Esophageal Cancer

The esophagus is a long muscular tube, that connects the throat to the stomach, transporting food that is swallowed to the stomach for digestion. Esophageal cancer is more common in males, and usually appears in patients 60-70 years of age.

Symptoms of esophageal cancers include:

1. Difficulty swallowing
2. Weight loss
3. Bloody vomit
4. Black tarry/sticky stools
5. Central chest pain
6. Heartburn
7. Hoarse voice

Risk factors include:

1. Smoking
2. Heavy alcohol consumption
3. Diet low in fruits and vegetable
4. Obesity
5. Reflux
6. Barret’s esophagus (in this condition, the esophageal lining is altered as a complication of longstanding poorly controlled reflux)

A thorough head and neck examination is performed which includes the examination of the oral cavity, the neck and a nasoendoscopy. Physical examination is usually normal, unless there is a lymph node spread in the neck or enlarged liver due to distant spread. An OGD (esophagoduodenoscopy) is performed to visualize the growth and for biopsy.

Endoscopic ultrasound may also be done to determine the depth and local extent of the growth. A Computed Tomography scan (CT) evaluates the extent of the tumour and invasion of the surrounding structures. If the biopsy confirmed the diagnosis of cancer, then a CT scan of the thorax and liver is done as part of the staging work-up, looking for distant spread to the lungs or the liver.

All patients will be discussed at the multidisciplinary tumour board where the best recommended treatment options will be detailed. Treatment options depends on:

1. Age and general health of the patient
2. Extent of the esophageal lesion infiltration
3. Stage of the cancer
4. Patient’s expectations and preferences

For early stage disease, endoscopic surgery may be performed. However in more advanced disease, a combination of chemo-radiation and surgery is usually preferred. Surgery of more advanced disease is done via open approaches (transhiatal or transthoracic e.g. through the diaphragm or the chest respectively). Suitably selected cases can be done via minimally invasive techniques.