chemo is no longer working.
1. Trastuzumab: A small number of esophagus cancers have too much of the HER2 protein on the surface of their cells, which can help cancer cells to grow. Having too much of this protein is caused by having too many copies of the HER2 gene.
A drug that targets the HER2 protein, known as trastuzumab (Herceptin), may help treat these cancers when used along with chemotherapy. Trastuzumab is injected into a vein (IV) along with chemo.
2. Ramucirumab: For cancers to grow and spread, they need to create new blood vessels so that the tumors get blood and nutrients. One of the proteins that tells the body to make new blood vessels is called VEGF. VEGF binds to cell surface proteins called receptors to act. Ramucirumab (CyramzaTM) is a monoclonal antibody that binds to a receptor for VEGF. This keeps VEGF from binding to the receptor and signaling the body to make more blood vessels. This can help slow or stop the growth and spread of cancer.
Ramucirumab is used to treat cancers that start at the gastroesophageal (GE) junction when they are advanced (the GE junction is the place where the stomach and esophagus meet). It is most often used after another drug stops working. This drug is given as infusion into a vein (IV).
Immunotherapy is the use of medicines that help a person's own immune system find and destroy cancer cells. It can be used to treat some people with oesophageal cancer.
Immune checkpoint inhibitors: An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses "checkpoints" - molecules on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. But newer drugs that target these checkpoints hold a lot of promise as cancer treatments.
Pembrolizumab (Keytruda) targets PD-1, a protein on immune system cells called T cells that normally helps keep these cells from attacking other cells in the body. By blocking PD-1, this drug boosts the immune response against cancer cells. This can shrink some tumors or slow their growth.
This drug can be used in some people with advanced cancer of the oesophagus, typically after another treatment has been tried. It can also be used to treat some advanced cancers of the of the gastroesophageal junction (GEJ), typically after at least 2 prior treatments (including chemotherapy).
Pembrolizumab is given as an intravenous (IV) infusion.
We are one of the leading oesophageal cancer treatment centre in Bangalore.
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