Indian Experiences

Esophageal cancer is a relatively common cancer amongst both men and women and is the fourth most common cause of cancer-related deaths in India. Squamous cell carcinoma is the commonest histology (80%) although there has been a recent relative increase in the incidence of adenocarcinoma. Etiological factors for esophageal squamous cell carcinoma (ESCC) in India are unique and include alternative forms of tobacco consumption, alcohol, tea drinking, nutritional and dietary factors, and possibly human papillomavirus (HPV) infection. Most patients present with advanced stage of disease and in poor general health at the time of diagnosis. Diagnostic and staging workup of ESCC in India is similar to other countries through the use of PET-CT and endoscopic ultrasonography is not universal. Treatment of early-stage disease (T1/T2 and N0) is primarily surgery alone, while patients with more advanced, resectable disease (T3/T4a or N+) are usually treated with neoadjuvant chemotherapy or chemoradiotherapy followed by surgery. Unresectable or metastatic disease is treated with palliative radiotherapy, chemotherapy, or esophageal stenting. Surgical technique is widely variant, with both transthoracic and transhiatal esophagectomy being performed along with minimally invasive (including robot-assisted) esophagectomy depending on the specialization and expertise of the surgeon. Research on esophageal cancer has focused on epidemiology, etiological factors, primary treatment options, neoadjuvant and adjuvant therapy, surgical techniques, perioperative care, and palliative treatment. The National Cancer Grid works to promote collaborative research and standardization of treatment across the country.