Esophageal Cancer Treatment in Bangalore

Oesophageal (Food Pipe) Cancer

A Guide for Patients and Caregivers

What Is the Oesophagus?

The oesophagus, often called the food pipe, is a muscular tube that carries food and liquids from the mouth to the stomach. When we swallow, coordinated muscle movements gently push food downward into the stomach.

For medical purposes, the oesophagus is divided into three parts:

• Upper oesophagus – near the throat
• Middle oesophagus – within the chest
• Lower oesophagus – close to where the oesophagus joins the stomach

Each area of the esophagus has an effect on the symptoms experienced by the patient, as well as the type of treatment that will be administered.

What Causes Oesophageal Cancer?

Cancer of the esophagus occurs when cells at the lining of the esophagus experience an acute abnormal cell change leading to uncontrolled growth of those cells.

Common risk factors include:

• Smoking or tobacco use
• Alcohol consumption
• Long-standing acid reflux (GERD)
• Barrett’s oesophagus
• Obesity
• Poor dietary habits, especially low intake of fruits and vegetables
• Regular intake of very hot beverages
• Previous radiation to the chest (rare)

Many people with oesophageal cancer have more than one risk factor, though some develop the disease without any obvious cause.

Is Oesophageal Cancer Inherited?

Most oesophageal cancers are not inherited, but a small number may be linked to genetic susceptibility.

When Is a Genetic Risk Considered?

• Strong family history of cancer
• Cancer diagnosed at a younger age
• Multiple cancers in the same individual
• Family clustering of Barrett’s oesophagus or oesophageal cancer

How Is Genetic Risk Evaluated?

• A detailed family history assessment
• Referral for genetic counselling
• Hereditary (germline) genetic testing, usually using a blood or saliva sample

This testing looks for inherited gene changes and may help guide screening and prevention strategies for close family members.

Symptoms of Oesophageal Cancer

Symptoms often begin gradually and may worsen over time.

Common symptoms include:

• Difficulty swallowing, starting with solid foods
• Feeling of food getting stuck
• Unexplained weight loss
• Chest pain or discomfort
• Persistent or worsening heartburn
• Hoarseness or chronic cough
• Vomiting or regurgitation
• Anaemia or black stools, due to slow bleeding

Any ongoing swallowing difficulty should be evaluated promptly.

How Is Oesophageal Cancer Diagnosed?

Upper GI Endoscopy

This is the most important diagnostic test.

• A thin camera is passed through the mouth
• Allows doctors to see the tumour directly
• Biopsy samples are taken during the procedure

Endoscopy-Guided Biopsy

The biopsy confirms:

• Whether cancer is present
• The type of oesophageal cancer
• Features that help guide treatment

CT Scan

• Assesses tumour size
• Looks for spread to lymph nodes or nearby organs

PET-CT Scan

• Detects cancer activity throughout the body
• Helps identify spread not visible on routine scans
• Important for accurate staging

Types of Oesophageal Cancer

Squamous Cell Carcinoma

• – It comes from the flat lining of the oesophagus.
• – It is more common in the upper and middle oesophagus.
• – It has strong associations with alcohol and tobacco usage.

Adenocarcinoma

• – It is derived from gland cells in the lining of the oesophagus and usually occurs in the lower oesophagus or the junction with the stomach.
• – It is often caused by Barrett’s oesophagus (a condition where acid reflux causes changes to the normal cell lining) and long-standing acid reflux.
• – It is treated similarly to stomach cancer; however, the treatment may differ based on the cancer characteristics obtained using immunohistochemistry and/or molecular testing/next-generation sequencing on the biopsy.

Tests Done on the Biopsy Specimen

If the biopsy confirms cancer, the same tissue sample can be tested for additional information required to individualise (ie: target) the patient’s treatment.

Immunohistochemistry (IHC)

This test uses special colours (stains) to identify whether cancer cells have proteins. IHC confirms the diagnosis and helps determine whether immunotherapy or targeted therapy will be an option (i.e., testing for PD-L1, HER2 and MMR).

Molecular Testing and Next-Generation Sequencing (NGS)

These tests look for genetic changes within the cancer cells. NGS can analyse multiple genes at once and may help identify newer targeted treatments or clinical trial options, especially in advanced disease.

Staging of Oesophageal Cancer

Staging describes how far the cancer has spread and helps decide the best treatment approach.

Stage I – Early Stage

• Cancer limited to the inner layers of the oesophagus
• No lymph node or distant spread
• Often highly curable

Stage II and Stage III – Locally Advanced Disease

• Cancer has grown deeper into the oesophagus
• May involve nearby lymph nodes
• No spread to distant organs

Stage IV – Metastatic Disease

• Cancer has spread to distant organs
• Treatment focuses on disease control and quality of life

Treatment Options Based on Stage

Stage I (Very Early Cancer)

• Endoscopic resection
• Cancer removed through an endoscope
• Oesophagus preserved
• Suitable only for superficial tumours

Stage II and III (Locally Advanced Cancer)

Chemoradiotherapy Before Surgery

Radiotherapy

• Uses targeted radiation to shrink the tumour
• Given five days a week
• Usually over five to six weeks

Chemotherapy with Radiation

• Given only during the radiation period
• Makes cancer cells more sensitive to radiation
• Usually administered once weekly

Surgery After Chemoradiotherapy

• Removal of the cancer-affected portion of the oesophagus
• Nearby lymph nodes are also removed
• Remaining oesophagus is reconnected to the stomach
• Surgery may be open, minimally invasive, or robotic
• Best performed in experienced, high-volume centres

After Surgery

• No remaining cancer → regular follow-up
• Residual cancer present → adjuvant immunotherapy (commonly nivolumab)

Peri-operative Treatment for Adenocarcinoma

Lower oesophageal cancer and junctional cancer with stomach cancer are often treated as one.

• FLOT chemotherapy before and after surgery
• Increasingly combined with durvalumab in suitable patients
• Followed by surgery

Stage IV (Metastatic Oesophageal Cancer)

Squamous Cell Carcinoma

The most common use of combination chemotherapy and immunotherapy.

• Common Chemotherapy Regimens
• Carboplatin + Paclitaxel
• FOLFOX
• Irinotecan multiples

Some immunotherapy drugs include:

• Nivolumab
• Pembrolizumab
• Tislelizumab
• Toripalimab
• Adenocarcinoma

Adenocarcinoma

It is treated like stomach cancer.

• Chemotherapy – FOLFOX, CAPOX, irinotecan based regimens.
• Immunotherapy
• HER2 targeted therapy if HER2 positive.

Here are some of the Claudin 18.2-targeted treatments available including:

• Monoclonal Antibodies
• Antibody Drug Conjugates (ADC)
• CAR-T Therapies (specialized center)

Living With Oesophageal Cancer

• Proper nutrition is essential throughout your treatment
• Accommodating comfort while swallowing (with dietary modifications)
• Emotional/Psychological support are also essential
• Many patients continue living fulfilling lives after treatment and during treatment.

Key Takeaways

• Oesophageal cancer is survivable and very treatable if detected early
• The course of treatment is determined by the stage of disease, type of cancer and biologic characteristics of your tumor
• Squamous and Adenocarcinomas are treated differently
• Immunotherapy and targeted treatments have improved outcomes
• The best care is achieved through multi-disciplinary care teams