What Is Esophageal Cancer? What Is Cancer Of The Esophagus?

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Main Category: GastroIntestinal / Gastroenterology
Also Included In: Ear, Nose and Throat;  Cancer / Oncology
Article Date: 01 Dec 2009 - 0:00 PDT

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Esophageal cancer, also known as cancer of the esophagus is a malignant tumor of the esophagus, the tube that connects the throat (pharynx) with the stomach. The esophagus is also known as the gullet. Esophageal cancer is rare, and more common in Asia and parts of Africa, compared to Western Europe and North America.

There are approximately 7,000 new cases in the United Kingdom each year. The National Cancer Institute, USA, estimates that by the end of 2010 16,640 Americans will have been diagnosed with esophageal cancer.

In developed nations most cases occur in individuals aged at least 55 years. Initial symptoms include swallowing difficulties (dysphagia). Unfortunately, when most people are diagnosed, the cancer is well advanced. Even though a cure is much less likely with advanced cancers, modern therapies can slow down its progress.

There are various subtypes of esophageal cancer, the two main ones are:

• Squamous cell carcinoma about 40% of all esophageal cancers are of this type (Source: NHS, United Kingdom). Squamous cell cancer arises from the cells lining the upper part of the esophagus.
• Adenocarcinoma of the esophagus about 60% of all esophageal cancers are of this type (Source: NHS, United Kingdom). It arises from the glandular cells that exist at the junction of the esophagus and the stomach.
• Other rare types include choriocarcinoma, lymphoma, melanoma, sarcoma and small cell cancer.

The treatment, symptoms and prognosis for both main types of esophageal cancers are similar.

What are the signs and symptoms of cancer of the esophagus?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Most patients experience no symptoms during the initial stages of this cancer. That is why the majority of diagnoses occur when the cancer is well advanced. When symptoms are present, they may include:

• Dysphagia - swallowing difficulties. As the tumor narrows the passage in the esophagus, getting food through becomes harder. This is usually the first symptom.
• Regurgitating - some will call it vomiting. Food gets stuck, and comes back up.
• Weight loss.
• Cough - becomes more common when the patient is trying to swallow. Sometimes the patient may cough up blood.
• Voice changes - typically, the patient's voice becomes hoarse.
• Pain - and discomfort in the throat.
• Acid reflux - especially when the cancer affects the lower part of the esophagus.
• Chest pain (linked to acid reflux)

What causes cancer of the esophagus?

Cancer is a class of diseases characterized by out-of-control cell growth. Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can grow and interfere with and alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign, dangerous cancer that spreads is malignant.

More dangerous, or malignant, tumors form when two things occur: 1. a cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue in a process called invasion. 2. that cell manages to divide and grow, making new blood vessels to feed itself in a process called angiogenesis.

If the patient with malignant cancer receives no treatment, it can grow and spread to other parts of the body (metastasis). As soon as the cancer gets into the lymphatic system it can more effectively reach other parts of the body, including vital organs.

Experts do not know exactly why the runaway growth of cancer cells starts.

The following risk factors are linked to esophageal factors:

• Achalasia - a type of esophageal motility disorder.
• Age - the chances of developing this type of cancer are much higher for patients aged over 60 years.
• Alcohol - people who consume large amounts of alcohol regularly have a higher risk. For people who smoke and drink a lot (do both), the risk is much higher than the two factors added up separately. People whose faces flush (go red) when they drink have a higher risk if they consume alcohol regularly.
• Celiac disease - patients with celiac disease have a higher risk of developing squamous cell carcinoma.
• Diet - some studies indicate that people who eat very low quantities of fruit and vegetables have a higher risk of developing this type of cancer.
• Genes - anybody with a parent or sibling who has/had esophageal cancer has a higher risk of developing it themselves.
• GERD (gastroesophageal reflux disease) - known as acid reflux. Patients can develop Barret's esophagus, increasing the risk of eventual malignancy.
• HPV ( human papillomavirus)
• Long-term exposure to some chemicals/irritants - such as soot, metal dust, exhaust fumes, lye, and silica dust.
• Males have a higher risk than females.
• Obesity - a much higher percentage of obese individuals develop esophageal cancer compared to people of normal weight. According to the National Health Service (NHS), UK, the risk is double.
• Other cancers - people who have had head and neck cancers have a significantly higher risk of developing cancer of the esophagus.
• Radiotherapy (radiation therapy) to the chest or head.
• Smoking - especially long-term, heavy, regular smoking.

How is esophageal cancer diagnosed?

The first person a patient will visit is usually a GP (general practitioner, primary care physician). The GP will carefully check the patient's medical history, ask about symptoms, and then carry out a physical examination. If any signs are detected, or if the GP suspects esophageal cancer, the individual will be referred to a specialist doctor

The following diagnostic tests will be ordered:

• Gastroscopy (endoscopy) - a long, thin instrument (endoscope) is passed through the patient's mouth, into the espophagus and towards the stomach. The endoscope has a light and camera at the end - the doctor sees the images on a screen and determines whether there are any tumors or abnormalities.
• Biopsy - a sample of tissue may be taken if during the endoscopy the doctor sees anything unusual. The sample is then examined under a microscope by a pathologist, who can determine whether or not there are any cancerous cells.
• Barium swallow test - the patient drinks a liquid that contains barium. Barium shows up on x-rays. Several x-ray pictures are taken at intervals. They will reveal whether there are any obstructions (which would be caused by a tumor).
• Endoscopic ultrasound - a small ultrasound probe is attached to an endoscope and is inserted through the patient's mouth into a targeted area. This test is usually done when the doctor knows there is cancer, but wants to have a better look at the tumor on a monitor. With this type of test it may be possible to determine whether the cancer has spread into nearby tissue.
• Other imaging scans - a CT scan may be ordered to help determine whether the cancer has spread, and if so, where to.

Staging the cancer - determining how much the cancer has advanced:

• Stage 1 - the cancer has not spread out of its original area. It is still only within the top layers of the esophagus lining.
• Stage 2 - the cancer has reached a layer of muscle close to the esophagus. The cancer has not yet reached any lymph nodes.
• Stage 2b - the cancer has spread to both the muscles that surround the esophagus as well as the lymph nodes.
• Stage 3 - the cancer has not spread to other parts of the body. But it has spread through the esophagus wall, nearby lymph nodes, as well as the muscles that surround the esophagus.
• Stage 4 - metastasis. The cancer has spread to other parts of the body, including vital organs.

What are the treatment options for esophageal cancer?

Recommended treatment options depend on several factors, including the cellular type of cancer, its stage, the general health and age of the patient, and whether other diseases are present. Treatment options include surgery, chemotherapy and radiation therapy (radiotherapy).

If the patient is unable to swallow, a stent may be inserted to keep the esophagus unblocked. A nasogastric tube (through the nose) may be needed to for feeding while the tumor is treated. Some may require a gastrostomy - a feeding hole in the skin that gives direct access to the stomach.

The medical team's aim is either to take out the whole tumor and any other cancerous cells, or stop the tumor from getting any bigger. Surgery:

• Esophagectomy - this is an operation to remove part of the esophagus. The section of the esophagus that contains the tumor is removed, after which the esophagus is reconnected to the stomach. Sometimes a small section of the large intestine is used to help connect the esophagus and the stomach.
• Oesophagogastrectomy - this includes the surgical removal of a part of the esophagus where the tumor is, as well as parts of the stomach and nearby lymph nodes. If the surgeon cannot connect the stomach and esophagus properly afterwards, a small part of the large intestine may be used.
• PDT (photodynamic therapy) - a special substance is injected into the esophagus that makes the cells extra sensitive to light. With an endoscope that has a laser attached to the end, the surgeon destroys cancer cells by burning them.

Chemotherapy - the use of chemicals to destroy cancer cells. Chemotherapy may be used before and/or after surgery, and is sometimes used in combination with radiation therapy. In most cancers, chemotherapy aims to cure the patient, delay or prevent recurrence, slow down cancer progression, or to relieve symptoms (in advanced cancer).

Radiation therapy (radiotherapy) - involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells. Radiotherapy works by damaging the DNA inside the tumor cells, destroying their ability to reproduce. This can either be applied externally (external beam radiation) or internally (brachytherapy). In cases of esophageal cancer, radiation therapy is usually given in combination with chemotherapy. Radiation therapy may also be given before or after surgery.

Written by Christian Nordqvist


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