The incidence of cancer of oesophagus is increasing every year worldwide. More than 5 lac deaths are reported every year globally. The rising incidence is due to increasing incidence of alcohol,obesity and nicotine consumption. The diagnosis is usually reached late as symptoms occur only after many months of disease activity.
- What is oesophagus ? Oesophagus is a 10 inch long food pipe that carries food and liquids from the throat, to the stomach. Ordinarily it does not have acid in it. However in a few there could be acid regurgitation from the stomach to the oesophagus.
- What are the early symptoms of cancer oesophagus ? Early cancer of the food pipe may not cause symptoms . Difficulty in swallowing particularly solids and later liquids is the hall mark of the disease. Pain behind the sternum, recurring burning sensation in the food pipe area and weight loss should not be ignored. Food getting stuck or chest pain or back pain are some other symptoms.
- What are the late symptoms ? Late symptoms include hoarse voice, coughing or vomiting of blood. Recurring pneumonia, frequent choking while eating are late symptoms. Presence of lymph nodes near the collar bone indicate presence of metastatic cancer.
- What causes cancer oesophagus ? It is not exactly known what causes oesophageal cancer. When cells of the oesophagus develop errors while multiplying it leads to unregulated growth. This is due to mutation. The accumulating abnormal cells form a tumour in the oesophagus that can grow to invade nearby structures and spread to other parts of the body.
- What are the different types of oesophageal cancers ? This depends upon the cells involved. The type of oesophageal cancer helps us to determine treatment options. Adenocarcinoma occurs in the lower part of oesophagus. Squamous cell carcinoma occurs in the upper and middle part of oesophagus. Squamous type is the most prevalent type of oesophageal cancer in our country. There are other types which are rare. They are small cell carcinoma, lymphoma, melanoma.
- Is it possible to prevent cancer of oesophagus? There are certainly some risk factors for its occurrence. They are excessive consumption of alcohol, chewing tobacco, smoking beedis or cigarettes and consuming very hot drinks.Recurrent episodes of acid reflux causing Barrett’s oesophagitis is also an important risk for cancer oesophagus. Hence avoid excessive alcohol, nicotine abuse , maintain a normal body weight, exercise, avoid betel nuts and very hot drinks.Consumption of fresh fruits, green or yellow vegetables and fruits provides anti cancer antioxidants.
- How is the diagnosis made? Upper gastrointestinal endoscopy is the investigation of choice. One can see the tumour and take a biopsy from it. Besides this CT scan, PET scan, X-rays of chest are necessary to stage the tumour and plan treatment.
- What is the treatment for cancer oesophagus ? Depending on the stage of illnesses, age of the patient and location of the disease the therapy is planned.It could either be surgical treatment or radiotherapy or chemotherapy. In most a combination is required. In very early stages surgery with chemotherapy could be the best option. A feeding tube either in stomach or jejunum is often required. In inoperable cases a stent can be used to facilitate swallowing.
- What is the life expectancy after the diagnosis? The five year survival rate is less than 15%. Most of the patients survive less than 12 to 15 months once the diagnosis is made.
Cancer oesophagus is a very challenging disease due to poor survival rates inspite of proper therapy. Not been able to swallow food and liquids is a very sad experience. Preventing cancer oesophagus by avoiding tobacco in all forms, avoiding excess alcohol and proper management of acid reflux is mandatory. Consumption of fruits and vegetables should be encouraged.
Author: Dr Jay Deshmukh
Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.