What is esophageal cancer?
Cancer that occurs anywhere in the esophagus or food pipe is called esophageal cancer.
Cancer of the esophagus typically occurs in one of two forms, squamous cell carcinoma arising from the stratified squamous epithelial lining of the organ, and adenocarcinoma affecting columnar glandular cells that replace the squamous epithelium. Other types of esophageal cancer are uncommon.
Cancers that start in the area where the esophagus joins the stomach (the GE junction) including about the first 2 inches of the stomach tend to behave like esophageal cancers; they are grouped with esophageal cancers.
What is Esophagus?
The esophagus, also known as the food pipe is a muscular tube measuring 20-25 cm long and 2-3 cm wide that serves as a conduit for moving food and drink from the mouth to the stomach.
Burden of the disease
- Esophageal cancer is the 6th most common cancer in India
- 6th most common cause of cancer-related deaths in India
- New cases: 52,396
- Deaths: 46,504
- Regional variation exists in the rates of esophageal cancer in India
- Number of cases in men is more than double than that in women (male: female ratio 2.4:1)
Are you at risk?
- Gender: The incidence is generally higher in men than women.
- Tobacco consumption: Smokers have a 5-times higher risk of developing this disease compared to non-smokers. Chewing of betel nut/ supari, often mixed with tobacco, increases risk of esophageal cancer.
- Alcohol:People who drink 12.5gm(1.5units) alcohol in a day have 34% higher risk of developing esophageal squamous cell carcinoma (SCC) 
- Gastroesophageal reflux disease and Barrett’s esophagus: In people with chronic reflux, the lining of esophagus changes to glandular (Barrett’s esophagus). In Barrett’s esophagus, the risk of adenocarcinoma is higher than in people not having it.
- Obesity: Studies have shown that the risk of esophageal adenocarcinoma is 13% higher per 5-unit body mass index (BMI) increase. 
- Diet: Having a diet rich in processed meat or drinking very hot liquids increase the risk of esophageal cancer. A diet containing lots of fruits and vegetables lowers the risk of this disease.
How can it be prevented?
Avoiding tobacco (in any form) and alcohol intake
Eating a healthy diet rich in fruits and vegetables
Maintaining a healthy weight
Treating reflux disease (heartburn)
When should you consult a doctor?
If you have any of the following symptoms, it is advisable to consult your doctor:
- Difficulty in swallowing food (dysphagia)
- Unexplained weight loss
- Worsening indigestion or heartburn
- Tightness or pain in the chest
- Cough or hoarseness of voice
Screening for esophageal cancer is recommended if you are at a high risk, for example if you have Barrett’s esophagus.
If you are at high risk of esophageal cancer, upper GI endoscopy at regular intervals with biopsy from suspicious areas is recommended.
How can it be diagnosed?
- Endoscopy: A flexible tube equipped with a camera is pushed down the throat into the esophagus. Using the endoscope, the doctor examines the esophagus, looking for suspicious areas and takes a piece of tissue for pathologic examination.
Endoscopic ultrasound (using an ultrasound probe at the end of an endoscope) helps the doctor to see the extent of growth of tumor into nearby areas as well as to check for enlarged lymph nodes.
- Imaging tests can help to look for suspicious areas, check for spread of cancer and during treatment to look if the disease is responding or not.
- Barium swallow: In this test, you will have to drink thick chalky liquid called barium that coats the walls of the esophagus. X-rays are taken which show the suspicious areas in the lining of esophagus, from which a tissue piece can be taken and examined for abnormal cells.
- CT scan: To look for the spread of cancer to nearby organs and lymph nodes
- MRI scan: Helps in detecting spread of tumor, especially to brain and spinal cord
- PET scan: Helps to see the spread of cancer to other parts of the body.
- Biopsy is done in cases of suspected malignancy on endoscopy or imaging studies. The tissue piece removed during endoscopy is sent to the laboratory for pathological examination to look for cancerous cells.
- Bronchoscopy may be done if you have cancer in the upper part of your esophagus to check for spread to the windpipe (trachea) or the tubes leading from the windpipe into the lungs (bronchi).
The stages of esophageal cancer range from 0 to IV.
Stage 0. Cancer is limited to the epithelium or the cells lining the esophagus.
Stage I. The size of the tumor is small (7 cm or less) and is limited to the esophagus.
Stage II. Cancer has either involved all the layers of esophagus but without spread to lymph nodes OR is limited to the inner three layers of esophagus with involvement of 1-2 nearby lymph nodes.
Stage III. Cancer involves all the layers of esophagus and has spread to nearby lymph nodes (not more than 6 in number).
Stage IV. Cancer has spread to 7 or more lymph nodes OR involved the coverings of lungs (pleura) or heart (pericardium) OR spread to trachea, aorta, spine OR to distant organs like liver and lungs.
The National Comprehensive Cancer Network (NCCN) provides guidelines for the treatment of esophageal cancer . The treatment options depend on the stage of the cancer as well as your overall health.
- Endoscopic resection (for very small tumors)
- Removing a part of esophagus (esophagectomy)
- Removing a part of esophagus and upper portion of stomach (esophagogastrectomy)
- Chemotherapy: Use of drugs to kill cancer cells. This can be used before or after surgery or in combination with radiation therapy.
- Radiation therapy or radiotherapy: Often combined with chemotherapy and used before surgery and sometimes after surgery. Radiotherapy may also be used for relieving symptoms of advanced esophageal cancer.
- Targeted therapy: Trastuzumab (herceptin) may be used if your esophageal cancer is positive for HER2. Anti-angiogenic therapy (drugs that stop the making of new blood vessels to starve the cancer) may be used if chemotherapy has not worked.
- Immunotherapy: may be used to boost your body’s defense mechanism to fight cancer cells.
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