Globally, Esophageal cancer is the eighth most common cancer with an annual incidence of 572000 new cases. In India, the annual incidence of new cases is about 52,396, and is the fourth most common cause of cancer-related deaths. There has been a significant increase in the incidence of esophageal cancers worldwide, with reports showing a higher incidence of adenocarcinoma in countries with a higher human development index (HDI). For example, in the United States, the incidence of adenocarcinoma of esophagus has increased by about 400% over the past 25 years, and in contrast, in countries like India, the incidence of esophageal squamous cell carcinoma is still more common. The reported deaths in India per year is approximately about 42000.
Overview
Oesophageal cancers are the eighth most common cancer and the sixth most common cause of cancer-related death. It is a highly lethal cancer where the diagnosis is usually made late due to late symptoms at presentation. The only way of detecting early disease is to screen the high-risk population where curative treatment is given. Squamous cell carcinomas and adenocarcinomas account for more than 95% of esophageal cancers. For most of the 20th century, esophageal squamous cell carcinomas (SCC) were more common, however, during the past three decades, the incidence of esophageal adenocarcinomas (AC) are on the rise, which has been mainly observed in Western countries, and more recently in some Eastern countries as well.
- Statistics for Esophageal Cancer
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- What is oesophagus?
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It is an organ that allows the food particles that we chew and swallow to enter through it to the stomach. It acts as a bridge between the tongue and the stomach. It has 3 subdivisions, cervical, thoracic and abdomen.
- Clinical features
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- Early symptoms are nonspecific, transient sticking of solid food progressing to dysphagia initially for solids, followed by liquids.
- Retrosternal discomfort/burning sensation
- Dysphagia initially for solids and later liquids is the predominant symptom usually indicates advanced disease
- Change of voice /dry Cough
- Loss of weight
- Anemia in case of EGJ tumours
- Types
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- Squamous cell carcinoma
- Adenocarcinoma
Symptoms
Early mucosal lesions are usually asymptomatic, but those presenting with symptoms are usually diagnosed with higher stage and advanced disease. Symptoms include:
- Progressive dysphagia
- Weight loss
- Chronic gastrointestinal bleed
- Regurgitation of saliva or food
- Hoarseness of voice and cough (if recurrent laryngeal nerve involved)
- Tracheobronchial fistulas
Risk Factors
Some of the risk factors that are associated with esophageal cancer are as follows.
- Demographics and Socioeconomic factors, which showed no gender specificity in high incidence regions, but lower economic status is usually associated with SCCs.
- Smoking and Alcohol are associated with an increase in the risk of SCCs. It also increases the risk of ACs in patients with Barrett’s esophagus.
- Dietary factors- Foods containing N-nitroso compounds, toxins like aflatoxins, red meat, chewing of areca nuts or betel quid’s, high-temperature foods, low selenium and zinc levels, low folate intake are associated with esophageal cancers.
- Underlying Esophageal disease- Diseases like Achalasia cardia, or esophageal injury due to lye’s during childhood are associated with increased risk of SCCs.
- Atrophic gastritis has a two-fold increased risk of Esophageal SCCs.
- Tylosis, a rare disease, associated with hyperkeratosis of palms and soles is associated with an increased risk of SCCs.
- Gastroesophageal reflux disease (GERD), is associated with an increased risk of Esophageal adenocarcinomas. They usually arise from areas that have undergone a transformation, causing Barrett’s metaplasia. However, not all ACs are associated with symptomatic GERD. It is observed, that the risk is more common in long-standing GERD with severe symptoms of reflux disease, which increases the risk by five-fold, and the presence of Barrett’s metaplasia increases the overall risk by about 30-fold.
- Obesity and metabolic syndrome increase the risk of ACs, with associated reflux disease and Barrett’s metaplasia.
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