Oesophageal (food-pipe) cancer — expert surgery, explained clearly

The oesophagus is the muscular tube — your food pipe — that carries food and liquid from the mouth to the stomach. It is about 25 cm long and runs through the chest. When cells lining the oesophagus grow abnormally and invade surrounding tissue, the result is oesophageal cancer.

There are two main types:

• Adenocarcinoma — the most common type in India today; arises from glandular cells typically in the lower oesophagus and gastro-oesophageal junction. Strongly linked to long-standing acid reflux (GERD) and Barrett’s oesophagus. Rates are rising globally.
• Squamous cell carcinoma — arises from the flat cells lining the upper and mid oesophagus; historically more common in South Asia; linked to smoking, alcohol and hot beverage consumption.

The oesophagus has no serosal (outer protective) layer, so tumours can spread relatively early to surrounding structures and lymph nodes. This makes careful staging and timely surgical assessment important. When the disease is caught while localised, curative surgery — an oesophagectomy — offers the best chance of long-term control.

Oesophageal cancer often has no symptoms in its earliest, most treatable stage. As the tumour grows it begins to narrow the food-pipe. The most important warning signs are:

• Progressive difficulty swallowing (dysphagia) — starting with solids (bread, meat) and advancing to soft food, then liquids. This is the cardinal symptom and demands prompt endoscopy.
• Food sticking or getting stuck — a sensation that food is lodging behind the breastbone or in the throat.
• Unintentional weight loss — significant, unexplained loss of weight over weeks to months.
• Persistent or worsening acid reflux / heartburn — especially when it is long-standing or has changed in character.
• Painful swallowing (odynophagia) — a burning or squeezing sensation when swallowing.
• Regurgitation of food — bringing up undigested food without nausea.
• Persistent hoarseness or cough — when a tumour affects nerves near the voice box.

If you have been diagnosed with Barrett’s oesophagus — a pre-cancerous change in the lower food-pipe lining caused by longstanding reflux — regular surveillance endoscopy is essential even if you feel well. Any new difficulty swallowing or change in reflux symptoms in someone with Barrett’s warrants an urgent review.

Several factors are known to increase the risk of developing oesophageal cancer:

• Chronic acid reflux (GERD) and Barrett’s oesophagus — the leading risk factor for adenocarcinoma; longstanding, uncontrolled reflux damages the lower oesophageal lining, leading to Barrett’s, which can progress to cancer over years.
• Smoking and tobacco use — a major risk factor for both cancer types; doubles or triples risk.
• Heavy alcohol consumption — particularly for squamous cell carcinoma; the combination of smoking and alcohol multiplies risk significantly.
• Obesity — increases intra-abdominal pressure, worsens reflux, and is independently associated with adenocarcinoma of the lower oesophagus.
• Consumption of very hot beverages — repeatedly drinking scalding liquids (above ~65℃) is a recognised risk factor for squamous cell carcinoma.
• Diet low in fruits and vegetables — a diet poor in antioxidants and micronutrients is associated with higher risk.
• Achalasia — a motility disorder causing food to pool in the oesophagus; raises long-term cancer risk if untreated.
• Age and sex — more common after age 60 and significantly more common in men than women.

Having one or more risk factors does not mean you will develop cancer — but it does mean you should discuss surveillance and lifestyle modification with your doctor.

Diagnosis and staging follow a structured sequence. Every investigation has a purpose — together they build a picture of exactly where the tumour is, what type it is, and whether it has spread:

• Upper GI endoscopy (OGD scope) with biopsy — the first and essential investigation; the endoscopist visualises the tumour and takes small tissue samples to confirm the cancer type.
• Endoscopic ultrasound (EUS) — an endoscope with an ultrasound probe assesses how deeply the tumour has penetrated the oesophageal wall (T-staging) and samples nearby lymph nodes.
• CT scan of chest, abdomen and pelvis — assesses spread to lymph nodes and distant organs (liver, lungs, adrenals).
• PET-CT scan — identifies metabolically active cancer deposits that CT may miss; particularly important before planning surgery.
• Staging laparoscopy — for lower oesophageal and gastro-oesophageal junction tumours, a brief keyhole look inside the abdomen can detect small peritoneal deposits invisible on cross-sectional imaging.
• MDT / tumour board review — all findings are presented to a multidisciplinary team (gastroenterologist, oncologist, surgeon, radiologist, pathologist) to agree on the optimal treatment plan.

Accurate staging is not a delay — it is what makes the difference between the right treatment and the wrong one.

Treatment depends on the stage of the cancer, its location in the oesophagus, the type (adenocarcinoma or squamous cell), and the patient’s overall fitness. For localised disease, surgery remains central to curative treatment.

An oesophagectomy removes the tumour-bearing segment of the oesophagus along with surrounding lymph nodes, and uses the stomach (or occasionally a segment of colon) to reconstruct the food passage. The main approaches are:

• Ivor Lewis oesophagectomy — an abdominal incision to mobilise the stomach, followed by a right thoracic (chest) incision to remove the tumour and join the stomach to the remaining oesophagus in the chest; used for mid and lower oesophageal tumours.
• McKeown (three-stage) oesophagectomy — adds a neck incision so the join (anastomosis) is made in the neck; used for upper oesophageal tumours.
• Minimally invasive oesophagectomy (MIO) — laparoscopic (keyhole) abdominal phase combined with thoracoscopic (keyhole chest) approach; when the tumour and patient fitness allow, this reduces the surgical trauma of the open technique, with shorter hospital stay and faster recovery.

For many patients with localised but more advanced tumours, the MDT recommends chemotherapy — or combined chemotherapy and radiotherapy — given before surgery. This can shrink the tumour (downstage it), reduce microscopic spread, and improve the chances of a clear surgical margin. After completing treatment, re-staging scans determine whether surgery proceeds. This sequenced approach is now the standard of care for many oesophageal cancers.

When a cancer is detected at a very early stage — confined entirely to the innermost lining of the oesophagus — it may be removed endoscopically (through the endoscope, without open surgery) using techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). This is only appropriate for superficial, well-defined lesions, and the decision rests on careful EUS staging and MDT discussion.

When the disease is too advanced for curative surgery, the focus shifts to maintaining quality of life. Options include oesophageal stenting (a metal stent placed endoscopically to keep the food-pipe open), palliative chemotherapy, radiotherapy for symptom control, and nutritional support. Dr Kumar works closely with oncology and palliative care colleagues to ensure every patient receives coordinated, compassionate care regardless of stage.

Dr Ameet Kumar is a high-volume GI-oncology and HPB surgeon trained at AIIMS New Delhi — India’s premier surgical institution — and holds the FRCS qualification from the Royal College of Surgeons of Glasgow. With 4,500+ surgeries across 25 years, including oesophagectomies in complex patients, he brings both technical precision and honest, unhurried communication to every consultation.

His approach to oesophageal cancer:

• Thorough staging before any decision — reviewing all imaging, pathology, and EUS findings to establish exactly what surgery can achieve.
• MDT planning — working with oncologists and radiologists to sequence any neoadjuvant treatment correctly before operating.
• Minimally invasive oesophagectomy where appropriate — laparoscopic and thoracoscopic techniques when tumour location, staging, and patient fitness allow; smaller incisions, faster recovery, lower pulmonary complication rates.
• Ivor Lewis or McKeown oesophagectomy when open surgery is indicated — performed to oncological principles with careful lymph node clearance.
• Honest counselling — Dr Kumar will tell you clearly what the operation involves, what the realistic expectations for recovery are, and where surgery is not the right answer.

He is currently in private practice in Bengaluru, working with a multidisciplinary GI oncology team to offer surgical care to the standard he developed over a 25-year career at tertiary military and teaching hospitals.

An oesophagectomy is a major operation and recovery is gradual, but most patients are able to resume a good quality of life. Here is what the journey typically looks like:

• Hospital stay — typically 7–14 days, including time in a high-dependency unit for the first day or two. Most patients begin sips of water within 2–3 days of surgery.
• Eating again — food intake is reintroduced gradually: clear liquids, then soft foods, then a more normal diet over several weeks. The key principle is small, frequent meals — the reconstructed stomach is smaller and empties differently.
• Dietary adjustments — avoiding large meals, lying down immediately after eating, and very hot or very cold food in the first weeks; a dietitian helps plan appropriate nutrition. Some patients experience “dumping syndrome” (dizziness or diarrhoea after eating) which usually improves over months.
• Nutritional support — a jejunal feeding tube is often placed at the time of surgery to maintain nutrition during the early recovery phase; this is temporary.
• Return to activity — gentle walking from day one; most patients are back to light daily activities within 4–6 weeks. Heavier work takes longer.
• Follow-up — regular clinical review, CT scans, and endoscopy as per oncology protocols to monitor for recurrence and manage any long-term symptoms.

Recovery is a team effort. Dr Kumar and the multidisciplinary team will guide you through every step — from the operation through to nutritional rehab and long-term surveillance.