Esophageal Cancer

The most common presenting symptom of esophageal cancer is difficulty swallowing. Typically, food becomes lodged partway down the esophagus to the stomach. Liquids may pass without issue at first, but soon become obstructed as well.

• Progressive dysphagia: Initially affects only solid foods, but as the disease advances, even liquids are difficult to swallow.
• Odynophagia (painful swallowing): Often described as food “sticking” or a sharp, “stinging” sensation.
• Acid reflux or coughing: More likely when lying flat due to the accumulation of food above the tumour.
• Hoarseness: Occurs if the tumour invades the recurrent laryngeal nerve.
• Unexplained weight loss and loss of appetite.
• Retrosternal or back discomfort: Sometimes radiating to the shoulders or shoulder blades.
• Chronic cough or aspiration pneumonia may result from a tracheoesophageal fistula.

Early medical evaluation is strongly advised if you experience any of these symptoms.

• Age & Gender: Incidence rises after age 60; male : female ratio ≈ 4 : 1
• Tobacco & Alcohol: Synergistic effect significantly elevates SCC risk
• Barrett’s Esophagus / GERD: Chronic reflux increases adenocarcinoma risk; ~1 % of Barrett’s cases progress yearly.
• Dietary Habits: Frequent consumption of very hot beverages (> 65 °C) irritates mucosa; nitrosamine-rich, smoked, or pickled foods
• Obesity: Central adiposity promotes reflux and adenocarcinoma.
• Family History & Genetic Syndromes: Rare familial clusters.

 TNM Staging

• T (Tumour): Assesses the depth of tumour invasion (mucosa, submucosa, muscularis, etc.)
• N (Node): Evaluates regional lymph node involvement.
• M (Metastasis): Determines whether there are distant organ metastases.
   

Clinical Staging

Accurate TNM classification (T, N, M) guides prognosis and treatment selection.

• Endoscopy & Biopsy: Gold standard for visualization and histopathology.
• Barium Swallow (Contrast Radiography): Detects strictures, ulceration, “shouldering” of the lesion.
• CT Scan: Assesses local extent and thoracoabdominal metastases.
• Endoscopic Ultrasound (EUS): Evaluates depth of invasion and nodal involvement.
• PET-CT: Detects occult distant metastases for staging refinement.
• Bronchoscopy: When tracheal involvement or fistula is suspected.

Treatment is multidisciplinary and stage-dependent: