Navigating the Challenges of Oesophagal Cancer with Advanced Medicines

Mastering the Hurdles of Oesophageal Cancer Through Advanced Medications

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Oesophageal cancer is a challenging disease to treat. Learn about the advanced therapies available for oesophageal cancer and how to navigate the challenges of OEs with our guides.

What is Oesophagal Cancer?

Oesophageal cancer develops in the oesophagus, whereas the oesophagus is the muscular tube that carries food and liquids from the throat to the stomach. It can occur in any part of the oesophagus, spread to nearby tissues and organs, and distant sites in the body. The most common types of oesophageal cancer are squamous cell carcinoma, which usually occurs in the upper part of the oesophagus, and adenocarcinoma, which occurs in the lower part of the oesophagus. Risk factors for oesophageal cancer include smoking, heavy alcohol use, obesity, and long-term acid reflux. 

What are its risk factors?

Key risk factors for oesophageal cancer comprise:

• Chronic acid reflux (GERD): This condition causes stomach acid to repeatedly flow back into the oesophagus, damaging the lining and increasing the cancer risk.
• Smoking: Tobacco use, including cigarettes, cigars, and pipes, is a significant risk factor for oesophagal cancer.
• Alcohol consumption: Drinking alcohol excessively can elevate the likelihood of developing oesophageal cancer, especially when combined with smoking.
• Obesity: People who are overweight or obese are at a higher risk of developing oesophagal cancer.
• Barrett's oesophagus: This condition occurs when the cells in the lower oesophagus get damaged by acid reflux and replaced by abnormal cells that may increase the risk of cancer.
• Age and gender: Esophageal cancer is more common in men and tends to occur in people over 50.
• Family history: A family history of oesophagal cancer or other types of cancer may increase the risk of developing the disease.
• Poor diet: A diet low in fruits and vegetables and high in processed foods, red meat, and saturated fats may increase the risk of oesophagal cancer.

Happy patient after Esophageal Cancer treatment

What are common signs and symptoms of oesophagal cancer, and how is it diagnosed?

The common signs and symptoms of oesophagal cancer include:

• Difficulty swallowing (dysphagia) or a sensation of food getting stuck in the throat or chest
• Experiencing pain or discomfort in the chest, particularly behind the breastbone, may indicate potential issues.
• Unexplained weight loss
• Persistent coughing or hoarseness
• Vomiting or coughing up blood
• Indigestion or heartburn that does not respond to medication
• Fatigue or weakness
• Loss of appetite

Doctors diagnose oesophagal cancer using a combination of tests and procedures, which may include:

• Physical exam and medical history: The doctor will ask about the patient's symptoms, medical history, and risk factors for oesophagal cancer.
• Endoscopy: This procedure involves inserting a thin, flexible tube with a camera (endoscope) through the mouth and into the oesophagus to look for abnormalities and take a tissue sample (biopsy) for testing.
• Imaging tests: Doctors use X-rays, CT scans, PET scans, and other imaging tests to look for signs of cancer and determine the extent of the disease.
• Laboratory tests: Oncologists conduct several blood check tests and other laboratory tests to evaluate the patient's overall health and detect abnormalities.

After oesophagal cancer diagnosis, the doctor examines the cancer cells to determine the cancer stage and the appropriate treatment options.

What is the staging system for oesophagal cancer, and how is it determined?

Known as TNM, the staging system for oesophageal cancer refers to tumours, nodes, and metastases. The TNM system takes into account the size and extent of the tumour (T), whether cancer has spread to nearby lymph nodes (N), and whether it has spread to other parts of the body (M). 

The stages of oesophagal cancer are as follows:

• Stage 0: The cancer is only in the inner layer of cells lining the oesophagus and has not spread to nearby tissues or lymph nodes.
• Stage I: The cancer has penetrated the deeper layers of the oesophagus but hasn't metastasised to adjacent lymph nodes or other organs.
• Stage II: Cancer has grown through the wall of the oesophagus and may have spread to nearby lymph nodes.
• Stage III: Cancer has spread to nearby tissues and organs or lymph nodes but not elsewhere.
• Stage IV: Cancer has spread to other parts of the organs, such as the liver, lungs, or bones.

Determining the stage of oesophagal cancer usually involves a combination of imaging tests such as CT scans, PET scans, endoscopic ultrasounds (EUS), and biopsies of the affected tissues and lymph nodes. The cancer stage is vital in determining the appropriate treatment options and predicting the patient's prognosis.

What are the different treatment options for oesophagal cancer, and how are they selected?

The treatment options for oesophagal cancer depend on the cancer stage, the patient's overall health, and other factors. The main treatment options for oesophagal cancer include

• Surgery: Doctors perform surgery to remove the cancerous tissue and nearby lymph nodes. Depending on the location and stage of cancer, different surgical techniques may be used, such as esophagectomy (removal of part of the oesophagus), gastrectomy (removal of part of the stomach), or a combination of both.
• Radiation therapy employs high-energy radiation to eradicate cancer cells. It may be utilised independently or in conjunction with chemotherapy before or after surgery or as the primary treatment for patients deemed unsuitable for surgery.
• Chemotherapy: Chemotherapy involves using drugs to kill cancer cells. Chemotherapy alone or in combination with radiation therapy before or after surgery or as the primary treatment for patients who are not good candidates for surgery.
• Targeted Therapy: Targeted therapy involves using drugs that specifically target specific proteins or other molecules that contribute to the growth and spread of cancer cells. Targeted therapy may be used alone or with chemotherapy for patients with advanced oesophagal cancer.
• Immunotherapy: Immunotherapy involves using drugs that stimulate the patient's immune system to recognize and attack cancer cells. It may be used alone or with other treatments for patients with advanced oesophagal cancer.

Appropriate selection of a specific treatment plan depends on various factors, including the stage and location of the cancer, the patient's age and overall health, and the potential benefits and risks of each treatment option. A multidisciplinary team of healthcare professionals, including oncologists, surgeons, radiation therapists, and nutritionists, make treatment decisions.

What is the prognosis for oesophagal cancer, and what is the recommended follow-up for patients after treatment?

The prognosis for oesophagal cancer depends on various factors, including the stage and location of the carcinoma, the patient's age and overall health, and the success of the treatment. 

• Overall the five-year survival rate for oesophagal cancer is around 20%, but this varies widely depending on the individual case.
• Patients who receive treatment for oesophagal cancer will typically require close follow-up care to monitor for any signs of recurrence or complications. The recommended follow-up plan may include regular appointments with an oncologist or other healthcare provider, imaging tests such as CT scans or PET scans, and endoscopic exams to evaluate the healing of the oesophagus.
• Patients might also need to implement lifestyle adjustments, including quitting smoking, managing a healthy weight, and abstaining from alcohol and specific foods that could irritate the oesophagus.

In some cases, patients may also benefit from nutritional support or rehabilitation to help restore swallowing and other functions that may have been affected by cancer or its treatment. Patients with oesophagal cancer can stay vigilant about their health and follow their healthcare provider's recommendations for ongoing care and monitoring.

Treatment of oesophagal cancer

What are the recent updates on oesophagal cancer?

Here are some recent updates on oesophagal cancer:

Immunotherapy shows promise for recovery,

• Advanced medicines: Recent clinical trials have shown that immunotherapy drugs such as pembrolizumab and nivolumab can improve survival rates in patients with advanced oesophagal cancer. These drugs work by helping the patient's immune system recognize and attack cancer cells.
• Liquid biopsy: Liquid biopsy may aid in early detection: Liquid biopsy is a minimally invasive technique that involves analyzing blood samples for cancer cells or other biomarkers. Recent studies have shown that liquid biopsy may be able to detect oesophagal cancer at an early stage and may be a helpful tool for monitoring treatment response and detecting recurrence.
• New surgical techniques: Surgeons are developing new methods for performing esophagectomy, the surgery used to remove part of the oesophagus in patients with oesophagal cancer. These techniques may reduce complications and improve outcomes for patients undergoing surgery.
• Lifestyle factors may play a role: Recent research suggests that lifestyle factors such as smoking, obesity, and a diet high in processed meats may increase the risk of oesophagal cancer. Making lifestyle changes such as quitting smoking, losing weight, and adopting a healthy diet may help reduce the risk of developing this disease. 
• Multidisciplinary care is essential: The treatment of oesophagal cancer requires an integrative approach involving a team of healthcare professionals such as surgeons, oncologists, radiation therapists, nutritionists, and speech therapists. Recent studies have emphasized the importance of coordinated care and personalized treatment plans for improving outcomes in patients with oesophagal cancer.

The best treatment centres in India and the best available therapy for Oesophagal Cancer,

Several well-known cancer centres in India specialize in oesophagal cancer treatment and have experienced teams of experts in this field. Some of these centres include:

1. Tata Memorial Hospital, Mumbai
2. All India Institute of Medical Sciences (AIIMS), New Delhi
3. Rajiv Gandhi Cancer Institute and Research Centre, New Delhi
4. Fortis Memorial Research Institute, Gurugram
5. Max Institute of Cancer Care, New Delhi
6. Apollo Speciality Cancer Hospital, Chennai
7. HCG Cancer Centre, Bangalore

The optimal therapy for oesophageal cancer in India, as in any country, hinges on several factors, such as the cancer stage, location, the patient's overall health, preferences, and additional considerations. Treatment modalities may encompass surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy, tailored to individual specifications. Collaboration among oncologists, surgeons, radiation therapists, and nutritionists is imperative to ascertain the most suitable treatment plan. Patients should engage in consultations with their oncologists to identify the most appropriate treatment options.