Esophageal cancer: symptoms, diagnosis and treatment

What is esophageal cancer?

Esophageal cancer is a malignant growth in the esophagus, the tube connecting the throat to the stomach. There are two primary types:

• Squamous cell carcinoma: affects the upper or middle parts of the esophagus.
• Adenocarcinoma: more common in the lower esophagus, often linked to chronic acid reflux or Barrett's esophagus.

What are the symptoms?

• Difficulty swallowing (dysphagia).
• Unexplained weight loss.
• Chest or back pain.
• Persistent heartburn or indigestion.
• Vomiting or regurgitation of food.
• Chronic cough or hoarseness.

How is it diagnosed?

• Endoscopy: a camera used to view the esophagus and take biopsies.
• Barium swallow test: highlights abnormalities using X-rays.
• CT or PET scans: assess spread to nearby organs or lymph nodes.
• Endoscopic ultrasound (EUS): determines depth of tumour invasion and checks nearby lymph nodes.

When is surgery recommended?

• Early-stage cancer, where the tumour is localised and has not spread to distant organs.
• Locally advanced cancer, often after chemotherapy or radiation has shrunk the tumour.

What are the surgical options?

• Esophagectomy: removes the affected part of the esophagus and nearby lymph nodes; the stomach or a section of intestine is used to reconstruct it.
• Minimally invasive esophagectomy (MIE): small incisions with laparoscopic or robotic technique, reducing recovery time and complications.
• Endoscopic resection: for very early cancers limited to the esophageal lining, avoiding major surgery.
• Palliative surgery: for advanced cases, to relieve difficulty swallowing without aiming for cure.

What happens during an esophagectomy?

The surgeon removes the cancerous portion of the esophagus along with nearby lymph nodes. The stomach is reshaped into a tube and connected to the remaining esophagus; sometimes part of the colon or small intestine is used instead. The procedure may involve incisions in the neck, chest or abdomen depending on where the cancer sits.

What are the risks?

• Anastomotic leak at the surgical connection.
• Infection or bleeding.
• Respiratory complications such as pneumonia.
• Difficulty swallowing or reflux after surgery.
• Nutritional challenges requiring dietary adjustment.

How is recovery?

• Hospital stay: most patients stay 7–10 days, closely monitored.
• Diet: a liquid or soft diet at first, with solid food reintroduced gradually.
• Pain management: medication controls discomfort during recovery.
• Activity: light activity encouraged; heavy lifting and strenuous exercise avoided for 4–6 weeks.
• Follow-up: regular checks and imaging to monitor for recurrence.

Will I need other treatments as well?

• Neoadjuvant therapy: chemotherapy or radiation before surgery to shrink the tumour.
• Adjuvant therapy: chemotherapy or radiation afterwards to eliminate remaining cancer cells.
• Targeted therapy or immunotherapy: for advanced cases.

Surgery offers the best chance of cure when the cancer is found early and remains localised. Regular follow-up is essential to detect recurrence.