Esophageal Cancer
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Our Treatments
Esophageal cancer
Common in certain Indian regions, related to tobacco, hot beverages, and poor nutrition
Site
- Upper, middle, or lower third of the esophagus
- Can be squamous cell carcinoma (more common in upper/mid) or adenocarcinoma (lower third)
Risk Factors:
- Smoking, alcohol
- GERD/Barrett’s esophagus (adenocarcinoma)
- Hot beverages, poor nutrition
- HPV (less commonly)
Histological Types
- Squamous Cell Carcinoma (SCC) – more common in upper/mid esophagus
- Adenocarcinoma (AC) – more common in lower esophagus and gastroesophageal junction (GEJ)
Treatment Modalities by Stage
Stage
Preferred Treatment
Early-stage (T1a)
Endoscopic resection (EMR/ESD) ± ablation (if superficial and well-differentiated)
T1b-T2, N0
Esophagectomy (surgery) if fit; or definitive CRT if inoperable
Locally Advanced (T3/T4 or N+)
Neoadjuvant chemoradiotherapy → surgery (CROSS protocol: weekly carboplatin + paclitaxel with RT)
Unresectable or Inoperable
Definitive chemoradiotherapy (50.4 Gy + concurrent chemo)
Metastatic
Systemic therapy (chemo ± immunotherapy); palliative RT for dysphagia or bleeding
Role of Radiation Therapy
- Neoadjuvant: 41.4 Gy in 23 fractions (CROSS trial)
- Definitive RT: 50.4 Gy in 28 fractions + concurrent chemotherapy
- Palliative RT: 20–30 Gy in 5–10 fractions (dysphagia relief)
Chemotherapy Regimens
- Neoadjuvant/Definitive: Paclitaxel + Carboplatin (weekly)
- Systemic (advanced/metastatic): FOLFOX, cisplatin + 5-FU, or addition of immunotherapy (e.g., nivolumab) for PD-L1 positive or MSI-high tumors
Surgery
- Esophagectomy: Transthoracic (Ivor Lewis), Transhiatal, or Minimally Invasive
- Usually done after neoadjuvant therapy if resectable and operable
Key Points
- CROSS protocol (CRT → surgery) is standard for locally advanced resectable tumors
- Definitive chemoradiation is curative in inoperable cases
- Palliative RT improves symptoms in advanced/metastatic disease