Weight Loss,Not Just Swallowing Trouble: A Missed Red Flag for Esophageal Cancer in Rural India, Finds Maharashtra Study

Wardha,Maharashtra: An alarming new study from a tertiary care hospital in rural Maharashtra has revealed a disturbing trend in esophageal cancer diagnosis—patients are reaching hospitals far too late, when curative treatment is no longer possible.

The prospective study, conducted between 2022 and 2025 at Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Wardha, analysed 110 cases of esophageal carcinoma. It found that the disease predominantly affects people in their productive working years, is frequently diagnosed at an advanced stage, and remains financially out of reach for curative surgery for most patients.

Squamous Cell Carcinoma Dominates: Unlike Western countries, where esophageal adenocarcinoma is on the rise, the Wardha study found an overwhelming dominance of squamous cell carcinoma (80–91%), a subtype strongly linked to tobacco, alcohol, and kharra consumption—habits still common in rural India.

Women More Affected Than Men: In a surprising demographic shift, women accounted for 56.36% of cases, outnumbering men. Housewives formed the largest occupational group, highlighting a neglected at-risk population. Most patients were aged 51–70 years, with cases ranging from as young as 21 to as old as 88 years.

Worryingly, 41.82% of patients were underweight at diagnosis, pointing to severe undernutrition that both contributes to and worsens disease outcomes.

Dr. Vijendra V. Kirnake, Professor and Head, Department of Gastroenterology said “The typical patient we see is from a rural background—often a woman in her 50s or 60s who presents with marked weight loss and difficulty swallowing. By then, the cancer is already advanced,” 

Late Diagnosis a Major Concern

The study exposes a major failure in early detection:

• 37.27% of patients had distant metastasis at diagnosis

• 76.36% had lymph node involvement

• The most common presenting symptom was significant weight loss (22.73%), not early swallowing difficulty

“Weight loss is a red flag,” Dr. Kirnake explained. “By the time it becomes noticeable, the window for curative treatment is often closing. Even mild, persistent swallowing difficulty must prompt early investigation.” 

Curative Treatment Out of Reach for Most

Only 27.27% of patients were able to undergo potentially curative surgery. The majority received palliative care, including:

• Stent placement (45.45%)

• Palliative chemotherapy (47.27%)

These interventions aim to relieve symptoms rather than cure the disease.

High Mortality at One Year

One-year follow-up data paints a stark picture:

• Only 40% achieved remission

• 26.36% of patients died

Mortality was strongly linked to advanced cancer stage, lymph node involvement, poor physical condition, lack of surgery, and notably, being underweight, which emerged as an independent predictor of death.

“These are not just cancer deaths—they are deaths due to late presentation,” Dr. Kirnake stressed. “Surgery clearly improves survival, but only if the disease is detected early. Unfortunately, we are missing that opportunity.” I lost my grandfather who was a resident of Wardha due to a late diagnosis of Carcinoma Esophagus in stage 4 condition. Till date Hospital has managed around 450 Carcinoma Esophagus patients in last 5 years

Call for Public Health Action

The study calls for urgent public health interventions, including:

• Stronger tobacco and kharra cessation programs

• Community-level awareness about early symptoms

• A low threshold for endoscopic evaluation in high-risk populations

In central India where esophageal cancer remains common early diagnosis can transform outcomes, shifting care from late-stage palliation to life-saving intervention.

Carcinoma Esophagus (Esophageal Cancer)

Warning Signs

• Difficulty or pain while swallowing

• Vomiting or frequent choking

• Unexplained weight loss

• Persistent cough or hoarseness

• Chest or throat pain

Diagnosis

• Gastroscopy with biopsy

• Barium swallow

• CT scan

Treatment

• Surgery

• Radiotherapy

• Chemotherapy

• Palliative esophageal stenting

Prevention

• Avoid tobacco, kharra & alcohol

• Eat healthy food rich in fruits & fiber

• Stay physically active & maintain healthy weight

Care at AVBRH: Dedicated Gastroenterology & Cancer Departments offering advanced endoscopy, interventional radiology, surgery, chemotherapy & radiation — all under one roof.