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Cancer Information

Esophageal Cancer

Esophageal Cancer


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:

  • Squamous cell carcinoma (Epidermoid carcinoma) - Squamous cells are thin, flat cells lining the esophagus. This cancer is mostly found in the upper and middle part of the esophagus, but can also occur anywhere along the esophagus.
  • Adenocarcinoma - Glandular cells are secretory cells lining the esophagus and they produce and release fluids such as mucus. This cancer usually starts in the lower part of the esophagus, closer to the stomach.

  • Heavy drinkers of alcohol
  • Habitual smokers
  • Those with gastroesophageal reflux disease (GERD)
  • Those with Barrett's esophagus - a condition in which cells lining the lower part of the esophagus have been changed or replaced with abnormal cells that could develop into esophageal cancer
  • Esophageal strictures developing after ingestion of corrosive agents
  • Achalasia, a failure of smooth muscle fibres of the esophagus to relax
  • Obesity predisposes patient to reflux

*People who think they may be at risk should discuss this with their doctor.

  • Experience pain or difficulty in swallowing
  • Unexplained weight loss
  • Chest pain, pressure or burning
  • Indigestion and heartburn
  • Coughing or hoarseness of voice

*A doctor should be consulted if the above symptoms occur. 

  • Quit smoking
  • Consume alcohol in moderation
  • Maintain a healthy weight
  • Eat more fruits and vegetables 
  • Avoid chewing beetle nut

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.

  • Endoscopy surgery for removal of very superficial tumours - If the cancer is detected at a very early stage, endoscopic resection may be performed to remove the tumours and a fraction of the healthy tissues that surround them. 
  • Esophagectomy - During esophagectomy, the portion of the esophagus containing the tumour and nearby lymph nodes are removed. The remaining esophagus is then reconnected to the stomach.


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

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.


Optimising Clinical Care

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.

Patient Supportive Care Programmes

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.

For more information about our Patient Supportive Care Programmes, click here.


  1. 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

  2. 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

  3. 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)

  4. A Randomized, Multicenter, Double Blind, Phase III Study of Adjuvant Nivolumab or Placebo in Subjects with Resected Esophageal, or Gastroesophageal Junction Cancer