Everything You Need to Know About Oesophageal Cancer

Oesophageal cancer is a cell malignancy arising in the oesophagus, the tubular organ that runs from the throat to the stomach of your body. It is the sixth most frequent cause of cancer deaths worldwide. Hence, it is of major concern and a global health challenge. Oesophageal cancer develops slowly and thus takes several years for the symptoms to appear but once it starts to manifest, the condition may progress rapidly. It is observed more in men than women.

What is Oesophageal Cancer?

Cancer of the oesophagus develops when the cells that line the inner portion of the food pipe start to multiply in an uncontrolled way causing tumours. These cancer cells can occur anywhere in the oesophagus and can invade more regions of the gullet, as the condition progresses. Two types of oesophageal cancer are identified depending on the type of tissue where the malignancy starts -

• Adenocarcinoma: Adenocarcinoma arises from the tissue that produces mucus. It often affects the lower portion of the oesophagus.
• Squamous cell carcinoma: This type of oesophageal cancer forms in the squamous cells that line the interior of the food pipe. It can occur anywhere along the oesophagus but most commonly it is found to start in the upper and middle part of the gullet.

Symptoms of Oesophageal Cancer

The most common oesophagus symptoms of cancer are:

• Dysphagia- difficulty in swallowing down the food
• Heartburn or acid reflux that persists
• Indigestion that doesn’t go away
• Loss of appetite
• Feeling lethargic or fatigued
• Unexplained weight loss
• Pain in throat and hoarseness in voice
• Persistent cough
• Pain behind the breastbone

Block stool and coughing up blood are the rare symptoms associated with cancer of the oesophagus.

Risk Factors Associated with Oesophageal Cancer

There is a wide range of risk factors that increase the probability of developing oesophageal cancer in a person. Smoking and the use of smokeless tobacco pose a risk of developing oesophageal cancer. Chronic and heavy alcohol drinking is also found to elevate the risk of oesophageal cancer. Furthermore, having an unhealthy body weight may cause inflammation in the food pipe, which can later lead to cancer. Chronic untreated acid reflux disease can also lead to changes in the cells lining the lower part of the food pipe. This increases the chances of these cells becoming cancerous. It is important to note that Human Papilloma Virus (HPV) infection can bring about changes in the tissue in the vocal cord and mouth. This alteration in the cells may also lead to the development of cancer. Individuals who have had cancer in the neck or head are at risk of developing oesophageal cancer. Cancer of the oesophagus is also linked to rare diseases like achalasia and tylosis.

How is Oesophageal Cancer Diagnosed?

After inquiring about the symptoms and medical history of an individual, the doctor will recommend tests to diagnose the condition. One of them is the barium swallow test. In this special imaging test, barium and X-rays are used to produce images of the upper gastrointestinal tract. The patient needs to drink a liquid containing barium and then the healthcare provider will conduct the X-ray test.

CT(Computed Tomography) scan is one of the most commonly suggested processes for cancer.  A CT scan helps locate the position of the cancer in the oesophagus. It also looks at the chest, abdomen and pelvis to check whether the malignant cells have invaded these areas. For oesophageal cancer Gastroscopy/ Oesophago gastric duodenoscopy(OGD) is also suggested. It is an endoscopy test that uses a long flexible tube called an endoscope fitted with a tiny camera to get a picture of the inside of the oesophagus. This looks for abnormal areas or growths.

Alternatively, Endoscopic Ultrasound(EUS) can also be done. An endoscopic ultrasound scan combines ultrasound and endoscopy to investigate the inside of the food pipe. This can help the doctor find out the size of the tumour and check whether the cancerous cells have spread to other parts. Lastly, for identifying cancer, the biopsy is considered one of the most appropriate modes of diagnosis. The biopsy is the microscopic examination of the cells taken from the food pipe during an endoscopy.

Stages of Oesophageal Cancer

Cancer staging is a method of describing the location of cancer, whether or not it has spread and if it is affecting other parts of the body. The stages of oesophageal cancer are assigned according to the TNM system, a commonly accepted method that depends on three key components.

• T( Tumor) – Describes the size of the tumour
• N(Node)- This denotes whether cancer has spread to the lymph nodes.
• M( Metastasis)- Means the spread of cancer cells to other body parts

A grade to describe the degree of similarity of the malignant cells to the healthy cells is also assigned to the cancer together with the stage. The different stages of cancer of the oesophagus, based on the TNM system, are detailed below.

• Stage 0: Abnormal cells (not yet turned malignant) are found only in the epithelium, the top cell layer lining the interior of the oesophagus. This stage is called high-grade dysplasia. It has not spread to lymph nodes and other body parts.
• Stage 1: Cancer cells are growing into the tissue layers beneath the epithelium, reaching the muscle layer. It has not invaded nearby lymph nodes and other body parts.
• Stage 2: Cancer has infiltrated deep into the muscle layer or reached the outer layer of the oesophagus. It may have invaded 1 to 2 nearby lymph nodes but not spread to other body parts.
• Stage 3: The cancer has spread deeper into the muscle layer or the outer layer of the food pipe. It has invaded not more than 6 nearby lymph nodes. The malignancy might have reached some nearby organs, including the outer layer of the lungs, the sac surrounding the heart and the diaphragm.
• Stage 4: This is the most advanced and concerning stage of oesophageal cancer. The cancerous cells have spread to several distant lymph nodes and organs. The cancer can be of any grade.

How is Oesophageal Cancer Treated?

The best treatment method for oesophageal cancer is determined based on the stage and grade of the condition. Surgery is the common treatment option for early-stage oesophageal cancer, where a portion or most of the parts of the food pipe is removed. This surgery is called an oesophagectomy. Radiation therapy is another option. In this method of treatment, radiation beams are targeted at tumours to destroy or damage the cancer cells. Another popular cancer treatment is chemotherapy, in which potent drugs are used to attack and kill cancerous cells or suspend their growth in the body.

Endoscopic submucosal dissection is another increasingly endorsed treatment for oesophageal cancer. It is a minimally invasive procedure to remove cancer cells or tumours from the gastrointestinal tract. Alternatively, endoscopic mucosal resection can also be done to treat the cancer of the oesophagus. It is a minimally invasive procedure to remove malignant cells from the oesophagus. Endoscopic laser therapy is also another highly endorsed treatment where laser beams are projected on the cancer cells with the help of an endoscope. This kills cancerous growth.

With the advancement of medical technology, photodynamic therapy is nowadays increasingly used to cure cancer. In this treatment, drugs known as photosensitisers are used to kill cancer cells. A chemical reaction brought about by the activation of these drugs by light destroys the tumours.

Some oesophageal cancer cells contain a high concentration of HER2 protein that is required for their growth. For such conditions, targeted therapy can be a good option. In targeted therapy, drugs or other substances that precisely identify and attack HER 2 proteins are used. Apart from the discussed treatments immunotherapy can also be used to treat oesophageal cancer. Immunotherapy is a biological therapy that enhances the immune system to fight cancer cells. There are several types of this therapy, including immune checkpoint inhibitors, T-cell transfer therapy, monoclonal antibodies and immune system modulators.

Treatment Based on the Stages of Oesophageal Cancer

The treatment plan for patients with stage 0 cancer includes surgery, photodynamic therapy, laser therapy or endoscopic mucosal resection. Stages 1,2 and 3 of the cancer are treated by surgery, chemotherapy or radiation or a combination of these. Medical care for the advanced state of cancer, stage 4, mainly focuses on palliative therapy to relieve pain and other associated difficulties. Chemotherapy, radiation, targeted therapy and immunotherapy are also given to patients in this stage.

Conclusion

Cancer treatments are often expensive and can bring financial burdens on individuals, but they can be eased with cancer insurance. Cancer Insurance provides financial and healthcare protection against cancer treatment costs. The insurance plans cover the charges of hospitalization, therapies and other non-medical expenditures. In addition to cancer-specific coverage, having a comprehensive health insurance plan can further safeguard your finances against a wide range of medical emergencies.

It is wise to take a cancer insurance policy in the wake of the increasing number of cancer incidents worldwide. This will help a person cope with financial needs during a period of emotional turmoil.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

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