Esophageal Cancer in Singapore: Causes, Symptoms, Stages, Survival Rates & Treatment Options

 

Esophageal cancer is one of the more serious gastrointestinal cancers seen in Singapore, affecting the long muscular tube that carries food from the throat to the stomach. While it may not be as common as colorectal or stomach cancer, it is known for being aggressive and often detected at later stages. Understanding the causes, early warning signs, staging system, and treatment options can help patients seek timely medical attention. This guide provides a detailed look at esophageal cancer in Singapore, based on current medical practices and expert recommendations.

What Is Esophageal Cancer?

Esophageal cancer develops when abnormal cells grow uncontrollably in the lining of the esophagus. Over time, these cancer cells can invade nearby structures, spread to lymph nodes, and metastasize to organs such as the lungs or liver. In Singapore, the two most common types are:

1. Squamous Cell Carcinoma

This type originates in the upper or middle portions of the esophagus. It is strongly linked to smoking, alcohol consumption, and chronic irritation.

2. Adenocarcinoma

This cancer develops in the lower part of the esophagus and is associated with chronic acid reflux (GERD) and Barrett’s esophagus.

Causes & Risk Factors of Esophageal Cancer in Singapore

Several lifestyle and medical factors increase the risk of esophageal cancer. These include:

1. Smoking and Alcohol Use

Tobacco and heavy alcohol intake significantly increase the risk of squamous cell carcinoma.

2. Gastroesophageal Reflux Disease (GERD)

Chronic acid reflux can damage the lower esophagus and lead to Barrett’s esophagus, a major risk factor for adenocarcinoma.

3. Barrett’s Esophagus

This condition occurs when the normal lining of the esophagus changes due to prolonged acid exposure. Patients with Barrett’s have a higher risk and require regular monitoring.

4. Obesity

Overweight individuals are more prone to severe acid reflux, which indirectly increases the risk of esophageal cancer.

5. Diet

Low intake of fruits and vegetables and frequent consumption of processed foods or hot beverages may contribute to risk.

6. Age and Gender

Esophageal cancer is more common in individuals above 50 and is seen more often in men.

Common Symptoms of Esophageal Cancer

Esophageal cancer often develops silently in the early stages. Symptoms typically appear once the disease has progressed, which is why early detection can be challenging. The common warning signs include:

1. Difficulty Swallowing (Dysphagia)

A progressive feeling of food “getting stuck” in the throat or chest is one of the first symptoms. Patients may initially struggle with solid foods and later even liquids.

2. Persistent Chest Pain or Discomfort

This may feel like heartburn, inflammation, or pressure behind the breastbone.

3. Unexplained Weight Loss

Difficulty eating, loss of appetite, and increased metabolism due to cancer often cause sudden weight loss.

4. Chronic Heartburn or Regurgitation

Frequent acid reflux, especially when combined with other symptoms, warrants medical evaluation.

5. Hoarseness, Coughing, or Vomiting

These symptoms appear when the tumour presses on nearby structures.

If these symptoms persist, especially in high-risk individuals, consulting a gastroenterologist or cancer specialist in Singapore is crucial.

How Esophageal Cancer Is Diagnosed in Singapore

To diagnose esophageal cancer, specialists typically use a combination of tests:

1. Gastroscopy (Endoscopy)

A thin flexible tube with a camera is inserted through the mouth to inspect the esophagus. Any suspicious area can be biopsied for confirmation. This is the most accurate diagnostic test.

2. CT Scan or PET-CT Scan

These imaging scans help determine whether the cancer has spread to lymph nodes or distant organs.

3. Endoscopic Ultrasound (EUS)

This test provides detailed images of the layers of the esophagus and helps determine tumour depth.

4. Blood Tests

While blood tests cannot detect cancer directly, they help check overall health and suitability for treatment.

Stages of Esophageal Cancer

Doctors use the TNM staging system to determine how advanced the cancer is:

Stage 0

Abnormal cells are present but have not become cancerous (high-grade dysplasia).

Stage I

Cancer is confined to the inner layers of the esophagus.

Stage II

Cancer has spread to deeper layers or nearby lymph nodes.

Stage III

Cancer has invaded deeper tissues and multiple lymph nodes.

Stage IV

Cancer has metastasized to distant organs.

Early-stage cancer has a significantly better prognosis compared to late-stage disease.

Survival Rates in Singapore

Survival rates depend on cancer type, stage at diagnosis, and patient health:

• Early-stage cancer (Stage I): 40–60% 5-year survival
• Locally advanced cancer (Stage II–III): 15–30%
• Advanced metastatic cancer (Stage IV): < 5%

Early detection through screening—especially for high-risk patients—can greatly improve outcomes.

Treatment Options for Esophageal Cancer in Singapore

Singapore offers advanced treatment approaches, often combining multiple therapies to improve survival.

1. Surgery (Esophagectomy)

For early to mid-stage cancer, the surgeon removes part or all of the esophagus and reconstructs it using the stomach or intestines. Minimally invasive techniques are commonly used in Singapore.

2. Chemotherapy

Medications are used to shrink the tumour or kill cancer cells. It may be given before (neoadjuvant) or after surgery (adjuvant).

3. Radiation Therapy

Often combined with chemotherapy, radiation shrinks tumours and helps control symptoms.

4. Endoscopic Therapy

For very early cancer, endoscopic mucosal resection (EMR) or radiofrequency ablation (RFA) may remove abnormal cells without major surgery.

5. Targeted & Immunotherapy

Modern therapies used for advanced cancer help slow tumour growth by acting on specific cancer cell pathways or boosting the immune system.

6. Palliative Care

For late-stage disease, treatment focuses on improving quality of life, relieving pain, and managing swallowing difficulties.

When to Seek Medical Help

You should consult a specialist in Singapore if you experience:

• Persistent swallowing difficulties
• Chronic heartburn not responding to medication
• Unexplained weight loss
• Chest discomfort or regurgitation
• A history of Barrett’s esophagus or severe GERD

Early evaluation makes a significant difference in outcomes.