The Indian Council of Medical Research (ICMR) has issued a consensus document for management of esophageal cancer which is the eighth most common cancer in the world.
The ICMR’s initiative in this regard is significant as India, which is a country with a low human development index (HDI), has a high incidence of esophageal cancer with higher proportion of squamous cancers. India has an age standardised incidence rate (ASR) of 6.5 per 100,000 population for males and 4.2 per 100,000 population for females. This translates into approximately 47,000 new cases each year and 42,000 deaths.
The oesophagus in adults is a muscular tube about 10 inches long that helps move food from the mouth to the stomach. It is composed of a mucosal lining, submucosa, muscle tissue and an outer covering layer of cells called the adventitia above the diaphragm and the serosa below the diaphragm. The two main types of esophageal cancer are adenocarcinomas and squamous cell carcinomas.
The ICMR has come out with this rather lengthy consensus document on esophageal cancer treatment as even though the incidence of cancer of oesophagus is rising, majority of patients are still diagnosed in advanced stage of disease. The existing management approaches yield 5-year survival of between five per cent and 30 per cent. Hence there is an urgent need for more multimodality management protocols to improve the existing dismal survival for patients with esophageal cancer.
The ICMR has invited suggestions and comments from experts and others on the document.
Major risk factors for squamous cell carcinoma include poor nutritional status, low intake of fruits and vegetables, drinking beverages at high temperatures, excessive tobacco and alcohol consumption. Risk factors for adenocarcinoma include smoking, high BMI and chronic gastro-esophageal reflux disease (GERD) which can lead to Barrett’s esophagus.
Adenocarcinoma of the esophagus has been increasing in many countries in northern Europe and in the USA due to increasing prevalence of risk factors like obesity and GERD. Squamous carcinoma, common in Asian countries is probably related to tobacco and alcohol consumption.