Esophageal Cancer

What is Ayurveda?

Ayurveda is a traditional and ancient system of Indian medicine that has originated around 5000 years ago. It is a well-known fact and indeed basic principles in ayurveda preaches that health and wellness relies upon fine balance of mind, body and spirit. The word of “Ayurveda” is derived from two words: 1) “ayur” – meaning “life”, and 2) “veda” meaning “knowledge”. So, collectively Ayurveda means “knowledge of life”. Here we disscuss about Esophageal cancer , Esophgeal cancer is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach.

Ayurveda sciences, and its disease management relies firmly over concept of “doshas”. Three different types of doshas or governing principles is mentioned in Ayurveda. These doshas governs all the aspects of human physical and mental functions. The doshas are as mentioned below:

1) Vata dosha: Vata dosha is associated with the elements of air and space, as inferred by it properties. Vata dosha is concerned with all the movements and the change in the body.

2) Pitta dosha: Pitta dosha is associated with elements of fire and water, as inferred by its properties. Pitta doshas is concerned with all the transformation and the metabolism in the body.

3) Kapha dosha: Kapha dosha is associated with elements of water and earth, as inferred by its properties. Kapha doshas is concerned with all the stability and the structure in the body.

Ayurvedic science strongly believe that each individual is unique in term of specific combination of doshas, and further imbalance in the doshas can lead to different types of diseases, both physical and mental. Various different therapeutic modalities has been mentioned in Ayurveda which help in restoring the balance in the doshas and further ameliorate the disease.

Ayurveda can help in esophageal cancer patients on multiple aspects like by helping in improving the digestion, and reducing stress and anxiety. Ayurveda can improve sleep quality in esophageal cancer patients. Ayurveda can also help to modulate immunity and help in fight against esophageal cancer.

What is Esophagus?

Esophagus, which is also known as food pipe, is the muscular tube that connects the throat to the stomach. Esophagus plays a crucial role in the process of swallowing the food. It is located behind the trachea and in front of the spine. Esophagus extend from the throat, follows all the way across chest downwards, and then through the diaphragm and opening in the upper part of the stomach. The esophagus contains following layers from inward to outward are: 1) Mucosa 2) Submucosa 3) Muscularis propria 4) Serosa or Adventitia.

The most important function of the esophagus is to facilitate passage of the food from mouth to stomach, and it is one of the most important part of the digestive system. After swallowing the food, esophagus contract in wave like motion called peristalsis facilitating in passage of the food from the mouth to stomach. Inner lining of the esophagus secrete mucus which lubricate the esophageal lumen, and help in the smooth passage of the food.

Lower esophageal sphincter (LES) is a circular muscle that is located at the junction of the esophagus and the stomach. Lower esophageal sphincter (LES) relaxes to allow the food to enter the stomach, and then contracts to prevent regurgitation of the stomach acid, and its contents back into the esophagus which is commonly called as gastroesophageal reflux disease (GERD).

What is Esophageal Cancer?

Esophageal cancer, which is also known as esophageal carcinoma, is a cancerous tumor that develops in the tissues of the esophagus. It occurs when the cells of the lining grow uncontrollably and resulting into esophageal cancer. There are two main type of esophageal cancer 1) Squamous cell carcinoma 2) Adenocarcinoma. Squamous cell carcinoma mostly affects the upper 2/3rd of the esophagus, and the `adenocarcinoma affects lower 1/3rd of the esophagus.

Esophageal cancer mostly progresses slowly and can go undiagnosed in earlier stages. But, as the cancer progresses it can lead to various signs and symptoms. The exact cause of esophageal cancer is not known but certain factors can contribute to the risk of increased incidence of esophageal cancer. Long term smoking or chewing of tobacco is one of the major contributory risk factor in developing esophageal cancer. Chronic acid reflux or gastroesophageal reflux disease (GERD) may lead to development of Barrett’s esophagus which is a niche for a pre-cancerous condition. Esophageal cancer is usually diagnosed through a combination of modalities like medical history evaluation, physical examination, Endoscopy, Barium swallow, and histopathological studies of the biopsy samples.

Esophageal Cancer Statistics

Esophageal cancer is a global health concern, and is one of the common type of cancer worldwide. Below are some important statistics related to esophageal cancer:

1) Incidence:

Esophageal cancer is the eight most common type of cancer worldwide It is estimated that globally approximately 6, 04,100 cases was diagnosed in 2022, and in India it was estimated that 47,000 new cases of cancer is diagnosed. Esophageal cancer accounted for 3.2% of all cancer cases diagnosed worldwide.

2) Mortality:

Esophageal cancer is 06th leading cause of cancer related deaths globally, and approximately 544,000 deaths was attributed to esophageal cancer, accounting for almost 5.3% of all cancer related deaths. In India, approximately 42,000 deaths was registered due to esophageal cancer in year 2022.

3) Geographic Variation:

Higher incidence and mortality rates of esophageal cancer vary widely across globe, and high risk area include China, Iran, and northern parts of India. Eastern Africa, and parts of South America is also included into high risk areas. It has been noted that cases of cancer is higher in North East India as compared to Southern states.

4) Age-standardized incidence rate (ASR):

Globally, the age-standardized incidence rate (ASR) for esophageal cancer is 6.3 per 100,000 population. Highest age-standardized incidence rate (ASR) is found in Africa and Eastern Asia. Low ASR is found in regions of North America and Western Europe. In India, the age-standardized incidence rate (ASR) is 6.5% and 4.2% for males, and female population respectively. High ASR is found in North East region on India and low in Southern parts of India,

5) Types of Cancer Rate: :

Squamous cell carcinoma is the most common type of cancer globally, and accounts for almost 90% of overall esophageal cancer cases diagnosed. But in America, 70% of overall esophageal cancer cases diagnosed are Adenocarcinoma.

Types of Esophageal Cancer

There are two main types of esophageal cancer based on the types of the cells affected:

1) Squamous Cell Carcinoma:

Squamous cell carcinoma of the esophagus arise in the squamous cells. Squamous cells are flat and thin cells that line the upper 2/3rd of the esophagus. Squamous cell carcinoma is the most prominent type of esophageal cancer worldwide, and accounts for almost 90% of overall cases diagnosed. Squamous cell carcinoma is associated with tobacco use, alcohol consumption, and dietary factors.

2) Adenocarcinoma:

Adenocarcinoma of the esophagus develops from the glandular cells that produce mucus, and most commonly develops in the lower third of the esophagus. Adenocarcinoma is more prevalent in western countries, and accounts for almost 70% of esophageal cancer cases diagnosed. Chronic acid reflux disease or gastroesophageal reflux disease (GERD) may lead to development of Barrett’s Esophagus, which is a precancerous condition. Barrett’s Esophagus provides a niche to the development of adenocarcinoma in future.

There also described some less common subtypes of esophageal cancer which are:

a. Small Cell Carcinoma:

Small Cell Carcinoma of the esophagus is the rare and aggressive subtype of cancer, which grows rapidly and metastasize at earlier stages.

b. Sarcoma:

Sarcoma are the cancer that develops from the connective tissue of the esophagus such as from the muscles. Esophageal sarcomas are rare.

Symptoms of Esophageal cancer

Esophageal Cancer is defined by the malignant growth of the cells in the esophagus. The symptoms of the esophagus can vary depending on the stage and the location of the cancer. In initial stages, esophageal cancer can be asymptomatic but as the cancer progresses it can produce wide range of symptoms. Further is mentioned some common symptoms of esophageal cancer:

1) Difficulty in swallowing or Dysphagia:

Dysphagia is also commonly called difficulty in swallowing, and in esophageal cancer dysphagia is one of the most prominent complaints of the patients, and it can gradually worsen over time. Initially swallowing solids food can be challenge but as the cancer progresses swallowing liquids can also prove difficult.

2) Chest pain or discomfort:

Chest pain or discomfort is characterized by burning sensation in the retrosternal region, and the pain or burning sensation can worsen after swallowing or eating.

3) Chronic cough:

Chronic cough in the esophageal cancer can be characterized by cough that does not goes away or responds to conventional line of treatment, and progressively worsens over time. Chronic cough in esophageal cancer can be accompanied by blood in the cough or haemoptysis.

4) Regurgitation:

Regurgitation in the esophageal cancer is characterized by backflow of the swallowed material in the mouth and can further cause unpleasant taste.

5) Hoarseness in the voice:

Hoarseness in esophageal cancer is characterized by voice change that can gradually worsen over time or does not respond to conventional line of treatment or management. Hoarseness in the esophageal cancer can be due to tumour affecting the nerves supplying the vocal cords.

Many other symptoms of liver cancer include unintentional weight loss, fatigue, weakness etc. It is most important to note that having a particular symptom does not necessarily mean that you have stomach cancer. Kindly connect with your healthcare provider for further advice.

Treatment of Esophageal cancer

The treatment of esophageal cancer is typically a multi-pronged approach which involves a combination of different treatment approaches, and it depends on the stage of cancer, the location of the neoplasm, and overall general health status of the patient. The treatment options for esophageal cancer include:

1) Surgery:

Surgery is one of the most important treatment modalities in early-stage esophageal cancer. In surgical procedure, the tumor along with surrounding healthy tissue is removed. If cancer has proliferated more then entire esophagus is removed (esophagectomy), and the stomach is used to reconstruct the digestive tract.

2) Chemotherapy:

Chemotherapy involves the use of different cytotoxic drugs that is used to kill the cancer cells. Chemotherapy can be used in combination with surgery, radiation therapy, and or targeted therapy.

3) Targeted Therapy:

Targeted therapies involves administering drugs that specifically targets specific protein or molecular pathways that can be vital for the growth of the esophageal cancer. Targeted therapy can be used in combination with chemotherapy for better results.

4) Immunotherapy:

Immunotherapy involves administration of the drugs that helps the patient immune system to recognize cancer cells and kill it. Immunotherapy is promising in advanced stage cancer patients.

Esophageal Cancer in Ayurveda or आयुर्वेद में अन्ननलिका कैंसर

In Ayurveda texts, no such specific term designating esophagus cancer is mentioned or described, but its ‘Dosha Samprapti or Etiopathology’ can be compared with the topic or roga called ‘Arbuda/अर्बुद’. When the same dosha and dushya samprapti as mentioned in Arbuda/अर्बुद affects annanalika (अन्ननलिका), it is called अन्ननलिका अर्बुद or esophagus cancer.

It is most important to note that when a specific composition and set of doshas (vitiated Kapha and Vata Dosha) which when affects Mansha dhatu causes ‘Arbuda/अर्बुद’, and when the same set of doshas affects अन्ननलिका it causes ‘Esophagus Cancer or अन्ननलिका अर्बुद’.

As it widely mentioned in Ayurvedic texts that a balanced vata dosha is responsible for controlled cell division or proliferation, and a balanced Kapha dosha provides the building blocks or material for cell division, and necessary signals for cell proliferation. And when both kapha and vata dosha is vitiated or imbalanced in accordance of our normal sharirik and mansik prakriti it can lead to uncontrolled and abnormal growth or cell division due to sustained proliferative signaling leading to the development of ‘Esophagus Cancer or अन्ननलिका अर्बुद’.

Treatment of Esophagus Cancer or अन्ननलिका अर्बुद in Ayurveda

Ayurveda is the oldest and Indian indigenous system of medicine system, and is well known from very early centuries for preventing or suppressing various tumors. And nowadays scientists are keener to research on Ayurveda for the management of cancer.

The main goal of Ayurveda therapy is to find the cause of a Cancer while the therapeutic approach of Ayurveda is simply divided into two major categories

Oral Medications
Panchakarma

1) Strychnous nux vomica (Kuchla) in Esophagus Cancer

Strychnous nux vomica is species of plant that is native to Southeast Asia and India. It is commonly known in Ayurveda as Kuchla (कुचला), and belong to the family Loganiaceae. It is most important to note that Strychnous nux vomica or Kuchla (कुचला) has toxic properties.

Kuchla (कुचला) has been used in traditional ayurvedic medicines since many centuries for respiratory diseases, digestive disorders, and most importantly as nervine tonic. Modern research have revealed that Strychnos nux-vomica (Kuchla) is effective against cancer cells proliferation, and induces cancer cells death via apoptosis.

Agnitundi Vati (अग्नितुंडी वटी) in Esophageal Cancer

Agnitundi vati is a herbo-mineral ayurvedic formulation in a tablet or vati form, that is primarily prescribed in digestive disorders and fever. Agnitundi Vati (अग्नितुंडी वटी) is prepared by mixing different ingredients like purified mercury, purified Sulphur, Aamlaki (Phyllanthus embilica), Haritaki (Terminalia chebula), Vibhitaki (Terminalia bellirica), Strychnous nux vomica (Kuchla) etc. The entire mixture is titrated in fresh lemon juice, and a thick paste like consistency is achieved, and tablets or pills is prepared. The tablets or pills is then sun dried. Agnitundi Vati can prove beneficial in esophageal cancer patients.

Aconitum heterophyllum or Ativisha (अतिविषा) in Esophageal Cancer

Aconitum heterophyllum which is commonly known as Indian Aconite or Atis, is a plant species that belongs to Ranunculaceae family, and is native to Himalayan region of India, Nepal, and Bhutan. Aconitum heterophyllum has a long history of medicinal uses in Ayurveda. Traditionally, roots of the Aconite is used in different medical formulation and have analgesic, antipyretic, and anti-inflammatory properties. The anti-cancer properties of Aconitum heterophyllum is elucidated in following points mentioned below:

1) Cytotoxic activity: Aconitum heterophyllum exhibit cytotoxic effects by inducing cell cycle arrest and promote apoptosis (programmed cell death) in cancer cells

2) Anti-angiogenic activity: Angiogenesis is the formation of new blood vessels, and it plays a vital role in tumor proliferation and metastatis. By inhibiting angiogenesis, aconite inhibits the growth of new blood vessels and further limits the growth of the tumor.

3) Anti-inflammatory effects: It is well researched fact that chronic inflammation plays a vital role in the pathogenesis of development and progression of the cancer. Chronic inflammation provides sustained proliferative signaling which is imperative to the growth of the tumor. Aconitum heterophyllum proves beneficial in esophageal cancer patients by reducing the inflammation related processes.

Ativishadi Kwatha (अतिविषादि क्वाथ) in Esophagus Cancer

सामे सातिविषं व्योषं लवणक्षारहिङ्गु च|

निःक्वाथ्य पाययेच्चूर्णं कृत्वा वा कोष्णवारिणा|| Charak Samhita Chikitsasthan 15/105

Decoction of Ativisha, trikatu, sainndhav lavana, kshar and hingu can be administered in esophageal cancer patients or dried powders of the above mentioned formulation can also be administered. Ativishadi kwatha or powder can prove beneficial in esophageal cancer patients.

Yasad Bhasma (यशद भस्म) in Esophageal Cancer

Yasad Bhasma (यशद भस्म), which is also known as Jasada Bhasma, is a traditional Ayurvedic formulation that has used in different range of diseases since many centuries in traditional system of Indian medicine. Scientifically, Yasad Bhasma (यशद भस्म) is called as Zinc Oxide. Yasad Bhasma is prepared by first undergoing series of purification procedure on Yasad (Zinc), and afterward that purified Yasad (Zinc) is incinerated at high temperatures in controlled environment, and Yasad Bhasma is prepared. Yasad Bhasma (यशद भस्म) has several therapeutic properties and is used in multiple ailments, and is one of the most important drugs in Ayurveda.

Yasad Bhasma (यशद भस्म) is used in treatment of respiratory disorders, digestive ailments, and many neurological conditions. Yasad Bhasma (यशद भस्म) possesses good antimicrobial and astringent properties, and is good in wound healing and managing infections. Modern research has revealed that zinc has beneficial effects on cancer by decreasing angiogenesis and induction of inflammatory cytokines while increasing apoptosis in cancer cells.

Mrudu Virechan (विरेचन) in Esophageal Cancer

If Cancer is of mild grade, and no symptoms or mild symptom of dysphagia is present, mrudu virechan can be advised can be administered with utmost care.

Virechana Karma is one of the most important purification therapies mentioned under Panchakarma in Ayurveda. Virechana Karma mainly focusses on eliminating excessive dustha doshas mainly pitta dosha and kapha from the body. Virechana Karma involves administration of purgative medications to induce controlled and gentle purgation, and it eventually stops on its own.

About Team ‘Cancer In Ayurveda’

Team ‘Cancer In Ayurveda’ is a dedicated group of researchers and practitioners, and is focused in exploring the potential of Ayurveda in the successful management and treatment of cancer. Team ‘Cancer In Ayurveda’ recognizes the growing prevalence of cancer, and believes the limitation of conventional treatment in the management of cancer.

Team ‘Cancer In Ayurveda’ believe that Ayurveda can offer personalized approach toward the treatment of cancer, and emphasizes on different Ayurvedic Treatment modalities in the successful treatment of cancer.

Team ‘Cancer In Ayurveda’ strongly believes in providing comprehensive and holistic approach in the treatment of esophageal cancer patient. Efforts of Team ‘Cancer In Ayurveda’ is focused on `improving the quality of life of cancer patients and enhance survivorship.

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