Esophageal cancer or Esophagus cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.
Esophageal cancer is less well known than lung cancer, but nothing less serious. It starts in the inner layer of the esophagus, the 10-inch long tube that connects throat and stomach.
The most common symptom, which usually occurs late in the disease, is difficulty swallowing and a sensation of food sticking in your throat or chest.
In Bogie’s day, the outlook for people with esophageal cancer was poor. But survival rates have improved, in part because close monitoring of Barrett’s esophagus — a serious, premalignant complication of acid reflux disease — can help detect esophageal cancer early, when it’s more likely to respond to treatment. Even more important is that diet and lifestyle changes can significantly reduce the chances of ever developing this type of cancer.
As mentioned the esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach.
The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue.
Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows.
The stomach and esophagus are a part of the upper digestive system.
Cancer can occur almost anywhere along the length of the esophagus and is classified according to the types of cells in which it originates.
The two most common forms of Esophageal cancer or Esophagus cancer are named for the type of cells that become malignant (cancerous):
Squamous cell carcinoma: The most common esophageal cancer or esophagus cancer in black Americans and the most prevalent esophageal cancer worldwide.
Squamous cells are the thin, flat cells lining the esophagus. The cancer that forms in these cells is Squamous cell carcinoma.
This cancer is most often found in the upper and middle part of the esophagus, but can occur anywhere along the esophagus. This is also called epidermoid carcinoma.
Adenocarcinoma: Adenocarcinoma is more common in white than in black Americans, and is the fastest increasing cancer in the United States. Cancer that begins in glandular (secretory) cells is called Adenocarcinoma. Glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.
Cause of Esophageal Cancer
Healthy cells tend to grow and divide in an orderly way. This process is controlled by DNA. DNA is the genetic material that contains the instructions for every chemical process in the body. When this is damaged, changes occur in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of malignant cells.
Although the exact cause of esophageal cancer or esophagus cancer are not known, many factors are identified that can damage DNA in the esophagus which may lead to esophageal cancer. These factors include:
- Consumption of too much alcohol
- Smoking or use of tobacco
- Chronic acid reflux, a condition in which the lower esophageal sphincter relaxes abnormally or weakens, allowing caustic stomach acids to back up into your esophagus (esophageal reflux). The result is heartburn — a burning chest discomfort that in severe cases may mimic the symptoms of a heart attack. Occasional heartburn usually isn’t serious, but chronic acid reflux can lead to Barrett’s esophagus, a condition in which cells similar to the stomach’s glandular cells develop in the lower esophagus. These new cells are resistant to stomach acid, but they also have a high potential for malignancy.
- Gastroesophageal reflux is the most common cause of esophageal adenocarcinomas. Smoking, obesity and a diet with high sodium content have an increased risk of reflux problems.
- Exposure to silica dust may cause esophageal cancer or esophagus cancer.
- Eating a diet low in fruits and vegetables appears to contribute to esophageal cancer. Especially implicated are diets lacking in vitamins A, C, B1 (riboflavin), beta carotene and the mineral selenium.
- Sometimes esophageal cancer is associated with certain rare medical conditions, including achalasia, esophageal webs, and tylosis.
Symptoms of Esophageal Cancer or Sign of Esophageal Cancer
Symptoms of Esophageal cancer or sign of esophageal cancer in the early stages of the disease are very unusual. Symptoms are noticed when esophageal cancer is more advanced. Some of them include:
- Painful or difficulty in swallowing (dysphagia): Although this is the most common symptom of esophageal cancer, it usually doesn’t appear until a tumor has grown large enough to narrow the esophagus to about half its normal width.
- Severe, unintentional weight loss
- Pain in throat
- Pain behind the breastbone.
- Discomfort or burning behind breastbone.
- Hoarseness, a chronic cough and sometimes coughing of blood. These symptoms usually don’t appear until cancer is quite
- Indigestion and heartburn.
These and other symptoms may be caused by esophageal cancer or esophagus cancer or by other conditions. A doctor consultation is a must if any of the above symptoms noticed.
Esophageal Cancer Treatment
Esophageal cancer Treatment or Esophagus cancer treatment depends on the type, location and stage of cancer as well as on the age, overall health and personal preferences of the patient.
Decisions about therapy can be particularly complicated because various combinations of surgery, chemotherapy and radiation may be more effective than any single treatment.
When esophageal cancer is advanced, choosing a treatment plan is a difficult decision, and it’s important to take time to evaluate the type of treatment.
Different types of treatment are available for patients with esophageal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial.
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with esophageal cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Second opinion is also needed in such type of disease, for that matter any type of cancer needs second opinion. This can provide additional information to help to be more certain about the treatment option one wants to consider.
The goal of treatment is to eliminate the esophageal cancer completely. When that is not possible, the focus may be on preventing the tumor from growing or causing more harm. In some cases, an approach called palliative care may be best.
Palliative care refers to treatment aimed not at removing or slowing the disease, but to help relieve symptoms.
Surgery is the most common treatment for Esophageal cancer or Esophagus cancer, either as a therapy for the cancer itself or as a way to relieve symptoms, especially difficult swallowing. Surgery is also recommended if abnormal cells are very consistent (high-grade dysplasia) and occurring with Barrett’s esophagus.
Depending on the nature of the esophageal cancer, the operation may be performed in one of two ways:
Esophagectomy: Doctors generally recommend this approach for early-stage esophageal cancer that doesn’t involve the stomach. During this procedure, the surgeon removes the portion of the esophagus that contains the tumor along with nearby lymph nodes.
The remaining esophagus is reconnected to the stomach so that the patient can still swallow. In some cases the stomach is pulled up to the esophagus. In others, part of the large intestine is used to replace the missing section of the esophagus.
Esophagogastrectomy: In this procedure, which is used for more advanced esophageal cancer, the surgeon removes part of the esophagus, nearby lymph nodes and the upper part of the stomach. The remainder of the stomach is then pulled up and reattached to the esophagus. If necessary, part of the colon is used to help join the two.
Surgery for Esophageal cancer or Esophagus cancer is complex and carries risks that include infection, bleeding and leakage from the area where the remaining esophagus is reattached. Surgeons who are highly experienced in the procedure should be approached.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).
When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Chemotherapy can help in several ways, before surgery to shrink the tumor, in combination with radiation when surgery isn’t an option or to relieve symptoms in advanced cases of esophageal cancer.
Unfortunately, anticancer drugs affect normal cells as well as malignant ones, especially fast-growing cells in the digestive tract and bone marrow. For that reason, side effects including nausea and vomiting, mouth sores, an increased chance of infection due to a shortage of white blood cells, and fatigue are common. Not everyone experiences side effects; however there are now better ways to control them.
Radiation or Laser therapy is usually most effective against esophageal cancer or esophagus cancer when used in combination with chemotherapy, either before surgery or as the primary treatment. It’s also used to relieve pain and improve swallowing.
Most often, the radiation comes from a machine outside the body (external beam radiation), but sometimes thin plastic tubes containing radioactive material are implanted near the cancer cells in the esophagus (brachytherapy).
Radiation therapy is most commonly given five days a week for five to seven weeks. The most common side effects are fatigue, which generally becomes more noticeable later in the course of treatment, skin rash or redness in the area being treated, loss of appetite, and mouth sores or increased problems with swallowing.
In fact, swallowing may become so difficult that the doctor will recommend a feeding tube to provide nourishment during treatment.
These side effects generally aren’t permanent, and most can be treated or controlled. Long-term side effects are rare, but they can be serious when they do occur and include inflammation or scarring in the lungs, esophagus, heart or spinal cord.
This therapy is generally used to relieve pain and obstruction in the esophagus, but it’s also being studied as a treatment for early-stage esophageal cancer. During the procedure, an injection of a light-sensitive drug is give which remains in esophageal cancer cells longer than it does in healthy ones.
A laser light is then directed at the esophagus through an endoscope. This stimulates the production of an active form of oxygen that destroys the cancer cells while sparing healthy tissue.
Electrocoagulation is the use of an electric current to kill cancer cells.
Esophageal Cancer Prognosis
Esophageal cancer prognosis or the chances of being cured of esophageal cancer depend largely on the stage of the cancer at the time it is diagnosed. From 80% to 90% of patients with the earliest stage of Esophageal cancer or Esophagus cancer can expect to be alive and cancer free 5 years after treatment.
However, since the typical esophageal cancer is discovered at a relatively advanced stage, the overall success rate in curing esophageal cancer or esophagus cancer is not so good.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the esophageal cancer (whether it affects part of the esophagus, involves the whole esophagus, or has spread to other places in the body).
- The size of the tumor.
- The patient’s general health.
When esophageal cancer or esophagus cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when it is diagnosed. At later stages, esophageal cancer can be treated but rarely can be cured. Taking part in one of the clinical trials being done to improve treatment should be considered.
Esophageal Cancer Survival Rate
In an attempt to improve the survival of patients with Esophageal cancer or Esophagus cancer, previous research has focused on initially treating the patient with a combination chemotherapy and radiation (CRT) given concurrently, followed by surgical removal of any residual tumor. In this recent study, researchers evaluated which treatment-related variables could help predict survival and recurrence.
Survival among patients with Esophageal Cancer is improved with combined therapy followed by surgery. The complete surgical removal of the tumor was also a significant factor in determining overall survival rates and disease-free survival rates. Researchers concluded that the patient’s response to CRT and the ability to completely remove the tumor surgically were significantly associated with improved overall survival.
Esophageal cancer survival rate depends on the stage of the disease. Lymph node metastases or solid organ metastases are associated with low survival rates.
Patients without lymph node involvement have a significantly better prognosis and 5-year survival rate compared to patients with involved lymph nodes.
Stage IV lesions are associated with a 5-year survival rate of less than 5%.