Oesophageal Cancer

Oesophageal cancer is cancer of the food pipe. Two main types: squamous cell carcinoma (the commoner type in India, linked to tobacco, alcohol, hot beverages, certain diets) and adenocarcinoma (linked to chronic GERD, obesity, Barrett's oesophagus).

Main warning sign

Progressive difficulty swallowing — first with solids, then softer foods, then liquids. Often with weight loss. This symptom deserves an urgent endoscopy — never ignore it.

Other symptoms

• Pain or discomfort when swallowing.
• Food sticking or regurgitating.
• Unexplained weight loss.
• Chest pain unrelated to heart disease.
• Hoarse voice, persistent cough.
• Black tarry stools from bleeding (late).

Risk factors

• Tobacco (smoked and chewed).
• Alcohol.
• Very hot beverages — a recognised risk factor in parts of India and Iran.
• Chronic severe GERD → Barrett's oesophagus — adenocarcinoma.
• Obesity, especially central.
• Nutritional deficiency, low fruit/vegetable intake.
• Caustic injury (lye ingestion) — long-latency risk.
• Achalasia, tylosis.

Diagnosis and treatment

• Upper endoscopy with biopsy.
• Staging — endoscopic ultrasound, CT, PET-CT.
• Early cancers — endoscopic resection or surgery alone; good cure rates.
• Locally advanced — chemoradiation followed by surgery (trimodality) or definitive chemoradiation.
• Metastatic — chemotherapy, targeted therapy, immunotherapy.
• Stenting, nutrition support, palliative care — major role in symptom relief.
• Care at a high-volume centre with thoracic/upper-GI surgical expertise gives the best outcomes.

Prevention

• Stop tobacco. Cut alcohol. Let very hot drinks cool briefly before drinking.
• Control severe reflux; endoscopic surveillance for Barrett's.
• Eat plenty of vegetables and fruit; maintain healthy weight.