Oesophagus (Foodpipe) Cancer Treatment in Delhi, India

1.  Smoking 
2. Drinking a lot of alcohol
3. Long-standing acid reflux from the stomach.
4. High Fatty Diet
5. Obesity

Patients initially don't show any symptoms as the growth occurs in the tube connecting the mouth and stomach. However, as the growth increases in size, it starts causing difficulties in the passage of food and may present with the following symptoms:

1. Difficulty in swallowing (dysphagia)
2. Recurrent vomiting after eating
3. Pain in the chest or the back of the chest when you swallow (odynophagia)
4. Unexplained weight loss
5. Blood in vomiting
6. Coughing on swallowing
7. Hoarseness of voice

Max Institute of Cancer Care (MICC) at Max Hospitals, India, is one of the leading facilities in India, which offers the latest treatments under surgical oncology, radiation oncology, and medical oncology. Max Institute of Cancer Care is one of the largest Cancer Centres in North India, with presence in Saket, Patparganj, Shalimar Bagh, Vaishali, Mohali and Bathinda. The centres are highly efficient and offer specialized and dedicated daycare with all significant sub-specialities, disease management groups and privacy to cancer patients.

With over 100 oncologists, a team of multi-disciplinary specialists, including a surgeon, medical gastroenterologist, radiation and medical oncologists, radiologist and pathologist, discuss the treatment that would be best for the patient. The treatment for oesophageal cancer is usually decided based on the stage of the disease, and in early cancer, the optimal treatment is surgery. In locally advanced tumours, the treatment options are chemotherapy or chemo-radiotherapy. If the cancer responds well and shrinks, surgery may be offered after this treatment. The surgeons provide world-class treatment facilities and focused care when it comes to oesophageal cancer. The institute is highly efficient and offers specialized cancer care with all significant sub-specialities, disease management groups (DMG) and privacy to the patient.

To treat the cancer efficiently, procedures like Intensity Modulated Radiation Therapy (IMRT) is widely used. It enables high accuracy while ensuring minimal damage to other organs like kidneys, liver, and the spinal cord. Moreover, Intensity Modulated Radiation Therapy allows the doctors to deliver radiation to hard-to-reach areas.

Tumour Board

We believe that each patient and his/her disease is unique. For oesophageal cancer, the team in the disease management group (DMG) prepares a personalized treatment plan based on the discussions in Tumour Board meetings. We constantly review and improve our protocols and encourage the participation of our patients as well as caregivers, to understand the disease and its treatment process.

We have the best cancer specialists in India who specialize in treating oesophageal cancer with surgery, radiation therapy, chemotherapy, targeted therapy and photodynamic therapy.

The first investigation that will help diagnose oesophageal cancer will be an Endoscopy. Endoscopy entails passing a small camera with fibre optic light through the mouth into the oesophagus which allows the physician to see the exact location and size of the growth. It also allows them to take a small piece of a tumour called a biopsy. This piece of tissue is then examined under a microscope to understand the type of disease it is. A Contrast-Enhanced Computerized Tomography Scan (CECT Scan) of the chest and abdomen is advised to assess the extent of the spread of the disease. It is known as the staging of the disease. Many physicians may even ask for a Positron Emission Tomography–Computed Tomography Scan (commonly known as PET-CT) scan to assess the extent of the disease in the whole body.

One should discuss with their treating doctors about the aim of the treatment. If diagnosed at an early stage cancer in oesophagus can be cured in some cases.

Aim to control cancer (Curative intent): If a cure is not realistic, with treatment, it is often possible to limit the growth or spread of cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.

Aim to ease symptoms (Palliative intent): If a cure is not possible, treatments may be used to reduce the size of cancerous growth, which may relieve symptoms such as pain or difficulty with swallowing. If the tumour is advanced, you may also require treatments such as nutritional supplements, painkillers, or other techniques to keep you pain-free.

The treatment advised depends on various factors, such as the exact site of a primary tumour in the oesophagus, how large the cancer is and whether it has spread, i.e., the stage of cancer and the general health of the patient.

Max Institute of Cancer Care offers the following treatment options for oesophageal cancer:

A) Surgery: It involves removing a part or whole of the oesophagus which is then replaced with a tube formed out of the stomach. Surgery for removing the oesophagus can be done either by opening the thoracic cavity by keyhole surgery, i.e., using Video-Assisted Thoracoscopic Surgery. VATS entails making small holes into the chest cavity through which the telescope and instruments are introduced, and the surgery is conducted under magnification. It leads to less pain, faster recovery and early discharge from the hospital. 

B) Chemotherapy: It involves the use of conventional chemotherapeutic drugs to hinder the cancer cell’s ability to grow, divide and spread. It can be used both before and after surgery.

C) Radiation Therapy: It uses beams of radiation to attack the cancer cells. The radiation may be administered externally with the help of a machine or by temporarily inserting a radioactive wire into the oesophagus.

Chemotherapy and radiotherapy are an integral part of the treatment. As most of the patients present in locally advanced stages, their treatment usually starts with chemotherapy and radiotherapy to reduce the extent of the disease and then they undergo surgery. Many a time, they may need chemotherapy even after surgery. Some oesophageal cancer may be treated only with chemoradiotherapy and may not require any surgery. Patients with widespread disease usually receive chemotherapy alone., Radiation may occasionally play a vital role in controlling the symptoms and pain.

D) Targeted Therapy: It is the treatment that targets cancer-specific genes to hinder the growth and spread of cancer cells while restricting damage to healthy cells. Known as immunotherapy, it works by killing only tumour cells; unlike chemotherapy, which can also destroy healthy cells as a side effect.

Mainly, there are two types of targeted therapy - Monoclonal Antibody Therapy and Small-Molecule Drug Therapy.

E) Photodynamic Therapy: Light therapy may be used if cancer cells are small in size and limit to only one place. As part of the treatment, a photosensitising drug is injected into the patient’s body where cells absorb and keep the drug concentrated for a longer duration. When the patient is exposed to laser lights of a particular wavelength, the drug helps in destroying cancer cells.

Can oesophagal cancer be cured?
The chances of curing oesophagal cancer are higher when it is detected at an early stage. However, if oesophagal cancer is already advanced, it can still be treated, but it is rarely curable.

Is it possible to fully recover from oesophagal cancer?
Most oesophagal cancer patients are diagnosed in the middle or late stages of the disease. The survival rate after treatment for five years is around 90% for early-stage patients, whereas it ranges from 6% to 15% for patients with middle or late-stage disease.

Which organs do oesophagal cancer commonly spread to?
Esophageal cancer commonly spreads to the liver, and it can also affect the lymph nodes and lungs.

Can oesophagal cancer metastasise to other parts of the body?
Yes, oesophagal cancer can metastasise to other parts of the body, such as the liver, lungs, and lymph nodes.

Are there any alternative treatments for oesophagal cancer?
Some alternative treatments which patients are using for oesophagal cancer include herbal remedies, acupuncture, and massage therapy. However, it's important to note that these treatments should not be used as a substitute for conventional medical treatment.

How long does it take to recover from oesophagal cancer treatment?
The recovery time after oesophagal cancer treatment depends on the type of treatment received and the overall health.

What are the different types of oesophagal cancer?
The two main types of oesophagal cancer are squamous cell carcinoma and adenocarcinoma. What role does diet play in esophageal cancer? Maintaining a healthy diet that includes fruits, vegetables, and whole grains may help reduce the risk of oesophagal cancer.

How does esophageal cancer affect swallowing?
Esophageal cancer can cause difficulty in swallowing, known as dysphagia, and it can cause painful swallowing called Odynophagia, as it can obstruct the oesophagus and make it challenging for food to pass through.

How does oesophagal cancer impact the voice?
Esophageal cancer can lead to hoarseness or voice changes as it can affect the nerve and muscle control of the larynx.

FAQs Review

FAQs reviewed by Prof.(Dr.) Atul Sharma Vice Chairman, Medical Oncology, Cancer Care / Oncology and Dr. Rakesh Kumar Sharma Associate Consultant, Medical Oncology.