In this Health Article:
IntroductionEsophageal cancer is the malignancy of the esophagus. The esophagus is a hollow tube that carries food and liquids from your throat to your stomach. Esophageal cancers grow from the wall of the esophagus into the opening of the esophagus, creating a tumor or bump inside the esophagus
What Causes Esophageal Cancer?Esophageal cancers are typically carcinomas which arise from the epithelium, or surface lining, of the esophagus. A variety of risk factors like age, gender, heredity, tobacco smoking, heavy alcohol consumption, gastroesophageal reflux disease (GERD), Barret’s esophagus, presence of human pappillomavirus, swallowing lye or other caustic substances, dietary substance like nitrosamine or medical history of head and neck cancers, plummer-vinson syndrome can trigger esophageal cancer. Certain subtype of cancer is linked to particular risk factors like adenocarcinoma is more common in people with Barret’s esophagus or GERD. Radiotherapy or Celiac disease may also be associated in developing esophageal cancer. Obesity increases the risk of adenocarcinoma fourfold. It is suspected that increased risk of reflux may be behind this association.
What Are the Types of Esophageal Cancer?
Squamous cell carcinomas: Squamous Cell or epidermoid, carcinoma is cancer of the flat cells which line the esophagus. This is the most common kind of esophageal cancer among African-Americans. It is similar to head and neck cancer in their appearance. The major cause of squamous cell carcinomas might include tobacco and alcohol consumption.
Adenocarcinomas: Adenocarcinoma is cancer of the glandular tissue in the lower part of the esophagus. In the United States, Adenocarcinoma is more prevalent in Caucasians. This is often associated with a history of gastroesophageal reflux disease and Barrett’s esophagus.
Other Cancers of the Esophagus: Lymphoma, sarcoma, small-cell carcinoma and spindle-cell carcinoma all occur in the esophagus. In addition, cancer which originates in other parts of the body may spread to the esophagus. When this happens, it is not esophageal cancer, but a metastatic cancer of the esophagus. These metastasized tumors have the same kind of cancer cells - and similar characteristics - as the original tumor.
Symptoms of Esophageal Cancer: Dysphagia (difficulty swallowing) is the first symptom in most patients. Odynophagia (painful swallowing) may also be present to an extent. Substantial weight loss, pain in your throat, or mid-chest or between your shoulder blades, nausea, vomiting blood, coughing are certain symptoms of esophageal cancer.
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What Are the Diagnosis & Tests for Esophageal Cancer?Based on your reports of symptoms your doctor might ask you several questions that would help him/her determine whether you have esophageal cancer. Your doctor might also prescribe some tests to confirm the same.
Barium Swallow or Upper Gastrointestinal (GI) X-rays: A barium swallow test can show irregularities in the normally smooth surface of the esophageal wall. Barium in liquid form is used to coat the esophagus wall before the x-ray is taken, allowing the x-ray to show the esophagus clearly. This is the initial test for cancer in people with trouble swallowing.
Endoscopy: A flexible, very narrow tube with a video camera and light on the end is inserted through your mouth to diagnose your stomach and esophagus. During an upper endoscopy procedure, the patient is sedated (made sleepy) to allow for this narrow tube to pass through the mouth and into the esophagus and stomach. The camera is connected to a television set, allowing the doctor to see abnormalities in the wall of the esophagus clearly.
Computed Tomography (CT) Scan: The CT scan is a procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, as does a conventional x-ray, a CT scanner takes many pictures of the esophagus in various angles. A computer then combines these pictures into an image of a slice of your body. The CT scan can help to determine whether surgery is a good treatment option.
Magnetic Resonance Imaging: Your doctor might prescribe you for a MRI scan if he/she suspects cancer in your esophagus.
Endoscopic Ultrasound: This test is considered to be more accurate than CT scan and upper endoscopy in determining an esophageal cancer’s size and stage or how far it has spread into nearby tissues. An endoscope with a small ultrasound probe attached to its end is used. The probe sends very sensitive sound waves that penetrate deep into tissues. The sound waves that bounce off the normal tissues and the cancer are picked up by the probe and determine how deeply the tumor has invaded into the esophagus. This is the same technology that doctors use to examine the fetus in a pregnant woman. It is harmless and can detect small abnormal changes very well.
Bronchoscopy: This is similar to an upper endoscopy except in this instance the doctor looks into the trachea (windpipe) and bronchi (tubes leading from the trachea to the lung). This allows the doctor to determine whether the cancer has grown into these structures. The patient is sedated for this procedure.
Positron Emission Tomography (PET): In this test, radioactive glucose (sugar) is injected into your vein. Because cancers use sugar much faster than normal tissues, the cancerous tissue takes up the radioactive material. A scanner can spot the radioactive deposits. This test is useful for spotting cancer that has spread to nearby lymph nodes and sites distant from the esophagus. It may be a useful test for staging the cancer.
Thoracoscopy and Laparoscopy: These procedures allow the doctor to see lymph nodes and other organs near the esophagus inside the chest (by thoracoscopy) or the abdomen (by laparoscopy) through a hollow lighted tube.
Biopsy: During an endoscopy or other procedure, the doctor will remove a small piece of tissue. This tissue is then examined by a pathologist. He or she examines the tissue to determine whether cancer cells are present and if so, their type. It usually takes a couple of days to get the results of a biopsy.
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What Are the Treatments Available for Esophageal Cancer?Esophageal cancer treatment depends on the type, location and stage of cancer as well as on your age, overall health and personal preferences. Decisions about therapy can be particularly complicated because various combinations of surgery, chemotherapy and radiation may be more effective than any single treatment. When cancer is advanced, choosing a treatment plan is a difficult decision, and it's important to take time to evaluate your choices.
Surgery: Depending on the severity and the stage of the cancer two types of surgery is performed.
Esophagectomy: This is common type of surgery generally prescribe for early stage esophageal cancer. The part of the esophagus with cancer and nearby lymph nodes are removed. The esophagus is attached either to the stomach or the surgeon may replace the removed part of the esophagus with a piece of the small or large intestine.
Esophagogastrectomy: In esophagogastrectomy, surgery is done to remove part of the lower esophagus, nearby lymph nodes, and the upper part of the stomach. The esophagus is again connected to the remaining part of the stomach. This is often prescribed in more advanced stages of cancer.
Radiation Therapy: In this, high energy rays (such as x-rays) are used to kill or shrink cancer cells. External radiation uses a beam from outside the body. This is the most often used treatment for esophageal cancer. Radiation therapy by itself will not cure esophageal cancer. Often it is combined with surgery and/or chemotherapy. It is also used to relieve problems with swallowing, pain, or other symptoms of this cancer.
Chemotherapy: Chemotherapy refers to the use of drugs to kill cancer cells. Usually the drugs are given injected to the vein or taken orally. Once the drugs enter the bloodstream, they spread throughout the body. Chemotherapy alone cannot cure cancer of the esophagus. It is often combined with radiation treatment and surgery in some cases surgery.
PDT (photodynamic therapy): This method may be used to treat early stage cancers or the recurrence of cancer cells in the esophagus. First, a harmless chemical is injected into the bloodstream. It collects in the tumor for a few days. Then a special type of laser light is focused on the cancer through an endoscope. The light changes the chemical into a new chemical that can kill cancer cells. PDT is useful because it can kill cancer cells with very little harm to normal cells. But because the light must be used, it can reach only cancers ear the surface of the esophagus. It doesn’t work for cancers that have spread deeper into other organs.
How Do You Cope Up with Esophageal Cancer?Coping with extreme stages of esophageal cancer can be extremely difficult. Following are certain tips that would help your cope up with esophageal cancer.
- Consult your doctor periodically and get to know all about the diseases.
- Be open.
- Talk to your friends and relatives about your problem, Seek support wherever required.
- Although difficult, discuss end of life issue with your family and medical team.
What Are the Ways to Prevent Esophageal Cancer?Although it is not possible to prevent certain cases of esophageal cancer, following tips might help you in certain ways in reducing risk of esophageal cancer.
- Quit smoking
- Limit alcohol consumption
- Get help for heartburn. Seek immediate medical attention.
- Eat a healthy diet. Include lots of fruits and vegetables
- Maintain a healthy weight.
Self CareHere are few simple, esophageal cancer self-care tips that can reduce esophageal cancer breakouts and control future breakouts.
- Avoid spicy food.
- Try more frequent and smaller meals.
- Talk to your doctor about mineral and vitamin supplements.
- Have nourishing snacks within easy reach, an ideal way to increase your appetite.