ESOPHAGEAL CANCER

  • Home
  • ESOPHAGEAL CANCER

Esophageal Cancer is a type of cancer that occurs in the esophagus, the long, hollow tube that runs from the throat to the stomach. The esophagus carries food and liquids from the mouth to the stomach. Esophageal cancer typically begins in the cells lining the inside of the esophagus and can occur anywhere along its length.

 

Types of Esophageal Cancer

There are two primary types of esophageal cancer, classified based on the type of cells involved:

  1. Adenocarcinoma:

    • The most common type in the United States, it usually starts in the lower part of the esophagus, near the stomach.
    • Adenocarcinoma often arises from Barrett’s esophagus, a condition in which the lining of the esophagus is damaged by stomach acid and changes to tissue similar to the lining of the intestine.

  2. Squamous Cell Carcinoma:

    • More common globally, especially in parts of Asia and Africa.
    • Typically starts in the upper or middle part of the esophagus.
    • It develops from the flat cells that line the esophagus.

Risk Factors

  • Tobacco Use: Smoking or chewing tobacco significantly increases the risk.
  • Heavy Alcohol Consumption: Chronic alcohol use, especially in combination with smoking.
  • Gastroesophageal Reflux Disease (GERD): Chronic acid reflux can damage the lining of the esophagus, leading to Barrett’s esophagus and increasing cancer risk.
  • Barrett’s Esophagus: A condition where the esophagus lining is replaced by tissue similar to the intestinal lining.
  • Obesity: Associated with an increased risk of adenocarcinoma of the esophagus.
  • Dietary Factors: Low intake of fruits and vegetables, high intake of processed meats, and certain toxins, such as nitrosamines found in pickled vegetables and smoked foods.
  • Achalasia: A condition where the lower esophageal sphincter fails to relax properly, leading to difficulty swallowing and increased cancer risk.
  • History of Radiation Therapy: Particularly to the chest or upper abdomen.
  • Age and Gender: Esophageal cancer is more common in men and typically occurs in older adults, with most cases diagnosed in individuals over 60.

Symptoms

  • Difficulty Swallowing (Dysphagia): The most common symptom, often starting with difficulty swallowing solid foods and progressing to liquids.
  • Unintended Weight Loss: Significant and unexplained weight loss.
  • Chest Pain or Discomfort: Pain or burning sensation in the chest, particularly after eating.
  • Hoarseness or Coughing: Persistent cough or hoarseness, particularly if the cancer affects the vocal cords.
  • Indigestion or Heartburn: Chronic heartburn or acid reflux that doesn’t respond to treatment.
  • Vomiting: Sometimes with blood.

Diagnosis

  • Endoscopy: A thin, flexible tube with a light and camera is inserted down the throat to examine the esophagus. During the procedure, a biopsy may be taken for further examination.
  • Barium Swallow (Esophagram): A type of X-ray that involves swallowing a barium solution to outline the esophagus on imaging.
  • CT Scan or PET Scan: Used to determine if the cancer has spread to other areas of the body.
  • Endoscopic Ultrasound (EUS): Combines endoscopy and ultrasound to assess the extent of cancer invasion into the esophageal wall and nearby lymph nodes.
  • Biopsy: The definitive diagnosis is made by examining a tissue sample under a microscope.

Treatment

Treatment options depend on the stage of the cancer, the location, and the patient’s overall health:

  • Surgery:

    • Esophagectomy: The most common surgical procedure, where part or all of the esophagus is removed, sometimes along with the upper part of the stomach.
    • Esophagogastrectomy: Involves removing a portion of the esophagus and stomach.

  • Radiation Therapy:

    • Often combined with chemotherapy (chemoradiation) before surgery to shrink the tumor.
    • Can also be used palliatively to relieve symptoms in advanced cancer.

  • Chemotherapy:

    • Used before surgery to shrink the tumor or after surgery to kill remaining cancer cells.
    • In some cases, chemotherapy may be used alone for advanced cancer.

  • Targeted Therapy:

    • Drugs that target specific molecules involved in cancer growth, such as HER2-positive tumors or tumors with certain genetic mutations.

  • Immunotherapy:

    • Boosts the body’s immune system to fight cancer, used particularly in advanced or recurrent esophageal cancer.

  • Endoscopic Treatments:

    • Endoscopic Mucosal Resection (EMR): Used for very early-stage cancers, where the tumor is removed through the endoscope.
    • Photodynamic Therapy (PDT): Involves using a photosensitizing agent and laser to kill cancer cells, often used for palliative care.

Prognosis

The prognosis for esophageal cancer depends on the cancer’s stage at diagnosis, with early-stage cancers having a better prognosis. Unfortunately, esophageal cancer is often diagnosed at an advanced stage, making treatment more challenging. The overall five-year survival rate is relatively low, but advances in treatment are improving outcomes, especially for patients diagnosed at an earlier stage.

Regular follow-ups and monitoring are essential for managing esophageal cancer, and lifestyle changes, such as quitting smoking and alcohol, can help reduce the risk of recurrence.