What the diagnosis means
The oesophagus carries food from the throat to the stomach. Squamous cell carcinoma — the more common type in India, linked to tobacco, alcohol and very hot drinks — usually arises in the upper and middle oesophagus. Adenocarcinoma, linked to long-standing reflux and obesity, arises near the junction with the stomach. Staging uses endoscopy with biopsy, CT, PET-CT and sometimes endoscopic ultrasound.
Where medical oncology fits
Surgery (oesophagectomy) is a major operation, and radiation is highly effective for squamous cancers, so treatment is genuinely shared. Medical oncology:
- delivers chemoradiation before surgery (or as definitive treatment when surgery is not suitable) for locally advanced squamous cancers;
- gives peri-operative chemotherapy — before and after surgery — for adenocarcinomas of the lower oesophagus and junction;
- leads treatment of advanced or metastatic disease with chemotherapy, immunotherapy (guided by PD-L1) and, for HER2-positive adenocarcinoma, HER2-targeted therapy;
- in some patients, gives immunotherapy after surgery when cancer remains in the removed specimen.
What to expect
Chemoradiation runs for about five weeks with weekly chemotherapy. Swallowing may worsen before it improves; nutrition is protected with a soft diet, supplements and, when needed, a temporary feeding tube or a stent to keep the oesophagus open. Weight, hydration and blood counts are checked weekly. Surgery, if planned, follows a recovery gap of several weeks.
Questions to ask
- Which type is my cancer, and is it operable?
- Is treatment before surgery recommended, and could chemoradiation alone be curative in my case?
- Have HER2 and PD-L1 been tested (adenocarcinoma / advanced disease)?
- How will my swallowing and nutrition be supported during treatment?
- What is the goal of treatment and how will response be checked?
Preparing for your consultation
Bring the endoscopy and biopsy reports, CT/PET-CT with reports, weight history and current diet tolerance, and a list of medicines and other illnesses. If swallowing is severely limited, say so when booking — it affects urgency.