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Esophageal cancer treatment in India | Esophageal cancer surgery in India

Smith, a 48-year-old is a businessman from Nairobi Kenya. He is a father of three kids and husband of a beautiful wife. He is running his Logistics business having a presence in 5 cities in Kenya. 

Five years ago, Smith had started experiencing difficulty in swallowing food, indigestion, and heartburns. After ignoring a month, Smith visited a nearby doctor. The doctor examined Smith’s abdomen but found nothing abnormal. He prescribed a few medications. The medications helped him give some relief but after 15-20 days, the problems started bothering him again.

He decided to meet a gastroenterologist.  The doctor suggested gastroscopy and blood tests to Smith. 

Smith underwent the gastroscopy, the doctor detected a tumor in Smith’s esophagus and the doctor suspected it was a malignant tumor. The doctor recommended a CT scan to investigate further. The CT scan reflected that the tumor was present in local lymph nodes and had not spread from the esophagus into other organs.

Smith and his family was shocked to hear that. However, Smith’s best friend Danny and business partner motivated the family to fight cancer and suggested he not take any risk and go to India for the treatment. Danny already knew MedicoExperts as he did his mother’s knee replacement surgery in India. Danny gave the MedicoExperts contact details to Smith.

esophageal cancer treatment in india
Esophagus cancer treatment in india

Smith got in touch with MedicoExperts and forwarded all his reports. The MedicoExperts team presented the case to the tumor board. The board recommended a tentative protocol with a combination of surgery, chemotherapy, and targeted therapy and suggested the final protocol can be arrived at after thorough evaluation, including PET Scan. The family also had a video call with the head of the board and understood the tentative protocol thoroughly.

Smith decided to come to India with his wife for the treatment. 

After 15 Days, Smith and Linda came to India for treatment, and Smith got admitted to the hospital. The evaluation was performed to check the current condition of cancer. Reports came and the examination confirmed that cancer had not spread to adjacent tissue or organs and that it had entered only a few immediately adjacent lymph cells. 

The doctor started chemotherapy and after 2 cycles, esophageal cancer surgery was performed. The cancer was removed along with 52 lymph nodes. 

After the successful surgery, Smith is slowly getting back into the day-to-day routine slowly and a revaluation test was performed, the reports verified the successful removal of cancer. 

Smith and Linda was very happy with the outcome and thanked the doctor and MedicoExperts.

Before starting the discussions on different treatments option, let’s first understand what esophageal cancer is?

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What is Esophageal Cancer?

The esophagus is a muscular tube that is responsible for moving food from the throat to the stomach and Esophageal Cancer occurs when a malignant tumor forms in the lining of the esophagus.

Cancer starts when cells in the inner lining of the esophagus grow out of control. A tumor can occur anywhere along the length of the esophagus, including the place where the esophagus and stomach meet.

what is esophageal cancer
Types of Esophageal Cancer

What are the different types of Esophageal Cancer?

Esophageal cancer types are classified according to the type of cells that are involved. Your treatment options are influenced by the type of esophageal cancer you have.

Squamous Cell Carcinoma – This cancer begins in the thin cells that make up the lining of the esophagus. This occurs most often in the upper and middle portions of the esophagus. This is the most common esophageal cancer worldwide.

Adenocarcinoma – These cancers start in the glandular cells responsible for producing fluid such as mucus. It is most common in the lower part of the esophagus, near the stomach.

Other rare types – Small cell carcinoma, sarcoma, lymphoma, melanoma, and choriocarcinoma are all rare types of esophageal cancer.

Stages

What are the different Stages of Esophageal Cancer?

There are different stages for different types of Esophageal cancer. Doctors use a tool called as TNM system to describe the stage of cancer:

Tumor (T) – It indicates how intensely the primary tumor has grown into the wall of the esophagus and the surrounding tissue.

Node(N) – It shows if the tumor has spread to lymph nodes, where and how many?

Metastasis (M) – It shows if cancer has spread to other parts of the body, where and how much?

These results are combined to determine the stage of esophageal cancer for everyone. There are 5 stages and doctors often describe the type of cancer by its grade. The grade describes how much cancer cells look like healthy cells when viewed under the microscope. If esophageal cancer looks like healthy tissue and contains different cell grouping, then it is called “differentiated”. If the esophageal cancer cells look different from healthy tissue, it is called “poorly differentiated”.

Stages of Squamous Cell Carcinoma

The stages of squamous cell carcinoma may be divided based on whether the tumor is in the upper, middle, or lower part of the esophagus, as well as the grade of the cancer cells.

The cancer is found in the top lining of the esophagus. It has not spread to deep layers and has not spread to any lymph nodes or distant organs.

The cancer grade does not apply and can be located anywhere in the esophagus.

Stage IA – The cancer is in the top layers of the esophagus. Cancer has not spread to any lymph nodes or distant organs. 

The cancer is in grade 1 or in an unknown grade and located anywhere in the esophagus.

Stage IB – Cancer can be in either condition:

  • The cancer is in the top layers of the esophagus, but the cancer cells are less differentiated.
  • The cancer is in the third layer of the esophagus but has not spread to the lymph nodes or other parts of the body.

Cancer can be in any grade or an unknown grade and located anywhere in the esophagus.

Stage IIA – It can be any of these conditions:

  • The cancer is in the third layer of the esophagus and has spread into the thick muscle layer of the esophagus.
  • The cancer is in the outer layer of the middle or upper part of the esophagus.
  • The cancer is in the outer layer of the lower part of the esophagus.

Cancer might be in grade 2 or 3 and located anywhere in the esophagus.

Stage IIB – It can be any of the below conditions:

  • The cancer cells are in the outer layer of the upper or middle part of the esophagus. The cancer cells are less differentiated.
  • The cancer cells are in the outer layer of any part of the esophagus.
  • The cancer cells have spread into the lining of the esophagus and below layers. 

Cancer can be in grades 2-3 or any grade and located anywhere in the esophagus.

Stage IIIA – It can be any of the below conditions:

  • Cancer has spread into the lining of the esophagus and below layers. Cancer has spread to 3 to 6 lymph nodes near the tumor.
  • The tumor has developed into the third layer of the esophagus and has spread to 1 or 2 lymph nodes. 
  • Cancer has scattered outside the esophagus to nearby tissues and but has not spread to lymph nodes or any other parts of the body.

Cancer can be in any grade and located anywhere in the esophagus.

Stage IIIB – It can be any of these conditions:

  • Cancer has grown into the third layer of the esophagus and has spread to 3 to 6 lymph nodes. 
  • Cancer has developed into the outer layer of the esophagus and has spread to either 1 to 2 or 3 to 6 lymph nodes.
  • Cancer has spread to structures surrounding the esophagus and has spread to either no nodes or 1 to 2 lymph nodes.

Cancer can be of any grade and located anywhere in the esophagus. It has not scattered to distant organs.

Stage IVA – It can be either of these conditions:

  • Cancer has spread to nearby structures and may have spread to 3 to 6 lymph nodes.
  • Cancer has stretched to 7 or more lymph nodes.

It can be located anywhere in the esophagus.

Stage IVB – Cancer has scattered to other parts of the body such as the liver and lungs. 

Cancer can be of any grade and located anywhere in the esophagus.

Stages of Adenocarcinoma

Doctors use both T, N, M classifications and the grade for these stages of cancers:

The cancer is found in the top lining of the esophagus. It has not started to grow in the deep layers. The cancer grade does not apply.

Stage IA – The tumor has spread into the lining of the esophagus and underneath layers.

It has not scattered to distant organs or lymph nodes. 

Stage IB – Cancer can meet either of the below conditions:

  • Cancer has spread below the lining of the esophagus. The cancer cells are moderately differentiated.
  • The tumor has grown into the layers of the esophagus called the submucosa.

Cancer can be of grade 1 or 2 or an unknown grade.

Stage IC – Cancer can meet either of the below conditions:

  • The tumor has grown below the lining of the esophagus or the submucosa. The cancer cells are poorly differentiated here.
  • Cancer has expanded into the third layer of the esophagus and is well or moderately differentiated.

Cancer can be grade 1, 2 or 3.

Stage IIA – cancer cells are in the third layer of the esophagus. They can be grade 3 or unknown grade. 

Stage IIB – It can be either of these conditions:

  • The tumor has spread to the outer layer of the esophagus.
  • Cancer is in the inner layer or esophagus and has spread to 1 or 2 lymph nodes.

Stage IIIA – It can be either of these conditions:

  • Cancer is in the inner layers of the esophagus and has stretched to 3 to 6 lymph nodes.
  • Cancer is in the third layer of the esophagus and has stretched to 1 or 2 lymph nodes.

Stage IIIB – It can be any of these conditions:

  • Cancer is in the third layer of the esophagus and has stretched to 3 to 6 lymph nodes.
  • Cancer is in the surface layer of the esophagus and has spread to either 1 to 2 or 3 to 6 lymph nodes.
  • Cancer has scattered to structures near the esophagus and either no lymph nodes or 1 or 2 lymph nodes.

Stage IVA -It can be either of the below conditions:

  • Cancer has scattered to structures near the esophagus and either no lymph nodes or 3 to 6 lymph nodes.
  • Cancer has stretched to 7 or more lymph nodes.

Stage IVB – Tumor has spread to other parts of the body such as the liver and lungs. Cancer can be any grade.

Symptoms

What are the symptoms of Esophageal Cancer?

During the early stages of Esophageal Cancer, you will not experience any symptoms but as cancer progresses, you may experience:

  • Indigestion
  • Heartburn
  • Difficulty swallowing
  • Weight loss
  • Vomiting
  • Food coming back through the esophagus
  • Chest pain
  • Fatigue
  • Chronic cough
signs and symptoms-Esophageal-Cancer
causes of esophageal cancer

Causes

What are the causes of Esophageal Cancer?

Doctors consider that irritation in the esophageal cells develop cancer and some habits that can cause irritation include:

  • Alcohol consumption
  • Smoking
  • Being overweight
  • Not having enough fruits and vegetables
  • Having achalasia, where the muscle at the bottom of the esophagus does not relax properly

Diagnosis

How esophageal cancer diagnosed?

Tests for esophageal cancer that you may need:

This is the first test done when people have trouble swallowing. Series of X-rays are taken after you swallow barium, a thick liquid that shows up on X-rays. It helps doctors to identify a certain problem in your esophagus.

In this test, the doctor passes an endoscope, a thin light tube, puts it in your mouth, and passes it down into your esophagus and stomach. Endoscopy ultrasound helps to provide more information about the extent of the tumor in nearby tissues.

In this test, the doctor takes out a small piece of tissue from the esophagus. The cells are examined under a microscope for any cancer cells. It is more often done during endoscopy.

It is an X-ray in which pictures show where the cancer cells are in the esophagus and if it has spread.

It uses radio waves and magnets instead of X-rays to take more detailed pictures. It may be used to check if nearby lymph nodes are swollen, which might mean that it is cancer.

It uses sugar that can be seen inside your body with the help of a special camera. If there occurs to be cancer, then the sugar will show up as hot spots where the cancer is found. It can help to find if cancer has spread.

Treatment

Advanced esophageal cancer treatment in India

There are many ways to treat Esophageal Cancer that include:

Esophageal Cancer surgery is used to remove all the cancer cells when the cancer is small and hasn’t spread.  Your doctor can remove the cancer cells using an invasive approach, using an endoscope and several small incisions.

The side effects of surgery include pain, bleeding, lung complications, problem swallowing, nausea, heartburn, and infection.

It uses radiation beams to kill cancer cells. It can be administered externally (with the help of a machine) or internally (with the help of a device placed near the tumor called brachytherapy).

It can also be used to help with symptoms like pain, bleeding, trouble swallowing that happen if cancer has grown very large and has spread to other parts of the body. It is often combined with chemotherapy.

Side effects are severe with combined treatment that include fatigue, nausea, vomiting, painful sores in the mouth and throat.

Chemotherapy for Esophageal Cancer involves the use of drugs to kill cancer cells. It may be used before or after surgery. The drugs can be given in vein or taken as pills.

It is given in cycles and each cycle is followed by a break that gives the body time to recover. Treatment often lasts for many months. It is often given with radiation therapy.

Side effects can include hair loss, nausea, vomiting, fatigue, pain but the problem will go away after the treatment ends.

 It is a treatment that boosts your immune system to attack the cancer cells. These drugs may be given into the vein. 

Side effects may include fatigue, rashes, stomach sickness and these will go away after the treatment ends.

This therapy targets specific proteins on cancer cells to treat cancer. These affect mainly the cancer cells and not the normal cells in the body.

treatment cost

Esophageal Cancer treatment cost in India

The esophageal cancer treatment cost in India can range anywhere between $3000-$5000 (223243 – 372071 INR) depending upon the quality of treatment and hospitals.

Treatment cost

Frequently Asked Questions and patient concerns:

Is Esophageal Cancer curable?

Esophageal cancer is aggressive cancer and in most cases is a treatable disease though cure rates are low. It depends on several factors like the stage of cancer and the overall health of the patient. People with early-stage disease have a better chance of survival.

Is Esophageal cancer hereditary?

It happens in a person’s lifetime and is not passed on to their children. Hence it is not inherited but acquired during a person’s life.

Do you feel ill with esophageal cancer?

It might be hard to spot at an early stage but once cancer progresses, it affects your digestion such as having a problem swallowing.

At what age does esophageal cancer occur?

It is most often diagnosed at the age of 50 and above and is more common in men than women.

How fast does esophageal cancer progress?

It grows slowly for many years and once the symptoms develop can progress rapidly.

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