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RGCIRC, Niti Bagh
Ewing’s Sarcoma Treatment
Being diagnosed with oesophageal cancer can be overwhelming, both for patients and their families. Along with concerns about the disease itself, there may be uncertainty about the treatment, recovery and what lies ahead. But they don’t have to face it alone. At Rajiv Gandhi Cancer Institute & Research Centre (RGCIRC), patients receive comprehensive, multidisciplinary care focused not only on treating the cancer but also on supporting them through the physical and emotional challenges that may come with it. Treatment is planned individually based on the stage and location of the tumour, the patient’s overall health and other clinical factors, with specialists working together to determine the most appropriate course of care.
Understanding Oesophageal Cancer and Its Types
The oesophagus is a muscular tube that carries food and liquids from the throat to the stomach. Oesophageal cancer begins when cells in its inner lining become abnormal and start growing uncontrollably. As the tumour grows, it may extend through the layers of the oesophageal wall, involve nearby lymph nodes or spread to other parts of the body.
Types of Oesophageal Cancer
The two main types are distinguished by the cells in which the cancer begins:
- Squamous cell carcinoma (SCC): This cancer develops from the thin, flat squamous cells lining the oesophagus. While it may occur anywhere along the oesophagus, it is commonly found in the upper and middle portions.
- Adenocarcinoma: This cancer develops from glandular cells and most often arises in the lower oesophagus, including cancers close to the junction where the oesophagus meets the stomach.
Less common oesophageal cancers, including neuroendocrine or small-cell carcinomas and certain sarcomas, may also occur. Because these tumours behave differently from the two common types, their treatment needs to be planned according to the specific pathology.
Early Signs of Oesophageal Cancer
Oesophageal cancer may not cause noticeable symptoms in its early stages. As the tumour grows and begins to narrow the oesophagus, symptoms may include:
- A feeling that food is getting stuck in the throat or chest
- Pain or discomfort while swallowing
- Unexplained weight loss
- Pain or discomfort behind the breastbone
- Persistent indigestion or heartburn
- Hoarseness or a persistent cough
- Regurgitation or vomiting
- Blood in vomit or coughed-up mucus in some cases
Risk Factors for Oesophageal Cancer
- Tobacco use: Smoking and other forms of tobacco exposure increase the risk of oesophageal cancer, particularly squamous cell carcinoma.
- Heavy alcohol consumption: Long-term, high alcohol intake is strongly associated with squamous cell carcinoma, especially when combined with tobacco use.
- Gastro-oesophageal reflux disease (GERD): Long-standing acid reflux is associated with a higher risk of adenocarcinoma of the lower oesophagus.
- Barrett’s oesophagus: Repeated acid reflux can lead to changes in the cells lining the lower oesophagus, increasing the risk of oesophageal adenocarcinoma.
- Obesity: Excess body weight is associated with an increased risk of oesophageal adenocarcinoma, partly through its relationship with chronic reflux.
- Achalasia: This uncommon condition affects the movement of food through the oesophagus and is associated with an increased risk of oesophageal cancer.
- Increasing age: Oesophageal cancer becomes more common with advancing age.
- Regular consumption of very hot beverages: Repeated thermal injury from beverages consumed at very high temperatures has been associated particularly with an increased risk of squamous cell carcinoma.
Oesophageal Cancer Diagnosis at RGCIRC
At RGCIRC, the diagnosis of oesophageal cancer typically begins with a detailed evaluation of the patient’s symptoms, medical history and overall health. If oesophageal cancer is suspected, the care team may recommend:
- Upper gastrointestinal endoscopy: A thin, flexible tube with a camera is passed through the mouth to examine the oesophagus and identify any abnormal areas.
- Biopsy: During endoscopy, a small tissue sample may be collected for biopsy to confirm whether cancer cells are present.
- CT scan: Imaging of the chest and abdomen can help assess the size and location of the tumour and check whether the cancer has spread.
- PET-CT scan: This may be advised in selected cases to identify cancer activity elsewhere in the body and support accurate staging.
- Endoscopic ultrasound (EUS): EUS can help determine how deeply the tumour has grown into the oesophageal wall and whether nearby lymph nodes are involved.
- Bronchoscopy: Bronchoscopy may be used for upper or middle oesophageal tumours to check for airway involvement or an abnormal connection with the respiratory tract.
- Additional tests: Depending on the patient’s condition and findings, further investigations may be recommended to assess fitness for treatment and plan the most appropriate course of care.
The Stages of Oesophageal Cancer
Oesophageal cancer is broadly grouped from Stage 0 to Stage IV:
- Stage 0: Abnormal cancerous cells are confined to the innermost lining of the oesophagus. This is also referred to as high-grade dysplasia.
- Stage I: Cancer remains relatively localised and has grown into the superficial or muscle layers of the oesophageal wall without extensive spread.
- Stage II: Cancer has grown deeper into the oesophageal wall and may involve a small number of nearby lymph nodes.
- Stage III: Cancer has extended further through the oesophageal wall and/or involves more regional lymph nodes or certain nearby structures.
- Stage IV: This represents the most advanced stage. Stage IVA may involve nearby structures such as the airway, aorta or spine, or extensive regional lymph-node involvement, while Stage IVB means the cancer has spread to distant organs such as the liver or lungs.
Oesophageal Cancer Treatment at RGCIRC
At RGCIRC, treatment for oesophageal cancer is guided by a multidisciplinary team comprising surgical oncologists, medical oncologists, radiation oncologists, gastroenterologists, radiologists, pathologists and supportive care specialists, who work together to determine the most appropriate treatment approach. Depending on the case dynamics, the treatment may include:
- Endoscopic treatment: Very early-stage cancers may be treated using minimally invasive endoscopic procedures, such as EMR or ESD.
- Surgery: For operable cancers, surgery may be performed to remove the tumour and nearby lymph nodes. The tract is then reconstructed to allow food to pass normally.
- Chemotherapy: Anti-cancer medicines may be given before surgery, after surgery or as part of treatment for advanced disease.
- Radiation therapy: High-energy radiation may be used alone or in combination with chemotherapy to destroy cancer cells and control tumour growth.
- Advanced Radiotherapy: IMRT, IGRT, VMAT or other precision approaches may be used to target the tumour while helping limit exposure to healthy tissues.
- Chemoradiotherapy: Chemotherapy and radiation therapy may be given together, particularly before surgery for some locally advanced cancers or as the main treatment when surgery is not suitable.
- Targeted therapy and immunotherapy: These treatments may be considered for selected advanced or recurrent cancers based on the tumour type, biomarker findings and other clinical factors.
- Treatment to relieve swallowing difficulty: If the tumour significantly narrows the oesophagus, procedures such as oesophageal stent placement may be used to keep the passage open and help improve swallowing. RGCIRC provides self-expanding metal stent placement for oesophageal obstruction.
Note: The treatment plan is reviewed at different stages of care and may be adjusted according to the patient’s response and evolving clinical needs.
Supportive Care and Recovery
Supportive care forms an important part of oesophageal cancer treatment because the disease and its treatment can affect eating, body weight, strength and day-to-day functioning. At RGCIRC, dietitians, rehabilitation specialists and other supportive-care teams work alongside the treating oncologists to address these needs during treatment and recovery.
Nutritional Support
Difficulty swallowing, reduced appetite and treatment-related side effects can make it difficult to maintain adequate nutrition. RGCIRC’s dietitians assess nutritional needs and recommend an individualised diet plan based on the patient’s swallowing ability, treatment and overall health.
Support may include softer or texture-modified foods, smaller and more frequent meals, protein- and calorie-rich foods, or nutritional supplements. When eating by mouth does not provide adequate nutrition, the treating team considers feeding support according to the patient’s clinical needs.
Recovery After Surgery
Recovery after oesophagectomy takes time and usually involves a gradual return to eating and physical activity. Our care team supports pain control, breathing exercises, early mobilisation and a planned progression of food intake. RGCIRC’s physiotherapy and onco-rehabilitation services include breathing exercises, post-operative chest physiotherapy and rehabilitation support.
After surgery, patients often need to eat smaller, more frequent meals and adjust their eating habits as the digestive tract adapts. The team monitors nutrition, weight and recovery and provides additional support where required.
Follow-Up Care
After treatment, our oncology team schedules regular follow-up visits based on the stage of the cancer, treatment received and individual clinical needs. These visits help the team assess recovery, monitor treatment-related effects and investigate symptoms or findings that could suggest recurrence.
Patients should inform the treating team about new or worsening swallowing difficulty, persistent vomiting, unexplained weight loss or other concerning symptoms between scheduled visits.
Why Choose RGCIRC for Oesophageal Cancer Treatment in Delhi?
Here’s why patients and families trust RGCIRC for oesophageal cancer treatment in Delhi:
Multidisciplinary Oesophageal Cancer Care
At RGCIRC, specialists in GI and Thoracic Oncosurgery, Medical Oncology, Radiation Oncology, Gastroenterology, Radiology, Pathology and Clinical Nutrition work together to plan oesophageal cancer care. The multidisciplinary team considers the cancer type and stage, operability, overall health and nutritional status to determine the appropriate sequence of treatment. RGCIRC follows an organ-specific multidisciplinary model, with complex cases reviewed through tumour boards.
Recognised Experience in Trimodality Treatment
RGCIRC has documented experience in treating locally advanced oesophageal cancer with pre-operative chemoradiotherapy followed by surgery. A 10-year study by the Institute’s team involving 254 patients evaluated this trimodality approach and received RGCIRC’s Best Publication Award in 2023.
Expertise in Robotic and Minimally Invasive Oesophageal Surgery
Our GI and Thoracic Oncosurgeons perform robot-assisted and minimally invasive oesophagectomy for suitable patients. RGCIRC has also published its institutional experience with robot-assisted minimally invasive oesophagectomy, while its Surgical Oncology infrastructure includes four robotic surgical suites used across specialties including GI and thoracic surgery.
Precision Radiation Therapy
Our Radiation Oncology team uses advanced techniques such as IMRT, VMAT, IGRT and respiratory-gating approaches where clinically appropriate. These technologies help the team plan and deliver radiation accurately while considering nearby structures such as the heart and lungs. RGCIRC’s radiation specialists also have documented experience integrating image guidance and gating techniques into clinical practice.
Interventional Endoscopy and Swallowing Support
RGCIRC’s Interventional Gastroenterology team provides procedures such as self-expanding metal stent placement for oesophageal obstruction to help relieve difficulty eating. The team also performs EUS, EMR, ESD and feeding-tube placement when clinically required.
Biomarker-Guided Systemic Treatment
For selected advanced cancers, our Medical Oncology and molecular diagnostics teams assess biomarkers that may help guide targeted therapy or immunotherapy. Depending on the tumour type and clinical setting, testing may include HER2, PD-L1 and MSI/MMR, along with broader molecular testing where required. RGCIRC’s NABL-accredited molecular laboratory supports immunohistochemistry, FISH, PCR and next-generation sequencing.
Clinical Trials at RGCIRC
RGCIRC’s Clinical Research Centre has participated in more than 300 national and international cancer clinical trials, including studies of chemotherapy, targeted treatments and immunotherapy. Eligible patients with oesophageal cancer may be considered for an appropriate clinical trial when one is available and matches their diagnosis and treatment needs.
Accredited and Accessible Cancer Care
As a not-for-profit cancer centre accredited by NABH and NABL, RGCIRC combines advanced cancer-care infrastructure with a strong focus on accessible and compassionate treatment. Since 1996, the Institute has cared for more than 3.5 lakh patients and has received recognition in leading national and international healthcare surveys.
Consult an Oesophageal Cancer Specialist at RGCIRC
If you or a loved one has been diagnosed with oesophageal cancer, is experiencing persistent swallowing difficulty, or needs a second opinion on the recommended treatment, our multidisciplinary cancer team can review the diagnosis, stage and available treatment options and guide the next steps.
To book a consultation, schedule an appointment online or download the RGCI Care app on iOS or Android devices.
For appointments:
Rohini: +91-11-4702 2222
Niti Bagh, South Delhi: +91-11-4582 2222
OPD Hours: Monday to Saturday, 9:00 AM to 5:00 PM
Emergency Services: Available 24×7 at both campuses
Frequently Asked Questions
1. What are the early signs of oesophageal cancer?
Oesophageal cancer may not cause symptoms in its earliest stages. Progressively worsening difficulty swallowing is one of the most characteristic symptoms, sometimes accompanied by a feeling that food is getting stuck, painful swallowing, unexplained weight loss, persistent indigestion, chest discomfort or hoarseness.
2. Can acid reflux lead to oesophageal cancer?
Long-standing gastro-oesophageal reflux disease (GERD) can increase the risk of Barrett’s oesophagus, which in turn raises the risk of oesophageal adenocarcinoma. However, most people with acid reflux or Barrett’s oesophagus do not develop oesophageal cancer.
3. Can an X-ray detect oesophageal cancer?
An X-ray alone cannot confirm oesophageal cancer. A contrast study such as a barium swallow may reveal narrowing or an abnormality in the oesophagus, but upper GI endoscopy with biopsy is required to confirm the diagnosis.
4. Is oesophageal cancer curable if detected early?
Some early oesophageal cancers can be treated with curative intent using endoscopic treatment, surgery or other appropriate therapies. The likelihood of successful treatment depends on the stage, tumour type, lymph-node involvement, overall health and response to treatment.
5. Does every patient with oesophageal cancer need surgery?
No. Surgery is mainly considered for cancers that can be removed safely and when the patient is fit for an oesophagectomy. Some patients may receive definitive chemoradiation instead, while advanced cancers are generally treated with systemic therapies and symptom-relieving measures.
6. What is the treatment for Stage IV oesophageal cancer?
Treatment for Stage IV oesophageal cancer usually focuses on controlling the disease, relieving symptoms and maintaining quality of life. Depending on the tumour type, biomarkers, previous treatment and overall health, options may include chemotherapy, immunotherapy, targeted therapy, radiation therapy and procedures such as oesophageal stenting to relieve swallowing difficulty.
7. What are the newer treatments for oesophageal cancer?
Immunotherapies and biomarker-guided treatments have expanded the options available for selected patients. Depending on the cancer type and treatment setting, testing for markers such as PD-L1, HER2 and MSI/MMR may help determine whether immunotherapy or targeted treatment is appropriate. Clinical trials may provide additional options for eligible patients.
8. What is the survival rate for oesophageal cancer?
Survival varies considerably according to how early the cancer is detected, whether it has spread, its type, overall health and response to treatment. Population statistics cannot predict what will happen for an individual patient. For example, US SEER data report substantially better five-year relative survival for localised oesophageal cancer than for disease that has already spread, highlighting the importance of stage at diagnosis.
9. Can a patient eat normally after oesophageal cancer surgery?
Many patients are able to return to eating by mouth after recovery from oesophagectomy, but eating patterns often change. Smaller, more frequent meals, slower eating and nutritional adjustments may be required because the operation changes the digestive passage and the amount of food that can comfortably be eaten at one time.
10. Which is the best hospital for oesophageal cancer treatment in Delhi?
RGCIRC is a specialised cancer centre in Delhi with multidisciplinary expertise in oesophageal cancer treatment. Care brings together GI and Thoracic Oncosurgery, Medical Oncology, Radiation Oncology, gastroenterology, imaging and pathology, with access to complex and minimally invasive oesophageal surgery, chemoradiation, systemic therapies and supportive care according to the stage and individual treatment needs.