Esophageal cancer

Esophageal Cancer

The esophagus is a long, hollow tube that runs from the throat to the stomach. It helps move the food you swallow from the back of the throat to the stomach to be digested. Esophageal cancer occurs when malignant tumor grows in the lining of the esophagus.

The cancer usually begins in the cells that line the inside of the esophagus. It can occur anywhere along the esophagus. Usually more men than women get this disease.

In India, esophageal cancer is the sixth most common cancer with incidence of 5%. It is the fifth most common cancer in males and sixth most common cancer in females. The male to female ratio is 2.4:1.

Types of esophageal cancer

There are two major types of esophageal cancer:

  1. Adenocarcinoma – It occurs when cancer begins in the glandular cells of the esophagus which are responsible for the production of fluids like mucus. They are most common in the lower portion of the esophagus.
  1. Squamous cell carcinoma – It occurs when cancer begins in the flat, thin cells that make up the lining of the esophagus. It most often appears in the top or middle of the esophagus, however it can appear anywhere.
  1. Other rare types – Some other rare forms of esophageal cancer include sarcoma, small cell carcinoma, melanoma, lymphoma, and choriocarcinoma.

Early symptoms

Some of the early signs and symptoms of esophageal cancer are:

  1. Weight loss without trying
  1. Difficulty in swallowing (dysphagia)
  1. Worsening heartburn or indigestion
  1. Chest pain, pressure or burning
  1. Coughing or hoarseness

In case you experience any of these signs and symptoms persisting for a long time, you should immediately consult a doctor for check-up.

Causes and diagnosis

It is not exactly clear what results in esophageal cancer. It occurs when cells in the esophagus develop changes in their DNA. It makes the cells grow and divide out of control. The growing abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread elsewhere in the body.

Tests used to diagnose esophageal cancer include:

  1. Using a scope to examine the esophagus (endoscopy) – During endoscopy, the doctor passes a flexible tube equipped with a video lens down the throat and into the esophagus. Using the endoscope, the doctor analyzes the esophagus, looking for cancer or areas of irritation.
  1. Collecting a sample of tissue for testing (biopsy) – The doctor may use a special scope passed down the throat into the esophagus (endoscope) to collect a sample of the suspicious tissue. This sample is then sent to a laboratory to look for cancer cells.
  1. Barium swallow study – Here, you swallow a liquid that includes barium and then undergo x-rays. The barium coats the inside of the esophagus, which then reveals any changes to the tissue on the x-ray.

Stages and treatment options

There are various stages of esophageal cancer:

  • Stage 1 – At this stage, the tumor is small (7 cm or less) and limited to the esophagus.
  • Stage 2 – The tumor has grown large but still remains within the esophagus. The tumor has not yet spread to the distant sites or nearby lymph nodes.
  • Stage 3 – The tumor has grown beyond the esophagus and may not spread to the nearby tissues and organs. But there is a chance the cancer may or may not have spread to the nearby lymph nodes.
  • Stage 4 – The tumor may be of any size and has grown beyond the esophagus. In this stage, the disease may have spread to the lymph nodes or distant sites like the abdominal cavity or liver.

The treatment you receive for esophageal cancer is based on the type of cells involved in the cancer, the stage, overall health and personal preferences:

  • Surgery – Surgery can be done alone or in combination with other treatments to remove the cancer. Operations used to treat this cancer include:
    • Surgery to remove very small tumors – If the cancer is very tiny, confined to the superficial layers of the esophagus and has not spread, the doctor may advice removing the cancer along with a margin of healthy tissue that surrounds it. It can be done using an endoscope passed down the throat and into the esophagus
    • Surgery to remove a portion of the esophagus – During esophagectomy, the doctor removes the portion of the esophagus that contains the cancer, along with the nearby lymph nodes, and a portion of the upper part of the stomach. The remaining esophagus is reconnected to the stomach
    • Surgery to remove part of the esophagus and the upper portion of the stomach – During esophagogastrectomy, the doctor removes part of the esophagus, nearby lymph nodes and a larger part of the stomach. The remaining part of the stomach is then pulled up and reattached to the esophagus. If needed, part of the colon is used to help join the two
  • Chemotherapy – It is a treatment which uses chemicals to destroy cancer cells. For people having advanced esophageal cancer, chemotherapy may be used alone to help relieve symptoms caused by the cancer
  • Radiation therapy –        It uses high-energy beams, like protons and x-rays, to kill cancer cells. It is also often used to relive complications of advanced cancer, like when a tumor has grown large enough to stop the food from passing to the stomach
  • Targeted drug therapy – This treatment focuses on specific weaknesses present within the cancer cells. By blocking these, this treatment can cause cancer cells to die
  • Immunotherapy – It is a drug treatment that helps the immune system to fight cancer. The body’s disease-fighting immune system might not attack cancer because the cancer cells make proteins that make it hard for the immune system cells to recognize the cancer cells as harmful. This treatment works by interfering with that process.

Side effects of treatments

Possible early side effects of esophageal cancer treatments may include:

  1. Mouth problems and difficulty in swallowing
  1. Hair loss in the treatment area
  1. Digestion and eating problems
  1. Nausea and vomiting
  1. Headaches
  1. Diarrhea
  1. Swelling and soreness in the treatment area
  1. Urinary and bladder changes

Late side effects, which are quite rare, occur months following treatment and are often permanent. They may include:

  1. Spinal cord changes
  1. Lung chances
  1. Brain changes
  1. Colon and rectal changes
  1. Kidney changes
  1. Joint changes
  1. Infertility
  1. Mouth changes
  1. Secondary cancer
  1. Lymphedema

Survivorship and prevention for esophageal cancer

Esophageal cancer treatment, be it chemotherapy, radiation or surgery, can be emotionally and physically draining for patients and their loved ones. Esophageal cancer and its treatment can cause malnutrition, exhaustion and other uncomfortable symptoms and signs. Post treatment, you may also need help to adjust to new lifestyle habits like a different way of eating.

There are many types of support that are available to esophageal cancer patients, such as:

  1. Physical therapy services to help patients who need to gain strength or have trouble swallowing after treatment.
  1. Nutrition consultations from a registered dietician to address nutritional and dietary needs.
  1. Assistance with a stent which may be placed in your esophagus to help with the swallowing.
  1. Education in using devices like a stent or a feeding tube, if necessary, to ensure patients are receiving the nutrition they need to heal and recover.
  1. Social work support to help navigate out-of-town housing, homecare, caretaker needs, emotional support, health insurance, transportation, or any other concerns you and your family might have.
  1. Pain management services to assist you with medication and pain management.

Although there is no definite way to prevent esophageal cancer, there are a few measures you can take to lower the risk:

  1. Limit the consumption of alcohol
  1. Avoid chewing tobacco and cigarettes
  1. Eat a diet with lots of vegetables and fruits and maintaining a healthy weight may also be effective ways to avoid cancer
  1. Seek prompt medical help for persistent heartburn, which may be a sign of gastroesophageal reflux disease (GERD), a well-known risk factor for esophageal cancer.

The chances for recovery improve the earlier esophageal cancer is found.

It is mostly found in the later stages when it can only be treated but not cured.  The chances of survival may improve with surgery if the cancer has not spread outside of the esophagus. According to the American Cancer Society, the percentages of patients who live for at least five years after being diagnosed with esophageal cancer is 43 per cent for localized cancer to the esophagus, 23 per cent for cancer that has spread regionally, and 5 per cent with distant cancer spread. Always remember to stay healthy, stay safe!

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