Cancer of the Oesophagus (Esophageal Cancer) – Causes, Symptoms, Diagnosis & Treatment Introduction Esophageal cancer, also known as cancer of the oesophagus, is a serious disease that develops in the long, hollow tube connecting the throat to the stomach. The oesophagus plays a vital role in carrying food and liquids for digestion. When abnormal cells in the lining of the oesophagus begin to grow uncontrollably, they form a malignant tumor, leading to esophageal cancer. This type of cancer is among the top ten most common cancers worldwide and often affects men more than women. Early detection is crucial because symptoms may appear only in advanced stages.

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Types of Esophageal Cancer

There are two main types of oesophageal cancer, based on the cell type and location within the oesophagus:

  1. Squamous Cell Carcinoma

    • Develops in the thin, flat cells lining the upper and middle parts of the oesophagus.

    • Common in people who smoke or consume alcohol heavily.

    • More prevalent in Asia and parts of Africa.

  2. Adenocarcinoma

    • Begins in the mucus-secreting glands in the lower oesophagus, often near the stomach.

    • Associated with chronic acid reflux and Barrett’s oesophagus.

    • More common in Western countries.

Causes and Risk Factors

The exact cause of oesophageal cancer is not always known, but several risk factors have been identified that increase a person’s likelihood of developing the disease:

  • Tobacco use: Smoking or chewing tobacco damages the oesophageal lining.

  • Heavy alcohol consumption: Regular alcohol intake, especially combined with smoking, multiplies the risk.

  • Chronic acid reflux (GERD): Persistent reflux can lead to Barrett’s oesophagus, a pre-cancerous condition.

  • Obesity: Increases acid reflux and strain on the digestive system.

  • Diet: Low intake of fruits and vegetables, or consumption of very hot beverages, can irritate the oesophagus.

  • Human papillomavirus (HPV) infection: Linked to squamous cell carcinoma in some regions.

  • Age and gender: More common in men over 50 years old.

  • Previous radiation therapy to the chest or upper abdomen.

Symptoms of Esophageal Cancer

In the early stages, oesophageal cancer may not cause any noticeable symptoms. As it progresses, symptoms may include:

  • Difficulty swallowing (Dysphagia) – A feeling that food is stuck in the throat or chest.

  • Pain or burning in the chest (heartburn or chest pain).

  • Unexplained weight loss.

  • Persistent cough or hoarseness.

  • Vomiting or regurgitation of food.

  • Fatigue and weakness.

  • Coughing up blood (in advanced stages).

Because these symptoms often appear late, early screening and medical evaluation for persistent swallowing issues are very important.

Diagnosis

To confirm oesophageal cancer, doctors use a series of tests and procedures, including:

  1. Endoscopy: A thin, flexible tube with a camera (endoscope) is passed through the throat to view the oesophagus.

  2. Biopsy: During endoscopy, a small tissue sample is taken for laboratory analysis.

  3. Barium swallow (X-ray): The patient drinks a barium solution that coats the oesophagus, making abnormalities visible in X-rays.

  4. CT scan, PET scan, or MRI: Used to determine the stage of cancer and whether it has spread (metastasized).

  5. Endoscopic ultrasound: Helps assess how deep the tumor has grown and if lymph nodes are affected.

Stages of Esophageal Cancer

Esophageal cancer is categorized into stages (0–IV) based on the tumor’s depth, lymph node involvement, and spread to other organs:

  • Stage 0: Abnormal cells in the innermost layer (precancerous).

  • Stage I: Cancer limited to the inner layers of the oesophagus.

  • Stage II: Cancer has spread to nearby tissues or lymph nodes.

  • Stage III: Deeper invasion into the oesophageal wall and nearby nodes.

  • Stage IV: Cancer has spread to distant organs (metastatic).

Treatment Options

Treatment depends on the cancer’s stage, location, and the patient’s overall health. Options include:

  1. Surgery (Esophagectomy):
    Removal of the affected portion of the oesophagus and nearby lymph nodes. In some cases, the stomach is pulled up and reattached to the remaining oesophagus.

  2. Radiation Therapy:
    High-energy rays are used to destroy cancer cells, often combined with chemotherapy.

  3. Chemotherapy:
    Anti-cancer drugs (like cisplatin, 5-fluorouracil, or paclitaxel) are used before or after surgery to shrink tumors or kill remaining cancer cells.

  4. Targeted Therapy:
    Drugs that specifically attack cancer cell growth mechanisms (e.g., trastuzumab for HER2-positive cancers).

  5. Immunotherapy:
    Helps the body’s immune system recognize and destroy cancer cells. Used in advanced or metastatic cases.

  6. Palliative Care:
    Focuses on relieving symptoms like swallowing difficulty, pain, and nutritional problems in advanced stages.

Complications

If left untreated, oesophageal cancer can cause:

  • Complete blockage of the oesophagus (inability to swallow).

  • Severe malnutrition and dehydration.

  • Spread to nearby organs like the lungs or liver.

  • Persistent pain and infections.

Prevention

While not all cases are preventable, you can lower your risk by adopting healthy lifestyle habits:

  • Quit smoking and avoid all tobacco products.

  • Limit alcohol consumption.

  • Maintain a healthy weight.

  • Eat a balanced diet rich in fruits and vegetables.

  • Manage acid reflux with proper medical treatment.

  • Avoid consuming very hot beverages.

  • Undergo regular check-ups if you have Barrett’s oesophagus or chronic GERD.

Prognosis and Survival

The survival rate for oesophageal cancer depends on early detection.

  • Localized cancer: Around 45–50% 5-year survival rate.

  • Regionally spread cancer: Around 25%.

  • Distant metastasis: Less than 10%.

Early diagnosis significantly improves outcomes, emphasizing the importance of recognizing symptoms early and seeking medical advice promptly.

Conclusion

Esophageal cancer is a challenging but increasingly treatable disease with the advancement of modern medicine. Awareness of risk factors, healthy living, and timely medical attention are key to prevention and improved survival. Regular monitoring of persistent swallowing problems or acid reflux can save lives.

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