Esophageal Cancer

Cancer of esophagus is called esophageal cancer. It occurs in the cells lining the interior of the esophagus.

Esophagus, also called food pipe, is a long hollow muscular tube that starts from your throat and ends at stomach.

Esophageal cancer can occur anywhere along the esophagus but in US citizens, it occurs most often in the lower portion of the esophagus. It is more common in men than in women.

Unlike in US, esophageal cancer occurs more often in Asia and parts of Africa.

Signs and symptoms of esophageal cancer include:

• Difficulty swallowing (dysphagia)
• Unintended Weight loss
• Chest pain, pressure or burning sensation
• Worsening indigestion or heartburn
• Coughing or hoarseness

In its early stage, esophageal cancer may remain asymptomatic. One risk factor for esophageal cancer is Barrette’s esophagus (a precancerous condition caused by chronic acid reflux) that may progress to esophageal cancer.

The cause behind esophageal cancer is not known yet. It occurs due to genetic mutations that causes uncontrolled cell growth and division. Abnormal cells build-up forms a tumor in the esophagus that is capable can invade the adjacent structures and spread to various parts of the body.

Types of esophageal cancer

Esophageal cancer is classified according to the type of cells that are involved and includes:

• Adenocarcinoma: Adenocarcinoma begins in the cells of mucus-secreting glands in the esophagus, most often occurs in the lower portion of the esophagus. It is the most common form of esophageal cancer in the United States, which primarily affects white men.
• Squamous cell carcinoma: Squamous cell carcinoma occurs most often in the middle part of the esophagus. The squamous cells are flat, thin cells lining the surface of the esophagus. It is the most prevalent esophageal cancer worldwide.

Other rare forms of esophageal cancer are choriocarcinoma, lymphoma, melanoma, sarcoma and small cell cancer.

Tests and procedures used to diagnose esophageal cancer include:

• Endoscopy: An endoscope (a hollow tube fitted with lens and light) is passed down the throat into the esophagus. It is used to detect the areas of irritation and suspected cancer.
• Biopsy: Sample of suspicious tissues, collected using an endoscope, is sent to laboratory for analysis.

Staging: Determining the stage or extent of cancer is useful for selecting a treatment option.

Tests used in staging esophageal cancer are:

• Computerized tomography (CT) scan
• Positron emission tomography (PET)

Stages of esophageal cancer

• Stage I: Superficial layers of cells lining the esophagus are affected.
• Stage II: The cancer has invaded deeper layers of esophagus lining and may have spread to nearby lymph nodes.
• Stage III: The cancer has spread to the deepest layers of the wall of esophagus and to adjacent tissues or lymph nodes.
• Stage IV. The cancer has metastasized to distant body parts.

Following treatment modalities are available for esophageal cancer:

Surgery

The cancerous part can be removed by surgery alone or in combination with other treatments.

Surgeries to treat esophageal cancer include:

• Surgery to remove very small tumors: When the tumor is small, limited to superficial layers of esophagus and has not metastasized, surgery can be performed to remove the cancerous part and portion of healthy tissues.
• Surgery to remove a portion of the esophagus (esophagectomy): Esophagectomy is performed to remove portion of your esophagus containing tumor and nearby lymph nodes. Then the stomach is pulled upwards to make up for remaining part of esophagus and is reconnected.
• Surgery to remove part of your esophagus and the upper portion of the stomach (esophagogastrectomy): It involves removal of the part of esophagus, nearby lymph nodes and the upper part of your stomach. The remainder of stomach is then pulled up and reattached to the remaining esophagus.
• Surgical removal of esophagus can be done through a large incision or a laparoscopic which involves several small incisions and insertion of special surgical tools.

The surgery carries a risk of serious complications, such as infection, bleeding and leakage from the area where the remaining parts are reattached.

Treatments for complications

• Relieving esophageal obstruction: If esophageal cancer has narrowed the esophagus, a metal tube called stent can be placed in the esophagus to hold it open.
• Other options include surgery, radiation therapy, chemotherapy, laser therapy and photodynamic therapy.
• Providing nutrition: When you have difficulty swallowing or undergone esophageal surgery, a feeding tube may be used to deliver food directly to your stomach or small intestine.
• Chemotherapy: Chemotherapy uses chemicals or chemotherapeutic agents to kill cancer cells. Chemotherapy drugs can be used before surgery to shrink the tumor (neoadjuvant) or after (adjuvant) surgery to kill the cells that have survived the surgery. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.
• Radiation therapy: Radiation therapy kills cancer cells by using ionizing radiations. The source of the radiation can be a machine outside the body (external beam radiation) which is focused over the cancerous part or it can be placed inside the body near the cancer (brachytherapy). Radiation therapy is usually given before or after surgery in combination with chemotherapy. When the cancer advances to the state that food stops passing through the esophagus, radiation therapy can be used to relieve complications. Radiation can cause side effects like sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.
• Combined chemotherapy and radiation: Combining chemotherapy and radiation therapy may have synergistic effect. But combining chemotherapy and radiation treatments increases the incidence and severity of side effects.

You can prevent esophageal cancer by following these tips:

• Quit smoking: If you smoke, quit and if you don’t, don’t start. Talk to your doctor about smoking cessation techniques.
• Drink in moderation if you need to: Limit your alcohol intake to no more than one drink per day if you're a woman or two drinks per day if you're a man.
• Increase your intake of fruits and vegetables: Add a variety of colorful fruits and vegetables to your diet.
• Maintain a healthy weight: If you are overweight or obese, talk to your doctor about strategies to help you lose weight.

Consult with your doctor before using any alternative remedies for esophageal cancer.

Complementary and alternative therapies do not cure cancer but they may help you cope with the side effects of cancer and cancer treatment.

For example, pain caused by cancer treatment or by a tumor can be alleviated with complementary and alternative therapies like acupuncture, guided imagery, massage and relaxation techniques.

Lifestyle modifications are necessary in order to cope with esophageal cancer.

Cancer diagnosis can have devastating effect on you and so do the cancer and its treatment. Coping with the depression, anxiety and pain can take time. You may try these coping strategies to learn to live with cancer:

Broaden your knowledge of cancer: Having an insight of what’s happening with your body can make you stronger. Go for authentic cancer information and new developments in the field of cancer treatment. The National Cancer Institute and the American Cancer Society are good places to start.

Stay connected to friends and family: Socialization and keeping in touch with your family/friends can help you cope with the stress. You may share your problems with them and ask for the support you need.

Join a support group for people with cancer: Being in proximity with similar people can drive you ahead to live a happy life. Try online message boards, such as those available through the American Cancer Society.

There are several risks and complications associated with esophageal cancer.

Risks

• Alcohol
• Bile reflux
• Achalasia (a condition in which narrowed esophageal sphincter causes difficulty swallowing)
• Limited intake of fruits and vegetables
• Gastroesophageal reflux disease (GERD)
• Obesity
• Barrett's esophagus (precancerous changes in the cells of the esophagus)
• Radiation treatment to the chest or upper abdomen
• Smoking

Complications

• Obstruction of the esophagus: Cancer can obstruct swallowing
• Pain: Advanced esophageal cancer can cause pain.
• Bleeding in the esophagus: Esophageal cancer can cause bleeding. Though bleeding is usually gradual, it can be sudden and severe at times.