Esophageal Cancer

Definition of Esophageal Cancer


Esophagus is the tube that carries food from the mouth to stomach. Cancer of this muscular tube is called the esophageal cancer. There are many categories of esophageal cancer and two of the important ones are squamous cell cancer (cancer of the cellular lining of esophagus) and adenocarcinoma (cancer of cells that secrete mucus and other fluids). Squamous cell cancer usually occur in the upper half of esophagus whereas adenocarcinoma in the lower half.


Cause of Esophageal Cancer


The exact cause of esophageal cancer is not known. It has been proposed under the light of some scientific research that consumption of alcohol and/or tobacco are among the highest risk factors of esophageal cancer. This happens due to damage to the DNA of cells lining the inner aspect of esophagus.

DNA is a part of our genetic system, present in cells. It controls all the functions of cell and holds information about its morphology (physical appearance). Among the vast number of functions, an important one is cell division. These cell division promoting genes are called oncogenes and their counter genes, genes that slow down the rate of cell division are called tumor suppressor genes. Therefore alteration in either of these two genes can lead to cancer (either increased activation of oncogenes or decreased activity of tumor suppressor gene or a combination of both).


Signs and Symptoms of Esophageal Cancer


There are many presentations of esophageal cancer, some of them are:

  • The most common symptoms of esophageal cancer are dysphagia (difficulty in swallowing) and odynophagia (pain during swallowing). Dysphagia is first to appear, followed by odynophagia. It is worse with hard and bulky food such as bread or meat. Soft food and fluids are easy to swallow.

  • Weight loss is another common complaint. It is due to decreased appetite, intake and cancer.

  • Retrosternal pain is the pain in the region behind the sternum (a bone). It is the pain in the epigastrium with character like that of burning pain that is persistent and is worsened by swallowing.

  • Esophageal cancer is also associated with rough and hoarse-sounding cough. This raspy cough is due to the compression of a nerve located in the region of course of esophagus. This nerve is the recurrent laryngeal nerve that is affected by the growth of tumor causing husky voice and coughing.

  • Abnormal peristalsis (systematic swallowing reflex) due to presence of tumor leads to nausea, vomiting, regurgitation of food and increased risk of aspiration pneumonia.

  • The surface of tumor is fragile and can cause bleeding. Patient may vomit out blood (hematemesis).

  • In advanced stages of cancer, tumor compresses the neighboring structures causing problems like upper airway obstruction.

  • Sometimes the trachea and esophagus get connected through the fistula. This increases the chances of pneumonia accompanied with fever and cough.

  • Spread of cancer to other regions of the body may cause symptoms like jaundice and ascites by liver metastasis (distant spread of tumor), and shortness of breath and pleural effusion by lung metastasis.

Most of the symptoms of esophageal cancer are no detected at early stage of disease. Patients complain of symptoms in the later stages when the tumor has grown to a much larger size, obstructing as much as half of the inside of esophagus (the lumen). This causes pain when food passes through such a narrow passage.


Risk Factors for Esophageal Cancer


There are various risk factors of esophageal cancer which are as under:

  • Age – most of the cancers occur in old age. Esophageal cancers are most common after the age of 60 years.

  • Sex – Some diseases are more common in one sex than the other. Esophageal cancer is more prevalent in males.

  • Heredity – Esophageal cancer is more common in people whose relatives are suffering from different other cancers.

  • Use of tobacco and alcohol increase the risk of esophageal cancer, with greater risk when both combined than individually. They constitute about 90% of all esophageal cancers.

  • GERD (Gastro esophageal reflux disease) increase the chances of esophageal cancer due to chronic insult of lower end of esophagus. More common cancer in this situation is adenocarcinoma.

  • Corrosive injury to the esophagus may be caused by swallowing corrosive fluids like acids or alkaline solutions.

  • Coeliac disease may cause squamous cell carcinoma.

  • Obesity increases the likelihood of adenocarcinoma. There are four times increased chances of cancer in obese people.

  • Previous history of other cancers like cancer of head and neck increases the chances of developing esophageal cancer.

  • Thermal injury due to drinking of hot beverages.

  • Radiation therapy for the treatment of other conditions involving the area of mediastinum (region between the two lungs).

  • Infection of H. pylori constantly damages the lower region of esophagus which may ultimately produce cancer if not taken care.


Diagnosis of Esophageal Cancer


Various examination techniques and tests that help in diagnosing esophageal cancer are given as follows:

  • Esophagogastroduodenoscopy is done to visualize and biopsy the tumor.

  • Endoscopic ultrasonography

  • CT (Computed Tomography) scan of chest and abdomen for assessing the organs in this region like lungs, liver, etc.

  • PET (Positron Emission Tomography) scanning.

  • Laparoscopy (for lymph nodes assessment)

  • Bronchoscopy

  • Barium meal (for detecting masses in the lumen)


Prevention from Esophageal Cancer


Esophageal cancer can be prevented by avoiding the things that increase the risk of the disease. Some of the measures are as follows:

  • Lose weight

  • Eat healthy

  • Avoid alcohol and tobacco

  • Get early treatment for H. pylori infection

  • Avoid spicy food and acidic beverages


Treatment of Esophageal Cancer


Treatment of esophageal cancer varies with the stage of the disease:

  • Stage I –Endoscopic therapy

  • Stages II & III – Chemoradiation followed by surgery

  • Stage IV – Chemotherapy and supportive care

If a patient is in such a state of esophageal cancer that he/she cannot be treated with endoscopy, he is surgically treated:

  • THE (Transhiatal esophagectomy)

  • TTE (Transthoracic esophagectomy)

  • EMR (Endoscopic mucosal resection)

  • Minimally invasive esophagectomy

Some of the non-surgical interventions for esophageal cancer are:

  • Chemotherapy

  • Radiotherapy

  • Laser therapy

  • Stents