Treatment
When the disease is confined to the oesophagus and has not infiltrated vital structures, it is managed by surgical removal of the oesophagus. This is then normally replaced by the stomach, as replacement organ. In some situations when the stomach is not available or involved by the cancer even that is removed and both the organs are replaced by a part of the large intestine called as Colonic reconstruction or Coloplasty. In select situations, the team may decide on giving chemotherapy and radiotherapy to reduce the size of the tumour and then operate, and the chemoradiotherapy continued after surgery to prevent recurrence. Sometimes, the patient is advised chemotherapy and radiotherapy as definitive therapy avoiding surgery.

When the patient’s general condition is very bad and nutritionally depleted, none of these options may be possible. The doctors can still help by placing a stent, which is a tube, across the tumour. This helps the patient eat through the normal passage.

When the disease spreads to adjacent structures, pain can be a predominant symptom. This is essentially addressed by the palliative care physicians who provide medical support in terms of pain relief and help handle emotional problems. They even visit patients at home as the aim is to let them die with dignity and without suffering.

Routine screening is done in few countries but is difficult in country like India, but it is at least possible to detect the disease at a manageable or treatable stage, if the patient approaches the doctor at the first symptom. Sadly, even today, many do not come forward in time. An evasive group tries to avoid endoscopy. The pessimistic group tries to avoid surgery. But the model should be the optimist group, represented by patients like Shanthi. Although she initially avoided the endoscopy, she underwent the entire treatment course and got back to normal Not only is she normal now, she is able to spend time with people suffering from oesophageal cancer explaining the types of treatment, problems and therapy options as also overcoming emotional depressive episodes. In short, she functions as an ambassador.

There are many like Shanthi who are willing to offer their help to sufferers. These former patients, their kith and kin, the doctors who helped them, philanthropists and volunteers have come together and formed the “Oesophageal Patients Support Organisation (EPSO)”. The members are available to help with answers to doubts and help them in times of need.

What is the oesophagus?
The oesophagus is a 25 cm long tubular structure, which starts in the neck, traverses the entire chest, hugged by all important structures such as the heart, respiratory passage, the lungs on either side, the major blood vessels and the nerve responsible for speech.

Then it enters the abdomen to join the stomach, which is called the oesophagogastric junction. The food pipe “transports” food from the mouth to the stomach and any obstacle or block here manifests as difficulty in swallowing. Depending upon the severity of the obstruction, the difficulty in swallowing may be of different degrees.

Who can fall victim?
Generally, oesophageal cancer is found in people over 60 years of age.

It is common among those who use tobacco in some form or other and people who drink. The incidence increases if the person has been smoking and drinking for many years.

People who don’t eat nutritious food, malnutrition is considered an important cause of oesophageal cancer. Studies have shown deficiencies of vitamins A, D, E, and K, and minerals like Zinc, Selenium and Molybdenum can also contribute to the risk.

Drinking boiling hot coffee or tea adds to the problem.

It affects men more commonly than women, possibly because more men smoke and drink. In women who have been diagnosed to have oesophageal cancer, there were fewer with drinking and smoking habits (although many don’t reveal these facts during the initial visits).

Sometimes, there can even be a genetic factor that is when it can occur at earlier age group.

Symptoms
Often the doctor may suspect the possibility of oesophageal cancer just by listening to the patient’s history. There may not be any clinical finding, hence it is described as a “disease of symptoms and few or no signs”.

Typically, the patients present with progressive difficulty in swallowing. Initially the problem begins with solids and gradually extends to soft solids, semi–solids, and liquids. Ultimately, the patients may not even be able to swallow their own saliva.

Other symptoms could be due to the spread to adjacent structures.

Infiltration or spread to the nerves that supply the vocal cord can produce change in voice.

Stasis of food in the food pipe can lead to aspiration of food content into the respiratory passage, producing violent bouts of cough.

Infiltration of structures behind the food pipe can produce back pain.

Spread into the respiratory passage can lead to a condition called tracheoesophageal fistula, which can be described as communication between the respiratory passage and oesophagus. In this condition, the patients develop violent bouts of cough when they eat or drink, and even when they attempt to swallow their own saliva.

Spread into lymphatics can show up as swellings in the neck that can be felt by the doctor, and distant spread can affect the lungs and ultimately any organ in the body. Over a period of time the patient loses weight and becomes malnourished.

The writer is a gastrointestinal surgeon based in Chennai.
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Source: http://www.hindu.com