When Shridhar, a 43-year-old Chennai resident, first developed a persistent cough, he turned to using cough drops and lozenges without much relief. As the hoarseness in his throat and coughing continued, Shridhar tried his best to manage with home remedies such as gargling. But when swallowing food began to get painful, he finally reached out to doctors, only to receive a shocking diagnosis—cancer of the oesophagus or food pipe.
While Shridhar’s disease was treatable with surgery, it still meant that a large portion of his food pipe had to be removed and his stomach reattached to the remainder. Recovering to normalcy took many months, and to this day he has to be careful how much and how quickly he eats, lest he overload his narrowed stomach. Still, he considers himself fortunate as the cancer was caught early enough to guarantee him a favourable outcome.
“The oesophagus is the long hollow tube that runs from the throat to the stomach and transports the food we eat to the stomach for digestion,” explains Dr T Raja, Director of Medical Oncology at Apollo Cancer Centre, Chennai. When the cells lining this tube undergo chronic irritation, this leads to cellular changes that result in the development of cancer.
Studies show that oesophageal cancer is the fifth most common cancer type among men in India and the sixth most common type among women. Despite this, oesophageal cancer does not often receive the kind of public attention other kinds of cancer do. “People are generally more aware of cancers such as breast or lung cancer. Even among cancers of the gastrointestinal (GI) tract, people have often heard of stomach, colon or liver cancer. But oesophageal cancer is also an important type to be aware of,” says Dr Raja.
While it isn’t known what exactly causes oesophageal cancer, several factors that contribute to an increased risk of this disease have been identified, says Dr Raja. While some of these factors include medical conditions such as an infection of human papillomavirus (HPV), certain kinds of fungal infections or Barrett’s oesophagus (damage to the oesophagus lining due to chronic gastro-oesophageal reflux disease), there are also lifestyle factors that are more easily modifiable.
One of the most common contributing factors is tobacco consumption, particularly in the form of chewing tobacco. “Tobacco is loaded with carcinogenic chemicals and when these chemicals injure the oesophagus, they can trigger the development of cancer,” says Dr Raja. Alcohol consumption is another significant factor, particularly when heavy drinking is combined with tobacco use.
Diet also plays a significant role—a lack of fruits and vegetables can lead to shortfalls of vitamins such as Vitamin C and minerals such as molybdenum, increasing the risk of developing oesophageal cancer.
Obesity can also contribute to developing oesophageal cancer, with the risk increasing as the weight increases.
Finally, drinking hot liquids at a very high temperature on a regular basis is also thought to irritate the food pipe and raise the risk of this cancer.
The most recognisable symptom of oesophageal cancer is dysphagia or difficulty swallowing, says Dr Raja. “When patients have dysphagia, they are unable to swallow smoothly and may experience pain or discomfort in swallowing or feel a choking sensation,” he explains. “Isolated incidents may not be indicative, but if such difficulty is persistent or regular, then it is time to see a doctor.”
Pressure, burning or pain in the chest or throat can also be indicative of the presence of cancer.
It’s also time to see the doctor if one has a persistent cough or hoarseness in the voice. Unexplained weight loss is also an important factor to consider.
Finally, blood in the vomit, stools or while coughing are also symptoms of concern.
“However, many of these symptoms do not show up in the early phases of oesophageal cancer because the food pipe is an elastic and flexible organ. By the time these symptoms are appreciable, the cancer has often taken root. This is significant because early detection is key to improving outcomes in patients. In east Asian countries that have had higher rates of oesophageal cancer, population-based endoscopic screening is more common and hence this cancer is detected earlier and treated more easily,” says Dr Raja.
In the earliest stages, endoscopic or laser procedures can be used to treat highly localised cancer. The most common treatment available for oesophageal cancer is surgery. When the cancer is relatively localised, and is located at an operable place, surgery can be the best option. “These days, surgical techniques have vastly improved, with laparoscopic and minimally invasive robotic surgery techniques helping to drastically improve surgery outcomes and recovery times,” explains Dr Raja.
When the cancer is more advanced, a multimodal treatment involving chemotherapy and radiation would be necessary. Sometimes surgery may also be included as part of the sequence, after the cancer has been shrunk by chemotherapy and radiation. If the cancer has become widespread, then both radiation and surgery are not possible, and chemotherapy is the only option. “In recent years, there have been fantastic advances in medical treatments for oesophageal cancer with the development of immunotherapy and targeted antibody treatments,” says Dr Raja.
With any cancer, patient outcomes and quality of life depend on how quickly the cancer is detected and how effectively the treatment is targeted while preventing damage to other tissues and organs. This is why a high-tech, multidisciplinary cancer centre is important, stresses Dr Raja.
“At Apollo Cancer Centre, we use a variety of diagnostic and imaging techniques such as endoscopic ultrasound, PET-CT scans, and MRIs for precision detection of cancers,” he says. Besides these technologies, high levels of expertise and experience with diverse forms of cancer pathology are also vital, he adds.
In terms of treatment, the more personalised and targeted the treatment, the more effective it is. At leading oncological centres like the Apollo Cancer Centre , a variety of cutting-edge technologies are deployed. Robot-assisted surgery, for instance, allows cancers to be precisely targeted while preserving surrounding healthy tissue, reducing infection risk, and improving recovery times. Similarly, the use of highly sophisticated forms of radiation therapy such as Tomotherapy and Proton Beam Therapy allow for radiation to be targeted exclusively and effectively at cancer cells. Finally, techniques such as molecular profiling allow for use of the most effective chemotherapy treatments for each patient. Further, the multidisciplinary, collaborative approach ensures that from diagnosis to recovery, each patient’s specific medical needs remain in focus.
For more details on oesophageal cancer, please refer to: https://apollocancercentres.com/cancers/esophageal-cancer/
Dr T. Raja
D.M (Oncology)
Director - Medical Oncology, Apollo Cancer Centre, Chennai.
This article was published in association with Apollo Cancer Centre.