Oesophageal Cancer

Diagnostics Tests In Oesophageal Cancer

Clinical history: A clinician may ask you for symptoms such as difficulty and pain while swallowing, choking, indigestion, heartburn, vomiting, unexplained weight loss, coughing and pain in the chest or throat.

Barium swallow: An x-ray is taken after the patient swallows a liquid containing barium which coats the surface of the oesophagus. This contrast agent makes the tumour easier to visualise and allows the radiologist to discern details about the tumour that cannot be seen on a normal X-ray.

Endoscopy (Oesophagus-gastric-duodenoscopy, or EGD): A thin, flexible tube with a video camera is passed down the throat and into the oesophagus while the patient is sedated. If there is an abnormality seen, an endoscopic biopsy sample will be taken and sent to the pathology lab.
Endoscopic ultrasound: This procedure is usually done along with the endoscopy. An endoscopic probe with an attached ultrasound is inserted into the oesophagus through the mouth to gather more details about the tumour and the lymph nodes.

Bronchoscopy: This test is similar to the endoscopy, wherein a thin, flexible tube with a light on the end is passed into the windpipe. It helps clinicians detect if the tumour is growing into the person’s airway.

Biopsy: A biopsy can help the clinical team make a definitive diagnosis of oesophageal cancer. A small amount of tissue is removed and analysed by a pathologist. The pathologist can provide details on the characteristics and behaviour of the cancer cells that can help choose the best path of management.

Molecular testing: Laboratory tests can be done to identify specific genes and proteins in tumour cells to determine treatment options. Terms one might hear include PD-L1 and microsatellite instability (MSI) testing and HER2 testing.

Radiological tests: Computed tomography (CT or CAT) scan: CT scans can be used to measure the tumour size and help in staging. Sometimes a special dye may be used for better visualisation and is also useful to detect spread of the cancer.

Magnetic resonance imaging (MRI): MRI scans can be used to measure the tumour size for staging and is also useful to detect the spread of the cancer. Positron emission tomography (PET) scan: A PET scan creates pictures of organs and tissues inside the body to detect the spread of cancer to distant organs. A small amount of a radioactive sugar substance is injected into the vein which is absorbed by cells that use the most energy (including cancer cells).

Treatments

The management of cancer depends on various factors, including the stage of the cancer, additional health issues, age etc. Surgery, radiation or chemotherapy may be used.

• Surgery: The surgeon focuses on the removal of the tumour and a margin of surrounding healthy tissue. Surgery may be performed laparoscopically – a minimally invasive method of surgery. This is traditionally the most common treatment for oesophageal cancer but is useful mainly for patients with early-stage oesophageal cancer. In advanced oesophageal cancer, a combination of chemotherapy and radiation therapy may be used before surgery. This is done to shrink the tumour. Sometimes surgery is used to shrink the tumour in advanced cases in whom the entire surgery cannot be removed and is leading to symptoms.

• Side effects: Surgery of the Oesophagus carries a high risk of side effects including the leakage of food through the anastomosis into the chest, difficulty swallowing, vomiting nausea, heartburn etc.
• Endoscopic therapy: These are mostly palliative therapies in advanced disease. A number of procedures may be considered: Endoscopy and dilation (expands the Oesophagus and has to be repeated if the tumour grows) Endoscopy with stent placement (An Oesophageal stent is a metal, mesh device placed endoscopically to keep the Oesophagus open when the tumour leads to obstruction) Electrocoagulation (It is a form of palliative treatment that kills cancer cells with an electric current) Cryotherapy (It is a form of palliative treatment that uses a probe that can freeze and remove tumour tissue).

• Radiation therapy: Radiation therapy uses high-energy particles to destroy cancer cells. A radiotherapy regimen consists of a specific number of treatments over a period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is given via a machine outside the body. Side effects: fatigue, skin irritation, diarrhoea, blood in urine or semen, loss of hair, etc.

• Chemotherapy: It is the use of drugs to kill tumour cells or limit their growth. In some patients, it is administered before surgery to reduce the size of the tumour and make its removal easier during surgery. This strategy is called neo-adjuvant chemotherapy. Chemotherapy and chemoradiotherapy can also be administered after surgery to clear tumour cells that may remain. Side effects: This depends on the agent used but common side effects include hair loss, nausea , vomiting, diarrhoea, mouth ulcers, anaemia, higher risk of bleeding, lowered immunity, kidney damage, heart damage.

• Targeted therapy: Targeted therapy blocks specific genes or proteins, to reduce the growth and survival of cancer cells. These may be HER2-targeted therapy which targets tumours in which the HER-2 gene is overactive and anti-angiogenesis therapy which focuses on the blood vessel development within the tumour. Side effects: These depend on the agent used but may include chills, fever, diarrhoea, wheezing, headache, fatigue etc.
  Immunotherapy (biologic therapy): This therapy boosts the body's immune system against cancer cells. Side effects depend on the agent used.
• Palliative care: Palliative care focuses on reducing the symptoms and improving quality of life of the patients. Studies have reported that people who receive palliative care along with treatment tend to have less severe symptoms, a better quality of life, and more satisfaction with their care.

Sources: Cancer.Net; European Society of Medical Oncology (ESMO)