Epidemiological Trends and Clinical Characteristics of Esophageal Cancer in North-East India: A Hospital-Based Descriptive Study from a Tertiary Cancer Center

Abstract

Background: Esophageal cancer (EC) represents a significant public health burden in North-East India, with a substantially higher incidence compared to other regions globally. This hospital-based descriptive study aims to characterize the epidemiological trends, clinical characteristics, and treatment patterns of esophageal cancer patients in the North-East region of India. Methods: A hospital-based descriptive study was conducted analyzing clinical and epidemiological data of 1,937 esophageal cancer cases registered between 2018 and 2022 at the State Cancer Institute, Gauhati Medical College, Assam, India. Demographic data, clinical presentation, histopathology, tumor location, staging, and treatment modalities were systematically extracted and analyzed. Stratified analyses were performed by gender, age, and disease extent. Results: The study cohort comprised 1,284 males (66.3%) and 653 females (33.7%), yielding a male-to-female ratio of approximately 2:1. Esophageal cancer accounted for 15.4% of all malignancies in males and 8.5% in females. The mean age at presentation was predominantly in the sixth decade of life. Tobacco and alcohol consumption were identified as significant risk factors, present in 73.5% of cases. Squamous cell carcinoma was the predominant histopathological type (91.6%), with the middle third of the esophagus being the most common site of involvement (67.7%). At diagnosis, 32.6% of patients presented with localized disease, 52.8% with regional involvement, and 14.6% with distant metastases. Combined radiotherapy and chemotherapy (R+C) was the predominant treatment modality, accounting for 46.5% of male and 43.9% of female patient cases. Single-modality therapy was administered to 39.3% of males and 41.6% of females. Surgical intervention was performed in 6.7% of males and 5.9% of females. Conclusion: This hospital-based study confirms the high burden of esophageal cancer in North-East India with marked male predominance. Tobacco and alcohol use remain the dominant etiological factors. Most patients present at advanced stages with regional disease. Multimodal treatment approaches, particularly combined chemoradiotherapy, are the primary management strategy at tertiary care centers. These findings underscore the urgent need for region-specific prevention strategies, early detection programs, and equitable access to evidence-based multimodal treatment to improve outcomes in this high-incidence population.