Cancer of the esophagus begins in the inner layer of the esophageal wall and spreads through the esophageal wall, to lymph nodes as well as the blood vessels. Esophageal cancer can also spread to the lungs, liver, stomach, and other parts of the body.

Oesophagus cancer treatment in Malaysia


Types of esophageal cancer

There are 2 main types of esophageal cancer:

Squamous cell carcinoma

Squamous cell carcinoma of esophagus starts in the squamous cells that line the esophagus. It usually develops in the upper and middle part of the esophagus.

Adenocarcinoma of esophagus

Adenocarcinoma of esophagus begins in the glandular tissue in the lower part of the esophagus, which leads to stomach.

Neuroendocrine cancers, lymphomas and sarcoma make up less than 1% of esophageal cancers.

Risk Factors

The following factors may raise a person’s risk of developing esophageal cancer:
Men are 3 to 4 times more likely than women to develop esophageal cancer.
People between the ages of 45 and 70 have the highest risk.
Using any form of tobacco is linked especially squamous cell carcinoma.
Barrett's esophagus
This condition can develop with chronic gastro esophageal reflux disease (GERD). People with Barrett's esophagus are more likely to develop adenocarcinoma of the esophagus, but the risk of developing esophageal cancer is still fairly low.
A diet that is low in fruits and vegetables and certain vitamins and minerals can increase a person's risk of developing esophageal cancer.
Children who have accidentally swallowed lye have an increased risk of squamous cell carcinoma. Lye can be found in some cleaning products, such as drain cleaners.
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.

Symptoms of oesophageal cancer

  • Difficulty and pain with swallowing, particularly when eating meat, bread, or raw vegetables. As the tumor grows, it can block the pathway to the stomach. Even liquid may be painful to swallow.
  • Pressure or burning in the chest
  • Indigestion or heartburn
  • Vomiting
  • Frequent choking on food
  • Unexplained weight loss
  • Coughing or hoarseness


Diagnosis of oesophageal cancer

  • Barium swallow
    The patient swallows a liquid containing barium and then a series of x-rays are taken. If there is an abnormal looking area, a biopsy will be performed.
  • Upper endoscopy.
    If there is an abnormal looking area, a biopsy will be performed. An inflatable balloon to stretch the esophagus can also help widen the blocked area so that food can pass through.
  • Endoscopic ultrasound.
    This is used to find out if the tumor has grown into the wall of the esophagus, how deep the tumor has grown, and whether cancer has spread to the lymph nodes or other nearby structures.
  • Biomarker testing of the tumor.
    Our Oncologist will recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests can help determine your treatment options. See Treatment Overview below for further details.
  • Computed tomography (CT) scan.
  • Magnetic resonance imaging (MRI).
  • Positron emission tomography (PET).


Treatment overview

Treatment recommendations by our cancer specialists at Onco Life Centre are tailored, personalized and depends on tumor stage, tumor genomics (HER2, PDL1, TMB, MSI, NTRK1-3 fusion, BRAF, BRCA1, BRCA2, PALB2 gene mutation status), pre-existing medical conditions, your overall health and nutritional status.

Targeted therapy and immunotherapy is the foundation of precision medicine. Our Oncologists at Onco Life Centre work in close collaboration with Cancer Genomics Experts in the US to perform cancer gene mapping and DNA sequencing on our patients’ cancer tissue. Regular teleconferencing and live exchange of information with the US Genomics Experts allows our Oncologists to specifically design unique treatment plans for our patients. By targeting specific genes and proteins that are involved in driving cancer survival and progression, our patients at Onco Life Centre are experiencing significant and sustained improvements in their cancer responses and living longer.

At Onco Life Centre, we have made it our mission to improve the everyday lives of our patients. Our Oncologists and Pharmacists will seek to identify Compassionate Drug Access Programs that allows pre-approved new drugs outside clinical trials (and prior to product launch) for our patients who do not have satisfactory therapy options available.



For most people with locally advanced esophageal cancer, ASCO recommends chemo radiotherapy or chemotherapy before surgery because combined therapy has been shown to help people live longer. After chemo radiotherapy and surgery. Immunotherapy may be recommended if tumor cells are still found in the tissue removed during surgery. If surgery is not possible, the best treatment option is often a combination of chemotherapy and radiation therapy.

The most common surgery to treat esophageal cancer is called an esophagectomy.

In addition to surgery to treat the disease, surgery may be used to help people eat and relieve symptoms caused by the cancer. This is called palliative surgery. Putting in a feeding tube can enable nutrition to be directly fed into the stomach or intestine. A tube that passes nutrition directly into a person's stomach is called a percutaneous endoscopic gastrostomy or PEG.

Targeted therapy

Targeted therapy targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. To find the most effective treatment, our oncologist will run tests to identify the genes, proteins, and other factors in your tumor.

  • HER2-targeted therapy

    Some cancers may make too much of a protein called human epidermal growth factor receptor 2 (HER2). These types of cancer are referred to as HER2-positive. When your esophageal cancer expresses high levels of HER2, it can drive its growth and spread. For HER2-positive cancers, certain types of targeted therapy may work well to treat these cancers.

  • Anti-angiogenesis therapy

    Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor.

Please click here to learn more about Targeted Therapy

Immunotherapy is designed to boost your body's natural defenses to fight the cancer. The PD-1 pathway is critical in the immune system’s ability to control cancer growth. PD-1 and PD-L1 antibodies, which are called immune checkpoint inhibitors, block this pathway and can stop the growth of esophageal cancer. Drugs that target this pathway can be effective against MSI high or MSI-H, or PD-L1 positive esophageal cancers.

ASCO recommends immune checkpoint inhibitors in combination with chemotherapy as first-line treatment for people with advanced HER2-negative, PD-L1-positive esophageal or gastro esophageal junction adenocarcinoma and squamous cell carcinoma. Combination immunotherapy involving CTLA-4 inhibitor depending on how much PD-L1 is expressed.

Please click here to learn more about Immunotherapy

Chemotherapy can be given before surgery to shrink the tumor and make it easier to completely remove it. Chemo may also be given, often along with radiation, after surgery to kill any groups of cancer cells that may have been left behind but are too small to be seen. The goal is to keep the cancer from coming back.

Chemo may also be used as the main treatment for esophageal cancer that has spread to distant organs, to relieve cancer related symptons as well as to prolong patient survival.

Radiation treatment

Before surgery, radiation can be used along with chemo to try to shrink some tumors to make surgery easier. After surgery, radiation can be used to kill very small areas of cancer that cannot be seen and removed during surgery. Radiation, especially when combined with chemotherapy (chemo), might delay or prevent the cancer from coming back after surgery and may help people to live longer. Radiation can also be used to slow the growth and ease symptoms of advanced esophageal cancer such as pain, bleeding, and trouble eating.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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