The esophagus is the long, hollow tube that runs from your throat to your stomach and it carries food to the stomach to be digested. The wall of the esophagus comprises of several layers of tissue, including the mucous membrane, muscle, and connective tissue. The esophagus and stomach are part of the upper gastrointestinal (digestive) system.
Esophageal cancer usually begins in the cells lining the inside of the esophagus before spreading outwards through the other layers as it grows.
The two most common forms of esophageal cancer are:
*People who think they may be at risk should discuss this with their doctor.
*A doctor should be consulted if the above symptoms occur.
If you experience any of the symptoms mentioned, your doctor may refer you to a specialist after asking about your personal and family medical history and conducting a physical examination.
The following tests are used to diagnose esophageal cancer.
A hollow tube equipped with a lens (endoscope) will be passed down your throat and into your esophagus. Your doctor will then examine your esophagus for abnormalities or areas of irritation. Endoscope also provides the opportunity to remove a piece of tissue or sample (biopsy) from your esophagus. The tissue samples will then be sent to a laboratory to test for cancerous cells. Endoscopy ultrasound (EUS) is procedure that combines endoscopy and ultrasound to obtain images from your esophagus for investigations and staging.
In the event that you are diagnosed with esophageal cancer, your doctor will then work to determine the stage of the cancer. Staging the cancer helps determine the most suitable treatment options. Find out more about the different stages of esophageal cancer below.
Stage I - The cancer occurs in the superficial layers of cells lining the esophagus.
Stage II - The cancer has progressed to deeper layers of the esophagus lining and may have spread to nearby lymph nodes.
Stage III - The cancer has spread to the deepest layers of the esophagus wall and to nearby tissues or lymph nodes.
Stage IV- The cancer has spread to other parts of the body.
There are different treatments available for esophageal cancer depending on the stage, type and the position of the cancer. Factors other than the stage of the cancer that might have an impact on your treatment decision include your age, your overall health, and your own preferences. The three main types of treatment include surgery, radiation and chemotherapy.
Surgery is the most common treatment option for esophageal cancer.
Chemotherapy is the use of drugs to help kill cancer cells and shrink the size of the tumour. It can be given alone or combined with radiotherapy before or after surgery. It is also the treatment of choice if the patient is not suitable for surgery. The drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. In esophageal cancer, multiple chemotherapy sessions are usually required.
Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can come from a machine outside your body that aims the beams at your cancer (external beam radiation) or it can be placed inside your body near the cancer (brachytherapy).
Radiation therapy is commonly combined with chemotherapy in the treatment of esophageal cancer. It can be used before or after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, for example, in cases where the tumour grows large enough to obstruct food from passing through your stomach.
Surgery is the main form of treatment used in the cure of esophageal cancer. At the NCIS, we have a Upper Gastrointestinal (UGI) tumour multidisciplinary team (MDT) comprising of surgeons, medical and radiation oncologists, radiologists, pathologists, nurse clinicians and research nurses. The team is dedicated to optimising the level of care for our patients at the clinical level. This is done through weekly MDT meetings for discussions on patient conditions and how to provide the best treatment support for our patients with expert opinions from various cancer specialists.
The care for our patients does not stop after the treatments are administered. At the NCIS, the patients and family members are educated on how to cope and manage the illness through our Patient Supportive Care Programmes.
In order to constantly provide the most effective treatment options and improve the disease outcome, our team is active in conducting many clinical trials and have initiated several studies involving different centres and countries across the region.
In 2007, the National University Health System (NUHS) established the Singapore Gastric Cancer Consortium (SGCC) from a translational Research flagship grant under the National Medical Research Council (NMRC). To keep abreast on activities conducted by the SGCC, click here.
For novel therapy, our researchers have established a real-time genomic platform which provides a molecular classification that can predict both prognosis and drug responses. In addition, through the use of multiple gene expression platforms, this has led to the identification of new therapeutic targets that allow for specific targeted therapy. In addition, our researchers have also identified esophageal cancer stem cells aiding in the understanding of the cancer biology and the development of new treatment processes. To find out more about the findings, click here.
At the NCIS, we strongly believe that it is important to provide patients and their family members with an environment where they can seek psychological, educational and therapeutic support. At the NCIS, we offer a range of Patient Supportive Care Programmes to provide a platform for esophageal cancer survivors, patients and their caregivers to come together and share their experiences with one another in their fight against esophageal cancer alongside the support from our surgeons, oncologists, nurses and allied health workers.
Interactive activities are also organised regularly to allow our patients to feel at ease in communicating with others which in turn encourages mutual sharing and support in the process.
The Esophageal Cancer Treatment Team at NCIS is led by Associate Professor Jimmy So
together with his team of medical professionals. The team is committed to
delivering uncompromised and dedicated clinical research, expertise and care in
the prevention, management and cure of Esophageal Cancer.
A Randomized, Multicenter, Open-Label, Phase 3 Study of Nivolumab plus Ipilimumab or Nivolumab in Combination with Oxaliplatin plus Fluoropyrimidine versus Oxaliplatin plus Fluoropyrimidine in Subjects with Previously Untreated Advanced or Metastatic Gastric or Gastroesophageal Junction Cancer
A Randomized Phase 3 Study of Nivolumab plus Ipilimumab or Nivolumab Combined with Fluorouracil plus Cisplatin versus Fluorouracil plus Cisplatin in Subjects with Unresectable Advanced, Recurrent or Metastatic Previously Untreated Esophageal Squamous Cell Carcinoma
A Phase III, Randomized, Double-Blind, Clinical Trial of Pembrolizumab (MK-3475) plus Chemotherapy (XP or FP) versus Placebo plus Chemotherapy (XP or FP) as Neoadjuvant/Adjuvant Treatment for Subjects with Gastric and Esophageal Adenocarcinoma (KEYNOTE-585)
A Randomized, Multicenter, Double Blind, Phase III Study of Adjuvant Nivolumab or Placebo in Subjects with Resected Esophageal, or Gastroesophageal Junction Cancer