Esophageal cancer occurs when malignant cells develop in the lining of the oesophagus, the muscular tube that carries food and liquids from the throat to the stomach. In India, esophageal cancer ranks among the top ten cancers, with a higher incidence reported in certain regions due to dietary habits, tobacco use, and environmental factors.

AEarly symptoms of esophageal cancer, such as difficulty swallowing, persistent indigestion or heartburn, unexplained weight loss, and chest pain, often prompt individuals to seek medical attention. If you experience any of these symptoms, it’s crucial to consult a doctor promptly for a thorough evaluation. Early diagnosis through imaging studies, endoscopic procedures, and biopsy is vital for determining the extent of cancer and developing an appropriate treatment plan tailored to each patient’s needs.

1. Tobacco Use:

• Smoking cigarettes, cigars, or pipes is a major risk factor for esophageal cancer, particularly squamous cell carcinoma.
  
• The carcinogens in tobacco can damage the cells lining the oesophagus, leading to mutations and cancer development.
  
• The risk increases with the duration and intensity of smoking.
  

2. Alcohol Consumption:

• Heavy and chronic alcohol consumption is strongly associated with an increased risk of esophageal cancer.
  
• Alcohol can act as a solvent, enhancing the absorption of carcinogens in tobacco, and directly damage the esophageal lining.
  
• The combination of smoking and drinking significantly multiplies the risk.
  

3. Gastroesophageal Reflux Disease (GERD):

• Chronic acid reflux can damage the esophageal lining, leading to Barrett’s oesophagus, a condition where the cells change and become more prone to cancer.
  
• GERD is more commonly associated with adenocarcinoma of the oesophagus.
  
• Long-term untreated GERD increases the likelihood of developing esophageal cancer.
  

4. Barrett’s Oesophagus:

• A condition resulting from chronic GERD where the normal squamous cells of the oesophagus are replaced with glandular cells.
  
• These glandular cells are more likely to become dysplastic and progress to adenocarcinoma.
  
• Regular monitoring and treatment of Barrett’s oesophagus can help reduce the risk of progression to cancer.
  

5. Diet and Obesity:

• Obesity increases the risk of esophageal adenocarcinoma, likely due to increased instances of GERD and subsequent Barrett’s oesophagus.
  
• Diets low in fruits and vegetables and high in processed meats can contribute to esophageal cancer risk.
  
• Certain dietary habits, like consuming very hot beverages, may also damage the esophageal lining and increase cancer risk.
  

6. Human Papillomavirus (HPV):

• Some studies suggest a link between HPV infection and esophageal squamous cell carcinoma, although the association is less clear than with other cancers like cervical cancer.
  
• The virus can cause cellular changes that lead to cancer development.
  

7. Environmental and Occupational Exposures:

• Exposure to certain chemicals and pollutants, such as silica dust and asbestos, can increase the risk of esophageal cancer.
• Individuals working in industries involving such exposures should take precautions to minimise their risk.
  

8. Genetic Factors:

• A family history of esophageal cancer can indicate a genetic predisposition.
  
• Specific genetic mutations and syndromes, such as tylosis (a rare inherited disorder), are associated with higher risks of esophageal cancer.

9. Achalasia:

• A rare disorder where the lower esophageal sphincter fails to relax properly, leading to difficulty in swallowing and chronic esophageal irritation.
  
• Long-standing achalasia increases the risk of esophageal squamous cell carcinoma.
  

It’s essential to recognize the signs of Esophageal cancer early to seek medical attention promptly for proper evaluation and treatment. Here are common symptoms that may indicate the need for esophageal cancer treatment:

1. Difficulty Swallowing (Dysphagia): One of the earliest and most common symptoms, dysphagia worsens over time as the tumour grows and obstructs the passage of food and liquids through the oesophagus.

2. Persistent or Worsening Indigestion:Chronic indigestion or heartburn that does not respond to over-the-counter medications may signal esophageal cancer, especially if it persists despite dietary changes or antacids.

3. Unexplained Weight Loss:Rapid and unintended weight loss can occur as a result of difficulty swallowing and decreased appetite due to esophageal cancer.

4. Chest Pain or Discomfort:Pain or discomfort in the chest, behind the breastbone (sternum), particularly when swallowing or lying down, can be indicative of esophageal cancer.

5. Chronic Cough or Hoarseness:Persistent coughing or hoarseness that does not resolve with usual treatments can be a symptom of advanced esophageal cancer affecting nearby structures.

6. Regurgitation or Vomiting:Difficulty in keeping food down, regurgitation of food or liquids, and frequent vomiting, especially containing blood, are concerning symptoms.

7. Fatigue and Weakness:Generalised weakness, fatigue, and feeling constantly tired can be a result of nutritional deficiencies or the body’s response to the cancer’s metabolic demands.

8. Bleeding:In advanced stages, esophageal cancer may cause bleeding, which can manifest as vomiting blood (hematemesis) or black, tarry stools (melena).

These symptoms should prompt individuals to seek medical evaluation promptly. Early diagnosis is crucial for determining the extent of the cancer and initiating appropriate treatment, which may include surgery, chemotherapy, radiation therapy, or a combination of these approaches.