The tenth most prevalent cancer in the world is esophageal cancer (EC). It starts in the esophagus and sometimes extends to other organs such as the intestine, lungs, and liver etc., depending on the severity. The disease is more common in men as compared to women. Squamous cell carcinoma (a type of esophageal cancer) is more commonly seen in blacks whereas adenocarcinoma (another type of EC) is commonly seen in whites. In some cases of EC, the symptoms of the disease do not appear till the infection completely spreads. Thus early detection of the disease is very important for a better prognosis.
What are the stages of EC?
In accordance with stage of cancer, it is divided into 4 stages by the American Joint committee (AJC) TMS system.
GX (undifferentiated)
G1 (well differentiated, low grade)
G2 (moderately differentiated, intermediate)
G3 (poorly differentiated, high grade)
The lower the grade of the disease the better the prognosis. Thus staging of esophageal cancer helps in better diagnosis of the disease and to predict the prognosis of EC [1].
What is the scope of treatment in EC?
EC is relatively the most aggressive cancer compared to other gastrointestinal cancers. The treatment of this disease depends on the etiology.
Since esophagectomy (removal of the esophagus) is a very invasive procedure that can negatively affect the quality of life, less invasive procedures like endoscopic resection(ER) were developed to treat early esophageal cancers.
Chemoradiotherapy is crucial in the treatment of esophageal cancer. Chemoradiotherapy has been shown to be beneficial, in all stages of EC (I –IV).
According to the literature, combined endoscopic resection and chemoradiotherapy is the treatment of choice in cases where the esophagus has to be preserved [2].
More novel treatments are being explored such as salvage therapy, immunotherapy, and targeted therapy using monoclonal antibodies like bevacizumab, pembrolizumab, nivolumab, ipilimumab, ramucirumab, trastuzumab, and many more [3].
What is the prognosis for EC?
Even though there are plenty of treatment options available for esophageal cancer, each treatment has its disadvantages like damage to the important vital surrounding structures during surgical resection, common side effects of all chemotherapeutic drugs like fatigue, nausea, and low blood cell count, and radiation damage in radiotherapy. So based on the stage of the disease and the requirement of the patient, treatment option should be selected. According to the literature, the 5-year survival rate of EC confined to the esophagus is only 46%, which spreads to the surrounding organs such as the intestine with lymph node involvement is 26%, and which spreads to distant organs such as the liver is only 5%. Identified early and treated properly esophageal cancer has a favorable prognosis depending upon its extent [4].
Bottom line!
Death in esophageal cancer occurs mainly due to dysphagia (difficulty in swallowing) and also due to other symptoms that are common in other cancers like breathing difficulties, fatigue, and pain. In rare instances, esophageal cancer may never totally disappear. In such cases, chemotherapy, radiation therapy, or other therapies may be administered on a regular basis in an effort to try and control cancer. Further studies are required for the development of new drugs which have a better therapeutic effect and lesser side effects in EC.
References
1. G. Marom, “Esophageal Cancer Staging,” Thorac Surg Clin, vol. 32, no. 4, pp. 437–445, Nov. 2022, doi: 10.1016/j.thorsurg.2022.06.006.
2. J. Li and S. Ma, “History and current situation of neoadjuvant treatment for locally advanced esophageal cancer,”Thorac Cancer, vol. 12, no. 17, pp. 2293–2299, Sep. 2021, doi: 10.1111/1759-7714.14069.
3. R. J. Kelly et al., “Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer,”N Engl J Med, vol. 384, no. 13, pp. 1191–1203, Apr. 2021, doi: 10.1056/NEJMoa2032125.
4. S. Knippen and M.-N. Duma, “[Esophageal cancer: improved prognosis with neoadjuvant chemoradiotherapy],”Strahlenther Onkol, vol. 198, no. 1, pp. 86–88, Jan. 2022, doi: 10.1007/s00066-021-01881-3.
