I am Dr. Arun Kumar Giri, senior consultant surgical oncologist. Carcinoma oesophagus is one of the leading cause of cancer deaths in the world. It is the seventh most common cancer, occurring more commonly in males and sometimes also in females. Cancer of the oesophagus usually occurs in middle-age and old age people. It is usually starts with difficulty in swallowing solid food but later on it progresses to difficulty in swallowing liquids as well. The patient also loses weight significantly because of this not eating and drinking anything. Other symptoms apart from difficulty in swallowing are change in voice, cough, vomiting, symptoms of bleeding through the mouth and pneumonia. Sometimes the patient also has bony pain if the disease has spread to the bones. Causes of cancer oesophagus is most commonly tobacco, use of tobacco and alcohol. Significant use of tobacco associated with regular use of alcohol is associated with cancer oesophagus in up to 90% of the cases.
Number of years smoked and number of packets smoked per day also contribute/decide about the incidence of the disease. Disease which is acid reflux disease which is common in most people, many obese people wherein the acid in the stomach it goes into the food pipe and damages the mucosa of the food pipe and it can lead to cancer and pre malignant state is known as Barrett's oesophagus. Barrett's oesophagus can develop into cancer in up to 40 times higher as compared to normal population. Some people with iron deficiency may also develop oesophageal webs which may lead to cancer later on in their life. Obese people can also have increased incidence of cancer, those people maintaining less healthy lifestyle, sedentary life, not eating healthy fruits and vegetables can also develop cancer of oesophagus. We diagnose this cancer by endoscopy wherein a tube, endoscope is passed through the mouth into the food pipe and the area is visualized and a biopsy is taken which confirms the diagnosis.
Apart from endoscopy, to scale the extent of the disease we perform CT scan as well as PET scan of patient and PET scan tells the status of the disease in the entire body and after these tests, we proceed for the treatment. In early stages, in middle and lower part, lower third part is usually surgery and in locally advanced cases by radiation therapy and chemotherapy. Surgery is potentially curative treatment which may potentially cure the patient if the disease is in early stage. By surgery we remove the food pipe, part of the food pipe, fully either partially or completely and we replace it with the stomach and large bowel. Apart from radiation therapy, chemotherapy is given to the patients who have progressed on to the treatment or who are diagnosed with the advanced disease.
We also treat some patients with targeted therapy and immunotherapy. Certain patients who cannot be treated by these medications, these treatments, they are offered supportive care with the help of stinting and feeding tube insertions etc and other supporting measures. For prevention of this disease; vegetables and fruits which contain vitamin A, C, E, selenium, zinc and other ingredients and lot of fibres, you must maintain healthy lifestyle, quit tobacco if you are smoking tobacco, quit it, reduce the amount of alcohol intake and in case if you develop any symptom please report to your doctor who will proceed for endoscopy and if the disease is diagnosed it can be treated in time.