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Esophageal cancer arises in a hollow, long muscular tube that carries food from the throat to the stomach for digestion. The cells that are lining inside the esophagus are where esophageal cancer tends to develop. The disease can arise in any part of esophagus. It often happens to more men than women.
The disease has been found to be the top sixth cause of deaths from cancer across the globe. In some parts of the world, esophageal cancer could be associated with the use of tobacco and alcohol or certain dietary habits and obesity.
Symptoms
- Dysphagia or difficulty swallowing
- Unintentional weight loss
- Pain, pressure or burning in the chest
- Heartburn
- Coughs or hoarseness
When esophageal cancer is in the early stage, there may be no signs or symptoms appear.
If Barrett’s esophagus, a precancerous condition has been detected in a patient that have chronic acid reflux, he or she is more likely to develop esophageal cancer and therefore are recommended to undergo screening for esophageal cancer.
Causes
The cause of esophageal cancer is unclear. However, it is known that the disease develops when cells in the esophagus mutate in their DNA causing cells to grow and multiply. When the cells divide they build up and from into a tumor in the esophagus. This tumor then begins to invade and destroy the normal cells. These cells have the tendency to metastasize (spread to other parts of the body).
Types of esophageal cancer
The types of cells that are involved in esophageal cancer can be determine the types of esophageal cancer a patient has.
- Adenocarcinoma: This type of esophageal cancer initiates in the cells of glands that secrete mucus in the esophagus. It commonly happens in the lower part of the organ.
- Squamous cell carcinoma: These cells have a flat and thin structure. They appear on the surface of the esophagus. This type develops mostly in the top and middle sections of the organ.
- Other types: Small cell carcinoma, sarcoma, lymphoma, melanoma and choriocarcinoma are some of the uncommon types of esophageal cancer.
Risk factors
If the esophagus has chronic irritations, the cells mutate and causes esophageal cancer.
The following are the factors that contribute to esophagus irritation:
- Having gastroesophageal reflux disease or GERD
- Having Barrett’s esophagus
- Having bile reflux
- Having achalasia
- Smoking
- Obesity
- The use of alcohol
- Having regular habit of drinking hot fluids
- Insufficient consumption of fruits and vegetables
- Receiving radiation treatment to the chest or upper abdomen
Diagnosis
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Barium swallow study: Requires the patient to swallow liquid that contains barium, then undergo X–rays. The barium that covers the inside of the esophagus will signify any changes in the tissues, which will appear on the X–ray.
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Esophagoscopy: Is an endoscopic procedure of the esophagus. A flexible tube with a camera attached to the tip will be inserted in the throat through the mouth and into the esophagus to examine the esophagus and detect irritations.
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Biopsy: Doctor will take a sample of tissues during the esophagoscopy. The sample will then be sent to a laboratory for cancer test.
Determining the stage of the cancer
After esophageal cancer has been diagnosed, the doctor could recommend further tests to find out whether the cancer has spread.
The following tests may include:
- Bronchoscopy
- Endoscopic ultrasound (EUS)
- Computerized tomography (CT)
- Positron emission tomography (PET)
The information from the tests above will contribute to the evaluation of the cancer staging. The stages of the disease are signified Roman numerals that range from 0 to IV. The lowest stage is an indication of cancer affecting the superficial layers of the esophagus. The cancer has progressed to an advanced level and has invaded other parts of the body, when stage IV indicated. The stage of the cancer will determine the appropriate treatment option for the patient.
Treatment
The treatment option depends on the type of cancer cells, the severity of the disease and the patient’s health status.
Surgery
Surgical removal of the cancer can be done on its own or in combination with other treatment options.
- Surgical removal of very small tumors: If the cancer is tiny and has only occupied the surface level of the esophagus and has not spread to other parts, the cancer and healthy surrounding tissues will be removed by surgery. An endoscope will be passed down to the throat and into the esophagus to remove the cancer.
- Esophagectomy: A surgical removal of part of the esophagus that has cancer. A part of the upper stomach, and surrounding lymph nodes may also be removed. The rest of the esophagus will then be reattached to the stomach by lifting the stomach towards the esophagus.
- Esophagogastrectomy: A surgical removal of a part of the esophagus and the upper portion of the stomach. This procedure includes the operation a part of the esophagus, surrounding lymph nodes and a bigger part of the stomach. The remaining part of the stomach is lifted to join the esophagus. A part of the colon may be used to reconnect the two organs, if needed.
Surgical procedure for esophageal cancer can have complications, such as infection, bleeding, and leakage, which could occur in the area where the remainder of the esophagus is reconnected to the stomach. Removal of the esophagus can be done by an open surgery with large incisions or with minimally invasive laparoscopic surgery. The technique that will be used depends on the treatment plan of the doctor.
Treatments for complications
- Treatment for esophageal obstruction. In case when esophageal cancer causes the esophagus to become narrow, a metal tube or a stent will be placed inside the esophagus to hold it open. This will be done by an endoscope. Surgery, radiation therapy, chemotherapy, laser therapy and photodynamic therapy could be an alternative option to relieve the obstruction.
- Providing nutrition with the help of a feeding tube if there is difficulty swallowing or if the patient has esophagus surgery. The feeding tube will carry nutrition and deliver them directly to the stomach or small intestine, allowing the esophagus to restore.
Chemotherapy
Chemotherapy is a treatment that uses chemicals to destroy cancer cells. This type of drug is commonly used before or after the esophageal cancer surgery. Chemotherapy can be used with radiation therapy.
When the cancer has progressed and spread further than the esophagus, the use of chemotherapy only, can help relieve the symptoms.
Radiation therapy
Radiation therapy is use of powerful energy beams, such as X–rays and protons, to cause the cancer cells to die. Radiation therapy is given to patients with esophageal cancer in combinations with chemotherapy. It is usually given before the surgery. Complications that arise from an advanced level of esophageal cancer can be relieved by radiation therapy.
Combined chemotherapy and radiation
Combination of chemotherapy and radiation therapy can increase the effectiveness of each treatment. Combined treatment could be the only to treatment for certain patients or before the surgery.
Targeted drug therapy
Targeted therapy kills cancer cells by blocking the weak factors. The combination of targeted therapy and chemotherapy are typically used to treat advanced level of esophageal cancer or when other treatments have not shown any results.
Immunotherapy
Immunotherapy uses drugs to help the immune system to fight against cancer by identifying the cancer cells that have been hidden by proteins.
Immunotherapy is used to treat advanced level of esophageal cancer or when the cancer is recurrent or metastasized.
