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What is Esophagus?

Esophagus (Food pipe) is a muscular tube that runs from the throat to the stomach (abdomen) Esophagus helps in swallowing of food and pushes into the stomach for digestion.

Esophageal Cancers

Esophageal Cancers are one of the common Cancers across the world and are usually present after 55 yrs of age. Esophageal Cancers are more common in males as compared to females. Risk factors include age more than 45 yrs, tobacco chewing, alcohol, obesity, diet, obesity and Barrett's Esophagus, GERD and the habit of Radiation exposure.

Types

Esophageal Cancers are of two types, one is Squamous Cell Carcinoma and the other is Adenocarcinoma. Squamous Cell Carcinoma usually occurs in the upper and middle Esophagus but can occur anywhere along the Esophagus. Adenocarcinomas usually occur in the lower Esophagus and at the junction of the Esophagus and Stomach.

Signs and Symptoms


Early symptoms of Esophageal Cancer can range from a slight difficulty in swallowing of food to complete dysphagia (obstruction), other symptoms include weight loss, heartburn, chest pain, indigestion, vomiting and hoarseness of voice.

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Diagnosis and Staging


The best way to diagnose Esophageal Cancer is by Endoscopy, it does not only help in confirmation of diagnosis by taking a biopsy but also delineate the exact location of Cancer. CECT scan/PET-CT and Endoscopic ultrasound are also used for diagnosis.

Management of Esophageal Cancers


Esophageal Cancers are divided into three parts (upper, middle and lower) according to the location of the disease. Upper Esophageal Cancers are managed by Chemotherapy and Radiotherapy, Surgery has a limited role in upper Esophageal Cancers, for middle and lower Esophageal Cancers, Surgery is the best treatment option. Another important consideration in the management of Esophageal Cancer is the stage of disease at presentation. Early-stage Esophageal Cancer (stage-1) undergo Surgery upfront without any need for Chemotherapy or Radiotherapy. For locally advanced stage (stage II & stage III) Adjuvant Chemotherapy or Neoadjuvant Chemotherapy with Radiotherapy is given before Surgery, as giving Neoadjuvant Chemotherapy or Chemoradiotherapy helps in better control of disease and increases survival after Surgery. Esophageal Cancer in stage IV ( metastatic disease) is usually managed by palliative treatment like Esophageal stenting, palliative Chemotherapy or palliative Radiotherapy.

Surgical Management of Esophageal Cancers


Surgery for Esophageal Cancer involves the removal of the whole of Esophagus along with surrounding lymph node and natural reconstruction of neo-esophagus with a stomach tube. This is a complex surgery as it involves manipulation in the neck, chest, and abdomen but with the advancement of medical facilities and technical skills, this Surgery is safe and has a good outcome. Most of the time, it is possible to perform this surgery by minimally invasive technique. Note; Esophageal Cancer is a treatable disease and can be cured in early stages.

Survival depends on the initial stage of the disease, histology (Squamous or Adenocarcinoma) and response to treatment. Early-stage Esophageal Cancers have very good survival which gradually decreases as the stage progresses and stage IV has very diminished survival.

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