Esophageal cancer

Overview – Esophageal cancer can occur anywhere along the esophagus and begins in the cells that line the inside of the esophagus.

The esophagus is a long, hollow tube that runs from the throat to the stomach. The types of esophageal cancers based on the type of cells are adenocarcinoma, squamous cell carcinoma,  small cell carcinoma, sarcoma, lymphoma, melanoma, choriocarcinoma.

It is not clear what causes esophageal cancer. Chronic irritation in the cells of the esophagus increases the risk of esophageal cancer. The risk factors that cause irritation are having gastroesophageal reflux disease, having precancerous changes in the cells of the esophagus (Barrett’s esophagus), smoking, being obese, drinking alcohol, having bile reflux, having achalasia (a disorder making it difficult for food and liquid to pass into the stomach), not eating enough foods and vegetables, undergoing radiation treatment to the chest or upper abdomen.

 

Symptoms

  • Early esophageal cancer typically causes no symptoms
  • Dysphagia (difficulty swallowing foods) – The dysphagia gradually progresses from solids to liquid foods.
  • Worsening indigestion or heartburn
  • Weight loss
  • Chest pain or burning sensation
  • Regurgitation of saliva or food
  • Hoarseness and/or cough

 

Complications

  • Chronic gastrointestinal blood loss due to esophageal cancer can cause iron deficiency anemia
  • Tracheobronchial fistula which is an abnormal connection between the trachea and esophagus due to direct invasion through the esophageal wall can cause intractable coughing or frequent pneumonia.
  • Metastasis to the liver, lungs, bone, and adrenal glands.

 

Screening

  • Screening of esophageal cancer isn’t done routinely except for patients with Barrett’s esophagus. In Barrett’s esophagus, the tissue in the esophagus is replaced by tissue similar to the intestinal lining due to chronic regurgitation of acid from the stomach to the esophagus. This change in the esophagus increases the risk of esophageal cancer.
  • If you have Barrett’s esophagus talk to your doctor about screening for esophageal cancer.

 

Diagnosis

  • Diagnosis is made by obtaining a tissue sample by upper endoscopy, or by image-guided biopsy of a metastatic site.
  • Once the diagnosis is confirmed additional tests that are done to determine the cancer spread are endoscopic ultrasound, computerized tomography, positron emission tomography.

 

Lifestyle management

  • Follow a healthy diet and exercise program recommended by your doctor. Include a variety of colorful fruits and vegetables to your diet.
  • Maintain a healthy weight. Talk to your doctor about strategies to help you lose weight if you are obese or overweight.
  • Do not smoke.
  • Drink alcohol in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

 

Medical management

  • Treatment of cancer depends on the stage of cancer, type of cells involved in cancer, the overall health, and the patient’s preferences for the treatment.
  • Surgery is done to remove the cancer cells and can be done alone or in combination with other treatments.
  • Chemotherapy is used before or after surgery, or combined with radiation therapy, or used alone in people with advanced cancer.
  • Treatment of complications such as relieving obstruction can be done by placing a metal tube (stent) to hold the esophagus open, surgery, radiation therapy, chemotherapy, laser therapy, and photodynamic therapy.

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