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
The location of the cancer can influence symptoms and treatment decisions.
What Causes Oesophageal Cancer?
Oesophageal cancer develops when cells lining the food pipe undergo abnormal changes and start growing in an uncontrolled way.
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
- Arises from the flat lining cells of the oesophagus
- More common in the upper and middle oesophagus
- Strongly associated with smoking and alcohol use
Adenocarcinoma
- Develops from gland-forming cells
- Usually affects the lower oesophagus or the junction with the stomach
- Often associated with acid reflux and Barrett’s oesophagus
- Commonly treated in a similar way to stomach cancer
Tests Done on the Biopsy Specimen
Once cancer is confirmed, the same biopsy tissue is used for additional testing to personalise treatment.
Immunohistochemistry (IHC)
This test uses special stains to detect proteins on cancer cells. It helps confirm the cancer type and guides treatment decisions, such as whether immunotherapy or targeted therapy may be useful (for example PD-L1, HER2, and MMR testing).
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
Cancers of the lower oesophagus and junction with the stomach are often treated like stomach cancer.
- FLOT chemotherapy before and after surgery
- Increasingly combined with durvalumab in suitable patients
- Followed by surgery
Stage IV (Metastatic Oesophageal Cancer)
Squamous Cell Carcinoma
Treatment usually combines chemotherapy and immunotherapy.
Common chemotherapy regimens:
- Carboplatin with paclitaxel
- FOLFOX
- Irinotecan-based combinations
Immunotherapy drugs may include:
- Nivolumab
- Pembrolizumab
- Tislelizumab
- Toripalimab
Adenocarcinoma
Treated along similar lines to stomach cancer.
Options may include:
- Chemotherapy (FOLFOX, CAPOX, irinotecan-based regimens)
- Immunotherapy
- HER2-targeted therapy (if HER2 positive)
Claudin 18.2-targeted treatments (in selected patients):
- Monoclonal antibodies
- Antibody-drug conjugates (ADCs)
- CAR-T therapies (specialised centres)
Living With Oesophageal Cancer
- Good nutrition is vital throughout treatment
- Swallowing support and dietary changes improve comfort
- Emotional and psychological support is important
- Many patients continue to live meaningful lives during and after treatment
Key Takeaways
- Oesophageal cancer is treatable, especially when detected early
- Treatment is tailored based on stage, cancer type, and tumour biology
- Squamous cell carcinoma and adenocarcinoma are treated differently
- Immunotherapy and targeted treatments have improved outcomes
- A multidisciplinary care team provides the best care
