Oesophageal & GEJ Cancer Treatment in Lucknow
Expert Care at Lucknow Cancer Institute
Oesophageal and gastroesophageal junction (GEJ) cancers are aggressive malignancies with poor prognosis when diagnosed late. India has one of the highest incidences globally, particularly in North‑East regions. Dr. Sidharth Pant coordinates multidisciplinary care including neoadjuvant chemoradiation, surgery planning, and palliative chemotherapy to optimize outcomes and quality of life.
High Burden Disease in India
Epidemiology and regional variation in India
Regional Variation
Highest Incidence:
- North‑Eastern states (Assam, Meghalaya, Mizoram)
Lowest Incidence:
- Southern states (Kerala, Tamil Nadu)
Mortality Statistics
Critical Alert
Mortality: 32,000 deaths (oesophageal), 10,000 deaths (GEJ) annually in India.
Male‑to‑female ratio: 2:1 (oesophageal), 3:1 (GEJ)
Major Risk Factors
Understanding what increases your risk
Lifestyle Factors
- Tobacco use (smoking, chewing – strongest risk)
- Alcohol consumption (synergistic with tobacco)
- Dietary factors: Low fruits/vegetables, hot beverages, pickled foods
Medical Conditions
- GERD (chronic acid reflux – adenocarcinoma risk)
- Barrett's oesophagus (precancerous change)
- Obesity (GEJ adenocarcinoma)
- Achalasia (oesophageal motility disorder)
Prevention
- Tobacco/alcohol cessation
- Endoscopy surveillance for Barrett's
- Healthy weight, balanced diet
Warning Signs (Often Late)
Recognizing symptoms of oesophageal and GEJ cancer
Early Symptoms (Subtle)
- Progressive dysphagia (solids → liquids)
- Weight loss (odynophagia, early satiety)
Advanced Symptoms
- Vomiting/regurgitation (GEJ obstruction)
- Chest/back pain
- Hoarseness (recurrent laryngeal nerve involvement)
- Cough/hoarseness (tracheo‑oesophageal fistula)
- Haematemesis (bleeding)
- Aspiration pneumonia
Emergency Presentations
- Complete dysphagia
- Massive upper GI bleed
- Oesophageal perforation
Urgent Medical Attention Required
If you experience progressive difficulty swallowing or unexplained weight loss, seek immediate medical evaluation. Early diagnosis significantly improves treatment outcomes.
Histological Classification
Types of oesophageal and GEJ cancers
Oesophageal Cancer
Squamous cell carcinoma (70–80%):
- Upper/middle third
- Tobacco/alcohol related
Adenocarcinoma (15–20%):
- Distal oesophagus
- GERD/Barrett's related
GEJ Cancer
Adenocarcinoma (80–90%):
- Siewert classification (Type I–III)
- Rising incidence globally
Squamous cell (10–20%)
HER2 Testing
GEJ adenocarcinoma requires HER2 testing for trastuzumab eligibility.
Complete Diagnostic Work‑up
Diagnostic pathway and staging
Endoscopy
Upper GI endoscopy ± biopsy (gold standard) • Endoscopic ultrasound (EUS) for T/N staging
Imaging
CT chest/abdomen/pelvis (contrast) • PET‑CT (M staging, treatment response) • Barium swallow (if endoscopy delayed)
Staging (Simplified)
Stage 0
High-grade dysplasia
Stage I
T1N0
Stage II-III
Locally advanced
Stage IV
Metastatic
Multidisciplinary Treatment Protocols
Stage-specific treatment approaches
Early‑Stage (Stage 0–I)
- Endoscopic mucosal resection (EMR) / radiofrequency ablation (RFA) (T1a)
- Oesophagectomy (T1b)
- Gastrectomy (GEJ Siewert I–II)
Locally Advanced (Stage II–III)
Neoadjuvant chemoradiation (preferred):
- CROSS regimen: Carboplatin + Paclitaxel + 41.4 Gy radiation
- Improves R0 resection rate and survival
Perioperative chemotherapy:
- FLOT regimen for GEJ
Surgery after response assessment:
- Ivor Lewis oesophagectomy
- Total gastrectomy (GEJ)
Metastatic (Stage IV)
Palliative chemotherapy:
- FOLFOX, CAPOX
- Trastuzumab (HER2+ GEJ)
Immunotherapy:
- Nivolumab (PD‑L1+)
Palliative procedures:
- Radiation/stenting (dysphagia)
Surgical Expertise Coordination
Surgical options and post-operative care
Oesophagectomy Approaches
- Open Ivor Lewis (right thoracotomy + laparotomy)
- Minimally invasive (MIO)
- Robotic (select centres)
GEJ Cancer Surgery
- Proximal/total gastrectomy (Siewert I–II)
- Distal oesophagectomy (Siewert III)
Post‑Op Care
- High dependency unit monitoring
- Enteral nutrition (jejunostomy)
- Leak surveillance
Complications
- Anastomotic leak (5–10%)
- Pneumonia
- Chylothorax
Symptom Management & Nutrition
Supportive care for oesophageal and GEJ cancer
Dysphagia Management
- Oesophageal stenting (self‑expanding metal stents)
- Laser therapy, brachytherapy (palliation)
- PEG/jejunostomy feeding
Pain Control
- Analgesics, celiac plexus block
- Palliative radiation for bone mets
Nutrition
- High‑protein, high‑calorie supplements
- Small frequent meals
- Pancreatic enzymes if needed
Respiratory Care
- Physiotherapy post‑oesophagectomy
- Aspiration precautions
Survival & Monitoring
Prognosis and follow-up care
Prognostic Factors
- Stage at diagnosis
- Resectability/R0 resection
- Response to neoadjuvant therapy
- Performance status
Follow‑up Schedule
| Post-treatment Period | Follow-up Schedule |
|---|---|
| Year 1-2 | Every 3 months (CT + endoscopy) |
| Year 3-5 | Every 6 months |
| >5 years | Annually |