The Esophagus is a hollow muscular tube that connects the mouth to the stomach. Each time you swallow food or liquid, the esophagus transports it to the digestive system.
What is Esophageal Cancer?
Esophageal cancer can develop when cells in the soft tissues lining this tube begin to grow and divide abnormally, forming a tumor. Tumors typically start in the innermost layer of the esophagus and then spread outward. The spread of cancer from the esophagus to the lymph nodes and other organs is called metastasis.
What are the types of Esophageal Cancer?
Most esophageal tumors can be classified as one of two types — adenocarcinoma or squamous cell carcinoma.
Adenocarcinoma is the most common form of esophageal cancer in the United States, accounting for more than 50 percent of all new cases. It starts out in glandular cells, which are not normally present in the lining of the esophagus. These cells can grow there due to a condition called Barrett’s esophagus, which increases a person’s chance of developing esophageal cancer. Adenocarcinoma occurs mainly at the lower end of the esophagus and the upper part of the stomach, known as the gastroesophageal junction or the GE junction.
Adenocarcinoma of the esophagus occurs most often in middle-aged white men. Since the 1970s, the disease has become more common more rapidly than any other cancer in the United States. Doctors say the rise may be due to an increase in the number of people who develop gastroesophageal reflux disease (GERD), a condition in which contents from the stomach, such as acid, move up into the esophagus repeatedly, causing chronic inflammation
Squamous Cell Carcinoma
The second most common form of esophageal cancer is squamous cell carcinoma. This type of cancer begins when squamous cells, thin flat cells that line the inside of the esophagus, mutate and begin to grow uncontrollably. Squamous cell carcinoma of the esophagus is strongly linked with smoking and the consumption of excessive amounts of alcohol.
Gastroesophageal Reflux Disease and Esophageal Cancer
Normally, a sphincter muscle at the end of the esophagus opens to allow food to enter the stomach and closes to prevent harmful digestive acids from bubbling back up into the esophagus. When this sphincter muscle does not function normally, however, it can lead to a condition known as GERD. Studies have shown that having severe GERD over the course of many years increases the chance of developing gastroesophageal adenocarcinoma.
The following are the most common risk factors for esophageal cancer.
- Age : Esophageal cancer is most often diagnosed in people over age 50.
- Tobacco and Use of Alcohol : Use of tobacco in any form can increase your risk of developing esophageal cancer — particularly squamous cell carcinoma. The more you smoke and the longer you smoke, the greater your risk of esophageal cancer.
- Barrett’s Esophagus: Caused by long-term reflux of acid from the stomach into the esophagus, Barrett’s esophagus increases the risk of esophageal adenocarcinoma.
- Race: Squamous cell cancer of the esophagus is more common among blacks than whites. Adenocarcinoma is more common in white men than men of other race
- Obesity: Being overweight is a risk factor for esophageal adenocarcinoma.
- Vitamin Deficiencies: Some studies have linked esophageal cancer with deficiencies in beta carotene, vitamin E, selenium, or iron.
- Gender: Esophageal cancer is more common in men than in women, but the gender gap is narrowing.
Screening refers to any test that is given to detect disease before it begins to cause symptoms.Screening for esophageal cancer is not recommended for most people. However, your doctor may recommend regular endoscopic screening for adenocarcinoma if you have been diagnosed with Barrett’s esophagus or are at high risk of esophageal cancer for other reasons.
Diagnosis and Treatment at Max Cancer Centre Shalimar Bagh
Dedicated surgical oncologists, medical oncologists, radiation oncologists, gastroenterologists, radiologists, and pathologists work together closely to develop every patient’s treatment plan. We meet regularly to discuss individual patients and the latest advances in treatment.This team approach is particularly important in the treatment of esophageal cancer, because it is often best managed using a multidisciplinary approach. Having representatives of many different disciplines involved in your care ensures that all possible approaches to your treatment will be considered, and that your care will be well coordinated and personalized to your specific needs.
Diagnosis and Staging
Getting an accurate diagnosis is the first step toward getting the best cancer care.
Staging the tumor requires performing one or more possible studies, including:
- CT scans of the chest and upper gastrointestinal tract
- A combined PET/CT scan, which allows doctors to measure and analyze the location of tumors more accurately. This technology can also help track how the tumor responds to treatment as your care progresses.
- Endoscopic ultrasound, a procedure that uses an endoscope with a small ultrasound probe at its tip. The device can measure how thick the tumor is and see whether it has invaded the wall of the esophagus. The test can also help your doctors to determine whether cancer cells are in the lymph nodes.
- Bronchoscopy, an endoscopy procedure, to evaluate cancer involvement of the trachea (windpipe) or main bronchi (airways)
- Interventional radiology or surgical biopsies if suspicious areas are identified outside the esophagus Using results from your staging studies, your doctors will classify the cancer into one of four stages. The stage indicates how large the tumor has grown and how widely it has spread in the body.
Surgery: Surgery is an important part of treatment for many people with esophageal cancer. In the procedure called an esophagectomy, the goal is to remove all of the tumor in order to prevent its regrowth and spread. It is the primary modality of treatment in most cases of esophageal cancer.Surgery is an important part of treatment for many people with esophageal cancer. In the procedure called an esophagectomy, the goal is to remove all of the tumor in order to prevent its regrowth and spread.Studies have shown that cancer centers that perform more surgeries deliver better results for patients, including better survival rates, than those with less experience.We have among the lowest rates of complications following esophageal surgery in the country.Our thoracic surgeons are experts in performing complex esophageal surgery, including advanced minimally invasive techniques and robotic surgery. These approaches have been shown to lead to faster recovery after surgery than traditional open surgical approaches. Because surgical oncologists at Max Cancer Centre, Shalimar Bagh work as part of a multidisciplinary team, we are also very careful to recommend surgery only as part of a comprehensive treatment plan that will offer you the best results.
When Surgery Is Performed
Whether your doctors recommend surgery as the initial treatment for your esophageal cancer depends on several important factors, including:
- Whether the cancer is adenocarcinoma or squamous cell carcinoma. Squamous cell carcinoma does not always require surgery. It can sometimes be managed with chemotherapy and radiation therapy alone.
- The size of the tumor
- How deeply the cancer has invaded the layers of tissue in the wall of the esophagus
- Whether the cancer has spread to the lymph nodes
- Your overall health
In some cases, limited precancerous changes or very early stage tumors may be treated with a simple endoscopy and removal of the diseased inner lining of the esophagus — a technique called endoscopic mucosal resection (EMR). Radiofrequency ablation (RFA), an endoscopic procedure used to treat remaining areas of disease including Barrett’s esophagus, may also be used. If successful, surgery may be avoided in these cases.
Surgery is the best treatment option for more-advanced tumors, or early tumors and precancerous changes in the lining of the esophagus that cannot be treated with endoscopic techniques.
For most patients — because diagnosis of esophageal cancer usually happens only once it has reached an advanced stage — surgery is not the first treatment given. In many cases, patients first receive a combination of chemotherapy and radiation therapy to shrink the tumor and to increase the likelihood that any remaining cancerous tissue will be completely removed during a later surgery.
During surgery for esophageal cancer, the thoracic surgeon removes the tumor along with part of the normal esophagus, as well as a margin of tissue around the cancer and nearby lymph nodes to which cancer cells may have spread. This procedure is called an esophagectomy. Once these tissues are removed, the stomach is reattached to the remaining part of normal esophagus. In some cases, the colon or small intestine is used instead of the stomach to complete the connection.
Esophagectomy can be performed using open surgical methods or minimally invasive techniques. Your surgeon will carefully consider the appropriate approach for you.
Minimally Invasive Robotic Surgery
Many operations for esophageal cancer at Max Cancer Centre can now be performed using minimally invasive approaches, including robotic-assisted approaches. Minimally invasive surgery is a set of techniques that use small incisions to enter the body, limiting the amount of healthy tissue that is affected during an operation. Minimally invasive approaches are not effective for all patients with esophageal cancer, but when appropriate these techniques may offer a variety of benefits, including:
- Shorter hospitalization
- Less pain
- Decreased complications, particularly in older patients
Our surgeons are leaders in performing robotic-assisted surgery. Our team of thoracic surgeons is increasingly integrating robotic assistance into esophageal surgery, including complex esophageal cancer operations. This sophisticated surgical tool offers finer precision than is possible with other minimally invasive techniques.
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Radiation therapy for esophageal cancer is the use of high-energy beams to shrink or eliminate tumors