Esophageal cancer most often shows itself as difficulty swallowing. This article covers the signs and risk factors, staging and the treatments offered in Israel, from endoscopic removal to surgery and immunotherapy.
Signs of esophageal cancer
- Difficulty swallowing, first with solid food and later with liquids; the main symptom.
- Weight loss with no obvious cause.
- Pain or burning behind the breastbone, or pain on swallowing.
- Choking while eating or food coming back up.
- Persistent cough and hoarseness.
These complaints also occur with benign conditions, but progressive difficulty swallowing always calls for an endoscopy.
Causes and risk factors
There are two main types. Squamous cell carcinoma is linked mainly to smoking and alcohol. Adenocarcinoma develops in the lower esophagus against a background of long-standing reflux, Barrett's esophagus and obesity. Previous radiotherapy to the chest or neck also raises the risk.
Diagnosis in Israel
- Gastroscopy with biopsy confirms the diagnosis and tumour type.
- Endoscopic ultrasound shows how deeply the tumour has grown into the wall and whether nearby lymph nodes are involved.
- CT and PET-CT look for distant metastases.
- Tumour tests (HER2, PD-L1, MSI) guide the choice of drug therapy.
Stages
- I: tumour confined to the inner layers of the wall;
- II: growth into deeper layers or involvement of a few lymph nodes;
- III: growth through the whole wall, with lymph nodes or neighbouring structures involved;
- IV: distant metastases.
Treatment methods
Endoscopic removal
Very early tumours limited to the lining are removed through an endoscope, with no incisions and with the esophagus preserved.
Chemoradiotherapy and surgery
For locally advanced disease, chemotherapy or chemoradiotherapy is given first, then the esophagus is removed (esophagectomy) and a new passage for food is formed from the stomach. The operation is increasingly performed with minimally invasive techniques. It is major surgery with significant risks, so it matters that the centre has enough experience with these operations. Some patients with squamous cell carcinoma can be treated with chemoradiotherapy alone, without surgery.
Drug therapy
For advanced disease, chemotherapy is combined with immunotherapy or targeted drugs depending on the tumour markers. Immunotherapy is also given after surgery when tumour cells remain in the removed tissue.
Restoring swallowing
If the tumour blocks the passage, a stent is placed or radiotherapy is given; nutritional support is part of treatment at every stage.
The plan is drawn up by a team of oncologists, surgeons, radiologists and gastroenterologists. The outlook depends mainly on the stage, so no result can be guaranteed.
Planning treatment in Israel
Send the clinic your reports, the endoscopy report, the pathology report and CT or PET-CT discs, and bring the slides and blocks with you. The work-up takes about a week. The hospital stay after esophagectomy is one to two weeks, and flying home is usually possible after three to four weeks. Check where chemoradiotherapy will be given and ask for a written estimate listing what is included.
Frequently asked questions
Does difficulty swallowing always mean cancer?
No, but it is a reason to have a gastroscopy soon.
Can it be cured without removing the esophagus?
Sometimes: very early tumours are removed endoscopically, and in squamous cell carcinoma chemoradiotherapy is occasionally enough.
How do I eat during treatment?
A dietitian draws up a plan; tube feeding is used temporarily when needed.
How long does treatment take?
Combined treatment with surgery takes several months, so some stages can be completed at home.
Need a second opinion or esophageal cancer treatment abroad? Send a request and Clinics Direct medical coordinators will help you choose a clinic and find out the cost of tests and treatment free of charge.
