Experts see link between bad dietary habits and rising oesophageal cancer cases in Pakistan

The incidence of oesophageal cancer has risen by 20 per cent in Pakistan in the last decade, an increase that is probably being driven in part by growing rates of obesity and bad dietary habits, said Dr Shabbir Hussain, consultant clinical oncologist & assistant professor at Ziauddin University Hospital Karachi at a public awareness seminar on Saturday.

The seminar was organised by the Neurospinal and Cancer Care Postgraduate Institute to mark esophageal cancer awareness month.

“Karachi is seeing far higher rates of a type of esophageal cancer called adenocarcinoma, which is related to obesity and eating a high saturated fat diet. We think the obesity epidemic may be a big reason behind the increase. We know that being overweight significantly increases the risk of adenocarcinoma — the main type of esophageal cancer that’s on the up," Dr Hussain explained.

The esophagus is a long, muscular tube that connects the stomach to the throat. Esophageal cancer starts in the inside lining of the esophagus and spreads outward through the other layers as it grows.

“Symptoms include sudden or unexplained weight loss, chest pain, heartburn several times a week, heartburn that returns soon after your antacid wears off, heartburn that wakes you up at night, symptoms that persist even though you’re taking heartburn medications, difficulty in swallowing, chronic coughing and hoarseness, regurgitation of blood or black material and black stool, If you notice any of these change or symptoms, or any discomfort around the area of your esophagus, contact your doctor to schedule an appointment. Your doctor will examine the symptoms and determine if the cause is cancer, and if treatment is necessary,” added Dr Shabbir.

Risk factors that cause irritation in the cells of your esophagus and increase your risk of oesophageal cancer include: Having gastro esophageal reflux disease (GERD), tobacco in all forms, having precancerous changes in the cells of the esophagus called Barrett's esophagus.

The following factors may raise a person’s risk of developing esophageal cancer like age: people between the ages of 45 and 70 have the highest risk of esophageal cancer; men are three to four times more likely than women to develop esophageal cancer; black people are twice as likely as white people to develop the squamous cell type of esophageal cancer; and heavy drinking over a long period of time increases the risk of squamous cell carcinoma of the esophagus, especially when combined with tobacco use.

Achalasia is a condition when the lower muscular ring of the esophagus does not relax during swallowing of food, achalasia increases the risk of squamous cell carcinoma.

Researchers are investigating human papillomavirus (HPV) as a risk factor for esophageal cancer, but there is no clear link that squamous cell esophageal cancer is related to HPV.

Dr Syed Shiraz Ur Rehman, consultant general surgeon and associate professor at Liaquat National Hospital, Karachi, gave his perspective on the current management of Oesophageal cancer.

“Mainstay treatment is a multidisciplinary approach, which ensures each individual case is discussed with the relevant content experts, including general surgeon, medical and clinical oncologist, pathologist, gastroenterologist and radiologist, and tailored treatment is decided based on the best evidence available before and after surgery. Patients who are diagnosed at an early stage tend to have better prognosis,” said Dr Rehman.

“Over the period of time there has been a paradigm shift from open surgeries to minimally invasive surgeries. Laparoscopic and robotic surgeries have improved patient outcomes in terms of shorter hospital stay, faster recovery period and early return to work,” he further elaborated.

For some patients, radiation alone is sufficient to provide complete cure, in addition endoscopic mucosal resection (EMR) is a suitable treatment option for small cancers.

“Esophageal cancer is the most scariest disease; an estimated 604,100 people were diagnosed with esophageal cancer in 2020 worldwide and it is even more so in Pakistan where treatment outcomes are uncertain because of delayed diagnosis, patchy availability of specialised treatment and long and expensive therapies that most people cannot afford, oesophageal cancer continues to be diagnosed in late stages, when treatment is more toxic and expensive,” said guest speaker Dr Reena Kumari, consultant medical oncologist & assistant professor at Ziauddin University Hospital.

“The five-year relative survival rate for patients with esophageal cancer is 43 per cent for patients with localised disease found only in the esophagus; 23 per cent for regional disease that has spread to nearby lymph nodes and organs; and five per cent for metastatic disease that has spread to distant parts of the body,” she said while describing key facts.

“Immunotherapy for esophageal cancer is being explored to reduce recurrence, as a first line of treatment and in novel combinations for advanced stage metastatic cancer. Immunotherapy is a class of treatments that take advantage of a person’s own immune system to help kill cancer cell.”

Dr Kumari said: “Immunotherapy research on esophageal cancer is ongoing and holds the promise of new treatment options. Researchers found that the 12-months overall survival rate was 43 per cent in patients taking Immune checkpoint inhibitors compared to 20 per cent in those receiving chemotherapy, a two-fold increase in a large clinical trial for patients with advanced or metastatic esophageal squamous cell carcinoma that could not be treated surgically.”