What are the types of Esophageal Cancer?
Esophageal cancer is the sixth most common cause of cancer-related deaths worldwide and fourth in developing countries. The esophagus, also known as food pipe, is a muscular hollow tube-like organ that provides passage to swallowed food up to the stomach. Based on the type of cells affected, esophagus cancer can be divided into two major histology types: squamous cells carcinoma (affecting flat cells that line the inner side of the esophagus) and adenocarcinoma (affecting glandular cells that produce mucus and other fluids).
What is the Staging of Esophageal Cancer?
Staging for esophageal cancer is called as TNM staging system. It helps in disease prognostication and choosing an appropriate treatment strategy.
To understand the staging better, let’s understand the various layers of the esophageal wall. From inside to outside, these are epithelium, lamina propria, muscularis mucosa, submucosa, muscularis propria and serosa or adventitia.
Now let’s understand the staging of esophageal cancer based on this.
Tis (Carcinoma in situ) – Tumor is limited to the epithelium of esophagus
T1a – Tumor infiltrates into lamina propria or muscularis mucosa.
T1b – Tumor infiltrates into submucosa.
T2 – Tumor extends to involve muscularis propria.
T3 – Tumor infiltrates into serosa or adventitia.
T4 – Tumor infiltrates into surrounding structures.
Like in the figure below, it infiltrates into heart or pericardium.
And here, the tumor infiltrates into lung or pleura.
It may also infiltrate into the diaphragm.
It may also infiltrate into the wind pipe (trachea) or great vessels of heart.
N0 – No spread to regional lymph nodes
N1 – Involvement of 1 to 2 regional lymph nodes
N2 – Involvement of 3 to 6 regional lymph nodes
N3 – Involvement of 7 or more regional lymph nodes This figure shows the regional lymph nodes for esophagus.
M0 – Tumor has not spread to distant sites.
M1 – Tumor has spread to distant sites like lungs, pleura, peritoneum, liver, bones, etc
Like in the figure below, it has spread to both lungs.
And here it has spread to liver as multiple metastatic deposits.
Like this, it may spread to pleura, peritoneum, bones, etc.
What is the Stagewise Treatment of Esophageal Cancer?
Treatment of esophageal cancer depends on whether it is localised, locally advanced or metastatic disease.
Tis and T1a
Endoscopic Mucosal Resection is the technique used to treat Tis and T1a disease.
In this technique, the tumor is removed with the help of an endoscope. Only the superficial cancerous part is removed without affecting the deeper layers, as seen in the figure below.
Esophagectomy is also an option for early stage disease, in which cancer is removed with adequate margins and regional lymph nodes, and stomach is joined to remaining part of esophagus.
For T1b disease also, esophagectomy is the preferred treatment.
T2, T3, T4 or Node Positive
Surgery, Radiotherapy and/or chemotherapy is used for treatment in such cases. Treatment decision is taken by the oncologist based on disease extent, comorbidities, performance status along with other factors.
Chemotherapy is the mainstay of treatment. Targeted therapy or Immunotherapy is also an option in selected cases. Rarely, radiation therapy or surgery may be used for palliation of symptoms.
What Endoscopic treatments are used for Esophageal Cancer?
Various endoscopic treatment options are now available for the treatment of some early-stage esophageal cancers or for providing symptomatic relief from advanced stage disease. Treatments like endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic ablation, mainly aim to treat very early stage esophageal cancers. Other treatments like laser ablation, esophageal stent or feeding tube placement, mainly aim to relieve symptoms of more advanced staged esophageal cancers.
What is the role of Targeted Therapy for Esophageal Cancer Treatment?
Targeted drugs are designed to target a specific gene or protein characteristic of colon cancer cells. With advancements in diagnostic techniques, genetic abnormalities for esophageal cancer have been identified that can be targeted with the help of targeted drugs.
Molecular testing to confirm the genetic abnormality is the pre-requisite for starting a targeted therapy. They work differently than chemotherapy drugs that they target a specific gene or protein characteristic of the cancer cells. For example, Trastuzumab is a targeted drug used for Her-2 Neu positive esophageal cancers. They are generally used in combination with chemotherapy for the treatment of advanced stage disease.
What is the role of Immunotherapy in Esophageal Cancer?
Cancer cells utilize certain mechanisms to escape from the immune system of the patient from attacking these cells. Immunotherapeutic agents activate the immune system to recognize and kill cancer cells. Immune checkpoint inhibitors target PD-1, a protein on T-cells that normally helps keep these cells from attacking cancer cells. This activates the immune system to kill the PD-L1 expressing cancer cells.
Pembrolizumab may be used as the second-line or subsequent line therapy for MSI-H or dMMR positive unresectable/metastatic esophagus/EGJ/gastric tumors that have progressed on prior treatment and for which no satisfactory alternative treatment option is available.
Best Esophageal Cancer Specialist in Delhi
Dr Sunny Garg is a renowned Medical Oncologist in New Delhi with an experience of more than 6 years of treating esophageal cancer patients. He has practiced in leading cancer hospitals in Delhi, and currently practicing at Manipal Hospital, Dwarka.
He has a vest experience of treating esophageal cancer patients in all stages of disease. He is well versed with Immunotherapy, Targeted therapy and Chemotherapy for Esophageal Cancer treatment and also general supportive care for patients. He works in close collaboration with surgical and radiation oncologists, oncopathologists, nuclear medicine, and genetic counselors for comprehensive cancer care for the patients.
Call +91 9686813020 for appointment.