Food Pipe/ Oesophagus Cancer

About

Dr. Deepak Chhabra

Surgical Oncologist

MS. (Bom), DNB, M.R.C.S. (Edin. UK)

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FAQ

  1. What is cancer
  2. Cancer Risk factors
  3. Stages of Cancer
  4. Early signs of Cancer
  5. Early detection of Cancer

The world knows this man as a consultant oncosurgeon with vast experience in Gastrointestinal and Hepatobiliary-Pancreatic cancers,who specializes in stapled anastomosis for bowel cancers and sphincter saving resections for rectal cancers. In short, he is the person to be contacted for all kinds of cancer related cases.

Richa AgrawalPancreatic Cancer

Thank you Dr Deepak for all you have done for mum, for putting the smile back of her face. I wish you success in all your future endeavors and know that you will continue to touch peoples lives and help them be healthy - the way you have done for my mum….. and me.

Nicola MathiasStomach Cancer

For 67years I've led a very healthy life and thank the "Almighty" for it. However as I said all good things come to an end some time and so be it. Out of the blues was detected the dreadful illness "C" which had shown no signs or symptoms whatsoever..... Time had now come for me to choose a very efficient Oncologist for my treatment.

Patient

My mother was diagnosed of colon cancer, and I was recommended to see Dr Deepak Chhabra for consultation.
The first impression of Dr Chhabra was… he is so young! But after consulting him we realized his level of experience and there was a sense of confidence he spilt over us.We knew we could trust him.....

Neelu GroverColon Cancer
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What is Oesophagus?

The oesophagus (food pipe) is the initial part of the digestive system. The oesophagus is a hollow tube that takes food and fluids from the mouth to the stomach. When you swallow, the muscular walls of the oesophagus push food down to the stomach.

The oesophagus joins to the top part of the stomach. This is called the gastro oesophageal junction. There is a valve here that helps to keep the stomach contents from coming back up into the oesophagus. The valve is called the cardiac sphincter.

About

What is Cancer of Oesophagus?

Glands in the wall of the oesophagus produce mucous to help food to slide down more easily when you swallow. It is the cells of these glands that have a tendency to become cancerous. The cells may multiply and form a lump that can block the passage of food and also difficulty in swallowing.

The inner lining of the oesophagus is made of different cells. The lower part has more gland cells and ‘adenocarcinoma’ is common at this site while ‘squamous cell carcinoma’ begins in squamous cells that line the middle and upper parts. The treatment of squamous carcinoma is different from adenocarcinoma.

There are lymph glands around the oesophagus. The lymph nodes are often the first place that cancer cells spread to when they break away from a tumour. So surgeons often remove them during cancer surgery and send them to the lab where a pathologist examines them to see if they contain any cancer cells.

The presence of cancer cells in the lymph nodes is part of the staging of the cancer. The stage is important because it helps the doctor to decide a suitable treatment for you.

Causes

What are the causes of oesophagus cancer?

The exact causes of cancer are still undetermined, but there are some known risk factors that can make a person more likely to get this disease. Having a risk factor, or even several risk factors, does not mean that you will get the disease. And many people who get the disease may not have had any known risk factors. Research has shown that some of these risk factors affect the DNA of cells in the stomach and oesophagus, which can result in abnormal cell growth and may cause tumors to form.

Risk factors for oesophageal cancer include:

  • Alcohol: Drinking large amounts of alcohol increases your risk of cancer of the mouth, throat, oesophagus (food pipe)
  • GERD: long-term gastro-oesophageal reflux disease where stomach juice frequently spills back into the food pipe.
  • Obesity: This may be because obese people are more likely to suffer from acid reflux and this is a risk factor for oesophageal cancer in itself. Barrett’s oesophagus. This is a condition where some of the lining of the oesophagus changes, usually due to long-term reflux of stomach contents into the oesophagus with accompanying heartburn. The stomach acid comes back up into the oesophagus and irritates the lining. The risk of developing a cancer in Barrett’s oesophagus is high.
  • Occupational exposure to solvents used for dry-cleaning, and some other chemical fumes
  • Frequent drinking of very hot liquids.

Symptoms

What are the symptoms of oesophagus cancer?

  • Difficult or painful swallowing This is the most common symptom of oesophageal cancer. There may be some pain in the form of a burning sensation when swallowing food. Or you may feel that your food is sticking in your throat or chest and you can’t swallow it
  • Weight loss
  • Vomiting/coughing up blood
  • Regurgitation of saliva or food.

If you have not been diagnosed with oesophagus cancer and are just looking through this site, please be aware that many of these symptoms occur without any serious disease being present.

However, if you have any of the symptoms for more than two weeks, see your doctor for a check-up.

Tests

What are the tests carried out to diagnose oesophagus cancer?

This section lists common tests for the cancers. It is not necessary for all the tests to be performed for a patient. Your doctor will select the tests that will assist him / her to have the maximum information about the tumor/ disease. Before referring you for tests, your doctor will take a full medical history and examine you. You may also have a blood test and chest x-ray to check your general health.

Endoscopy / Gastroscopy

In this test, a thin, flexible ‘telescope’ (called an endoscope) will be passed down your throat so that the doctor can examine your oesophagus, stomach and the upper part of your bowel. If anything unusual is seen, the doctor can put instruments down the endoscope and remove tissue to examine under a microscope (biopsy).

Barium swallow and x-ray

This test is less commonly done now that endoscopy is available. If you have this test you will drink thick liquid called barium. This will coat the lining of your oesophagus, stomach and the first part of your bowel. You will lie down on a table and a radiologist will take x-ray pictures of your chest and abdomen. This will show up the lining clearly when x-rays are taken and abnormality in the lining can be detected.

Computerised tomography (CT) scan

A CT scan is a type of x-ray that gives a picture of organs and other structures (including any tumours) in your body. It is used to see more details of a cancer and its relation to the surrounding organs in your body. It also gives information related to cancer spread into the lymph nodes, liver or lungs.

Endoscopic ultrasound scan (EUS)

This is similar to having an endoscopy. It may be used for people who may have oesophageal cancer and occasionally for people who may have stomach cancer. For this test, the endoscope has a small ultrasound probe on the end for more detailed information about the local spread of the tumor. It can help the doctor decide whether you should have some other modality of treatment before surgery.

Biopsy

A biopsy is diagnosis made under a microscope by a pathologist using a small bit of tissue removed from a suspicious area or lump that is found to be abnormal. During the endoscopy/EUS, if the doctor sees anything unusual, they can pass small tools into the scope and take out some tissue that can then be examined under a microscope. This gives a confirmation of cancer.

Positron emission tomography (PET) scan

This test is combined with a CT scan by injecting a radioactive material in the body to highlight all areas where the tumor has or can spread. This test may be used to build up more information after an MRI or CT scan. PET-CT scan is not necessary for all patients. Your doctor will decide if you need to undergo this scan.

Treatment

What is the treatment of oesophagus cancer?

Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. You will be advised on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread and your general health.

The most common treatment options for oesophageal cancer are surgery, radiotherapy and chemotherapy. Your doctors take many factors into account when deciding which treatments are most suitable for you, including the stage of the cancer, your age, general health, and your level of fitness.

If your cancer hasn’t spread, you will almost certainly be offered surgery to remove your oesophagus.

Though cancer surgeries are extensive and take longer hours; with advanced medical care, surgeries have become safer and better equipments are now available to perform surgeries. Improved techniques of anaesthesia and post-operative monitoring have significantly contributed to overall safety of surgical procedures for cancers.

Surgery

SURGERY FOR OESOPHAGUS CANCER:

Though cancer surgeries are extensive and take longer hours; with advanced medical care, surgeries have become safer and better equipments are now available to perform surgeries. Improved techniques of anaesthesia and post-operative monitoring have significantly contributed to overall safety of surgical procedures for cancers.

If you are found suitable for the surgery, you will be usually admitted one or two days prior to the proposed date of surgery. There may be dietary restrictions and you may be given laxatives to evacuate your bowels prior to surgery. Your blood group will be checked and blood is usually reserved for all major abdominal surgeries. It is always a good idea to start with deep breathing exercises once you are admitted to the hospital.

Your doctor may summon a physiotherapist to assist you with the same. You will have most of your body parts shaved for the surgery. You will be given a consent form for your signature. The form would have details of the procedure to be performed on you by your treating surgeon. In case you have any doubts you should feel free to ask them to the surgical team.

The position of the tumour in the oesophagus will determine how much of the oesophagus is removed and what surgery will be performed

The position of the tumor at the oesophagus will also decide the approach to remove the tumor from your body. Your surgeon can approach the cancer via your neck, chest or abdomen and may sometimes combine these approaches.

If the cancer is at the lower portion of the oesophagus or the oesophago-gastric junction, the lower portion of food pipe and the upper part of stomach is removed. This is called an oesophago-gastrectomy.

If the cancer is at the middle portion of the oesophagus, the entire food pipe is removed. This is called a Total oesophagectomy The surgeon will pull the stomach up into the chest and use it to replace the oesophagus.

Removing lymph nodes

During the surgery all the lymph nodes around the oesophagus will be taken out. This is called Lymphadenectomy. The surgeon takes out lymph nodes because they may contain cancer cells that have broken away from the main cancer.

Taking them out reduces the risk of your cancer coming back in the future. The lymph nodes will be sent to the laboratory and checked. This will help your doctor work out the stage of your cancer. And the stage helps to decide which treatment is best for you.

You will be transferred to the Intensive care unit after the surgery. Your recovery will depend on the magnitude of surgery performed. After the operation, the patient is usually monitored in the ICU for 48 to 72 hrs and the overall hospital stay (if no complications) is usually between 10–14 days.

Your pain and discomfort will be taken care of by the anaesthetic team. You will be given pain-killers and an intravenous infusion (drip) to replace your body’s fluids until you are able to drink and eat again after a few days. You will also have a naso-gastric (NG) tube in place.

This is a thin tube that passes down your nose into your stomach or small intestine and allows any fluids to be removed so that you don’t feel sick. It is usually taken out within 48 hours. Sometimes a small tube (catheter) is put into the bladder to drain your urine into a collecting bag.

A feeding tube is generally placed at your tummy to help you with feeds till the stitches taken to join the internal parts have healed.

After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.

Drinking and eating after surgery.

After an anaesthetic, the movement of the bowel slows down and usually takes about 72 hours to get back to normal. After about 48-72 hours you will probably be ready to start taking small sips of water, however your doctors will tell you when it is appropriate for you to start drinking some fluids. This will be gradually increased after a couple of days until you are able to eat a light diet.

Going home.

You will probably be ready to go home in about 10-14 days after your operation and once your stitches have been removed. If deemed appropriate your doctor may send you home with stitches and call you later to remove the stitches. By and large you should be able to climb several flights of stairs after your discharge from the hospital and you will be given diet instructions.

Before you leave hospital you will be given an appointment for a post-operative check-up at the outpatient clinic.

Diet after Oesophagus Surgery

You will be transferred to the Intensive care unit after the surgery. Your recovery will depend on the magnitude of surgery performed. After the operation, the patient is usually monitored in the ICU for 48 to 72 hrs and the overall hospital stay (if no complications) is usually between 10–14 days.

Your pain and discomfort will be taken care of by the anaesthetic team. You will be given pain-killers and an intravenous infusion (drip) to replace your body’s fluids until you are able to drink and eat again after a few days. You will also have a naso-gastric (NG) tube in place.

This is a thin tube that passes down your nose into your stomach or small intestine and allows any fluids to be removed so that you don’t feel sick. It is usually taken out within 48 hours. Sometimes a small tube (catheter) is put into the bladder to drain your urine into a collecting bag.

After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.

At first, even tiny meals may make you feel uncomfortably full. If you have had part of your stomach removed, it will not stretch as much as it did before. If you have had your stomach pulled into the chest, eating large amounts will cause heaviness in the chest. You will need to eat very small amounts very often at first. Then, gradually increase the amounts and then the time between meals. At first, you may find you need to eat every hour or so in order to get enough nutrition.

There is no restriction on the type of food you eat after a oesophagus surgery and you should be able to eat all that you did before surgery. Fizzy drinks can make you feel full – it is probably best not to drink with meals at all, as any liquid will fill you up and cause reflux.

You may be advised not to lie flat in bed, but to sleep propped up on a couple of pillows to avoid acid reflux.

Try keeping a food diary if you are having problems you think are related to your diet. Take a small notebook and draw a line down the centre of each page. Write down what you eat and when on the left of the page. Write down any symptoms you get and when on the other side of the page. After a few days, you may be able to spot which foods cause which symptoms.