Esophagus also spelled oesophagus is the part of the gastro intestinal tract connecting pharynx of the mouth with the stomach. The lower end of the oesophagus which connects with the stomach normally remains partially closed so as not to allow the acid contents of the stomach to come and injure the oesophagus.

In India, oesophagus is the commonest site of gastro­intestinal cancer after the oral cancer.

Causes

Cancer of the oesophagus is common in Kashmir. Amongst the food habits of Kashmiris which differ from the people in other parts of the country, are consumption of large quantities of very hot saltish tea (noon clw.), high intake of spices such as chillies, animal fats and smoking. These factors, along with attendant vitamin deficiency, may combine to produce injury of the oesophagcal lining, leading to the high incidence of oesophageal inflammation seen in the Kashmiri population.

Symptoms

• Difficulty in swallowing solid or semi-solid food and in later stages even liquid food.
• Pain in the middle of the chest and also in the back.
• Loss of weight.
• Vomiting of food that has been taken lately, sometimes mixed with blood.

Diagnosis

Routine: Blood: Hb, and RBC may be lowered. 1LC and DLC may be normal.

ESR is raised.

Stool: Evidence of altered (occult) blood may be seen in the stool examination.

Special: Barium swallow may reveal a cancer or an ulceration.

Endoscopy: (oesophagoscopy) may show the lesion directly.

Biopsy: examination taken through endoscopic forceps, would clinch the diagnosis.

Additional: Liver scan may reveal if the cancer has spread in the liver.

Treatment

The cancer is usually not detected early enough.

Surgery: Surgical removal of the cancer in the upper two-thirds of the oesophagus is more difficult technically than in the lower one-third. Both the thorax and the abdomen have to be opened, so as to remove the cancer tissue and to rejoin the normal oesophagus with stomach. Healing from the operation takes a long time.

Radiation: It is only done to give some relief for sometime from the symptoms, such as pain or difficulty in eating. It is given for 4 or 5 days each week for a total of about 5 weeks.

Side-effects include nausea, diminished appetite and initially an increase in the difficulty in swallowing.

Surgery and radiation may be given together. Chemotherapy: No useful drug is available to treat the cancer of the oesophagus or its secondaries if they have spread in the liver, lungs and bones.

Prognosis

Oesophageal cancer has a grim prognosis, as it does not produce clear symptoms early enough. Vague discomfort during swallowing and heaviness or uneasiness underneath the sternum are usually ignored by the patient so that the cancer is not detected early.