Esophageal cancer (EC) is a relatively uncommon form of cancer compared to others, but it still poses a significant health challenge in the Malaysian population.
In Malaysia, EC has become a concerning issue, as it has become one of the leading causes of cancer deaths, accounting for approximately 0.83 per cent of all cancer cases in 2022, according to Globocan.
Alarmingly, it contributed about 93.7 per cent of the mortality rate from total incidence cases in 2022. Histologically, it has two subtypes, viz. esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), with the latter contributing more than 90 per cent of total EC incidence cases.
This situation highlights the urgent need to understand the current status of EC in Malaysia and the associated multifaceted challenges.
The incidence of EC in Malaysia is influenced by various risk factors, including dietary habits, smoking, and alcohol consumption. It has been reported that the population in the northern regions in Malaysia exhibit higher rates of ESCC, which are frequently linked to the consumption of preserved and spicy foods.
In contrast, EAC is highly linked with obesity and gastroesophageal reflux disease (GERD) and is more prevalent in urban areas, where lifestyle changes could lead to increased obesity risk and altered dietary practices.
Furthermore, the diverse ethnic groups in Malaysia also play a significant role in the epidemiology of EC, with some communities exhibiting elevated risks due to high tobacco use and specific dietary habits.
These intricate interactions between cultural factors and health behaviors have further complicated prevention efforts and necessitate the development of tailored public health strategies.
Having an early diagnosis of EC remains a significant challenge in Malaysia, due to the fact that many patients are diagnosed at advanced stages, limited by a lack of awareness and insufficient screening programmes.
Some early symptoms of EC, such as difficulty swallowing, unexplained weight loss, and persistent chest pain, can be deceptive as they are frequently mistaken for symptoms of acid reflux, stress, and heartburn.
This has eventually led to many patients delaying in seeking immediate medical attention, causing the EC to progress to advanced stages. Moreover, the poor health care infrastructure also exacerbated the situation by limiting patients’ access to diagnostic tools, such as endoscopy and medical imaging equipment, specifically in rural communities.
Consequently, many patients may not receive an accurate diagnosis or timely and appropriate treatments, leading to a poor prognosis.
The disparities in access and quality of treatment between urban and rural areas have been a major barrier for most cancer patients in Malaysia.
The advanced oncological centers with different treatment options, such as surgery, chemotherapy, and radiotherapy, are mainly concentrated in urban areas, leaving patients in rural or less-developed regions with limited accessibility.
Moreover, the steep costs of cancer treatment often force patients from low-income groups to discontinue their treatment regimen and seek alternative treatment that may compromise their chances of survival.
Despite continuous efforts to improve the multidisciplinary approach in cancer care, the management of EC remains challenging, as essential services such as integration of treatment, oncology, and palliative care are unevenly accessible throughout Malaysia, hindering the comprehensive and coordinated care for EC patients.
Lastly, the current research advances focusing on EC are still in infancy level and require more work to be done in terms of both preclinical and clinical stages.
Nonetheless, enhanced efforts have been invested in early-phase clinical trials but may not be readily available on public databases. For instance, Onco Life Centre in collaboration with other research institutions in Malaysia are actively exploring the application of immune checkpoint inhibitors in treating EC patients.
Besides, the Clinical Research Malaysia has launched the initiatives like Phase 1 Realization Project (P1RP) in developing guidelines, sites, expertise, and capability, as well as managing the risks, including those related to EC.
In terms of preclinical research in EC, several research groups are currently exploring the molecular and genetic driver, as well as the roles of tumor microenvironment to understand the tumorigenesis of EC, where intensive work needs to be explored before translating to clinical trials.
In view of the challenges in managing EC in Malaysia, a collaborative approach among health care providers, policymakers, and relevant stakeholders like researchers is urgently needed to bridge current gaps in cancer care.
To improve the EC prognosis, this collaborative effort should focus on enhancing the public health education, expanding the screening programs and ensuring equitable health care access across all regions of Malaysia.
Moreover, other factors such as genetic predisposition and environmental influences contributing to the EC progression must be thoroughly studied to enhance our understanding and facilitate the development of tailored prevention and treatment strategies by investing in EC research in both preclinical and clinical phases, particularly involving Malaysia populations.
Together, these proactive measures, community engagement, and strengthened health care infrastructure can lead to earlier diagnoses, improved treatment accessibility, and better patient outcomes.
Dr Wu Yuan Seng is a molecular pharmacologist and keen to find cure to combat gastrointestinal cancers, including esophageal cancer. Dr Maverick Yap Fook Choy is a molecular biologist and expert in biodiversity and keen to create a healthy environment for humans.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
