Esophageal Cancer: Causes, Types, Symptoms, Stages, Treatment
Cancer that begins in the esophagus is known as esophageal cancer. Esophagus is a long and hollow duct, which travels from the throat to the stomach and helps in carrying food to the stomach for digestion. Esophageal cancer commonly starts in the cells present in the internal lining of the esophagus. Esophageal cancer can develop anywhere in the esophagus. Men are more susceptible to esophageal cancer than women. Esophageal cancer is more common in Asia and some regions of Africa. Treatment comprises of surgery, chemotherapy, radiation therapy or a combination of all.
Causes of Esophageal Cancer
The cause of the esophageal cancer is not clear. As with other cancers, it is thought that DNA mutations in the cells cause the cells to rapidly and uncontrollably divide and accumulate resulting in a mass or a tumor. This tumor can then further invade the adjacent structures and metastasize to other regions of the body.
Types of Esophageal Cancer
The type of esophageal cancer depends on the type of cells which are involved and the different types of esophageal cancer are:
- Adenocarcinoma: This type of cancer starts in the cells of the glands which secrete mucus in the esophagus and it is the most common type of esophageal cancer occurring in the United States. Adenocarcinoma commonly affects the lower part of the esophagus.
- Squamous Cell Carcinoma: This type of cancer starts in the squamous cells, which are the flat and thin cells, lining the esophagus' surface and it is the most widespread type of esophageal cancer all over the world. Squamous cell carcinoma commonly affects the middle region of the esophagus
- Other rare forms of esophageal cancer are lymphoma, choriocarcinoma, sarcoma, melanoma and small cell cancer.
Risk Factors for Esophageal Cancer
- Alcohol consumption
- Acid/bile reflux/GERD.
- Chewing tobacco.
- Difficulty in swallowing due to achalasia (persistent esophageal sphincter).
- Drinking extremely hot liquids.
- Having Barrett's esophagus.
- Following an unhealthy diet which does not include fruits and vegetables.
- Consuming foods which are preserved in lye (lutefisk).
- Being overweight.
- Undergoing previous treatment for cancer such as radiation to the upper abdomen or chest.
- Individuals aged between 45 and 70 are at a higher risk for developing esophageal cancer.
- Men are at higher risk than women.
Signs and Symptoms of Esophageal Cancer
Esophageal cancer in the early stages commonly does not cause any signs or symptoms. Common symptoms of esophageal cancer include:
- Dysphagia (difficulty in swallowing).
- Unintentional weight loss.
- Pain, burning or pressure sensation in the chest.
- Frequently choking during a meal.
Investigations for Esophageal Cancer
- X-rays or barium swallow or esophagography of your esophagus.
Staging Investigations for Esophageal Cancer
Tests done to determine the extent and the stage of the esophageal cancer are:
- Computerized Tomography (CT) scan.
- Positron Emission Tomography (PET) scan.
Stages of Esophageal Cancer
- Stage I: In this stage, cancer is present only in the upper most layer of the cells which line the esophagus.
- Stage II: In this stage, cancer has spread into the deeper layers of the esophageal lining and could also have spread to the adjacent lymph nodes.
- Stage III: In this stage, cancer has metastasized to the deepest layers in the esophageal wall and has also metastasized to the nearby lymph nodes or tissues.
- Stage IV: In this stage, cancer has spread to other parts of the body and distant organs such as lungs, liver etc.
Treatment for Esophageal Cancer
Treatment for esophageal cancer depends on the type of cancer, stage of the cancer, the patient's general health and their treatment preferences.
Surgery for Esophageal Cancer
Surgery can be done alone or in conjunction with other treatment options. Surgical procedures for treating esophageal cancer include:
- Surgery is done for a very small tumor or if the cancer is very small and has not metastasized and is restricted to the top most layers of the esophagus. The surgeon may remove the cancer and a margin of surrounding healthy tissue. Surgery for esophageal cancer in the initial stage can be done with an endoscope which is passed into the esophagus via the throat.
- Esophagectomy is the surgery done to remove a part of the esophagus which contains the cancer/tumor and also the adjacent lymph nodes. The remainder of the esophagus is joined to the stomach.
- Esophagogastrectomy is the surgery which is done to remove a part of the esophagus along with nearby lymph nodes and the upper region of the stomach. The remaining part of the stomach is then pulled and reconnected to the esophagus. Sometimes, if required, a part of the colon is also used to join them.
Complications from surgery for esophageal cancer includes: Bleeding, infection, and seepage from the reattached part of the esophagus. Surgery for removing the esophagus can be done laparoscopically or as an open procedure. All this depends on the patient's condition and surgeon's preferences and experience.
Surgery for Providing Supportive Care
- There are many treatment options available for relieving esophageal obstruction, such as using a stent for widening and keeping the esophagus open.
- Percutaneous gastronomy is a procedure where a surgeon passes a feeding tube so as to provide nutrition directly into the patient's stomach or intestine. This is commonly a temporary measure till the healing of the surgical site is complete or till the patient is done with chemotherapy and radiation therapy.
Chemotherapy for Esophageal Cancer
Chemotherapy is a treatment which uses medicines or drugs to destroy the cancer cells. Chemotherapy can be done before the surgery (neoadjuvant chemotherapy) or after the surgery (adjuvant chemotherapy). Chemotherapy can also be done in combination with radiation therapy. Chemotherapy in patients with advanced cancer can be done to alleviate signs and symptoms of the cancer.
Radiation Therapy for Esophageal Cancer
Radiation therapy is a treatment which uses high-powered energy beams, such as x-rays, to kill cancer cells. A machine emanates the beams at specific points on the body where the cancer is present. Radiation therapy can be done externally (external beam radiation) or internally (brachytherapy). Radiation therapy can also be combined with chemotherapy, especially esophageal cancer. Radiation therapy can be done before surgery or after the surgery.
Side Effects of Radiation Therapy are: Reactions resembling sunburn to the skin, difficult or painful swallowing, and unintentional damage to the adjacent organs (lungs and heart).