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A complete overview of Esophageal Cancer

Definition of Esophageal Cancer

Esophagus is a hollow muscular tube that extends from your throat to the abdomen and carries food that you swallow to the stomach. Esophageal cancer starts in the inner lining layer and spreads outwards and along the length of the esophagus. The growing tumour gradually occludes the passage of food and causes symptoms. Esophageal cancer is more common in South East Asia and parts of Africa.

Types of Esophagus Cancer

There are basically two types of esophageal cancer namely

1. Squamous Cell Carcinoma – which mainly affects the upper third of esophagus is associated with excess smoking or alcohol consumption
2. Adenocarcinoma – involves the lower third and is mainly associated with reflux disease and Barrett’s esophagus

Causes of Esophageal Cancer

The main causes and risk factors for esophageal cancer include

• Elderly age
• Excessive smoking or tobacco consumption
• Consumption of alcohol
• Consumption of smoked and excessively spicy food
• Genetics
• Obesity
• Barrett’s esophagus – a specialized change in the inner lining of esophagus due to long standing reflux disease.
• Caustic injury due to consumption of lye, corrosives with suicidal intent or accidentally.

Symptoms of Esophageal Cancer

Early on during the initial stages of the disease there are usually no symptoms. The symptoms that may be experienced include

1. Food getting stuck in the throat or at the chest level - dysphagia
2. Pain during swallowing
3. Regurgitation or vomiting of undigested food
4. Chest pain or back pain
5. Weight loss
6. Heart burn and
7. Hoarseness of voice

Diagnosis of Esophageal Cancer

A typical history about symptoms will make your doctor suspect esophageal cancer. However you may require the following tests

Endoscopy and Biopsy

A long flexible tube fitted with camera and light is passed down your throat. The tumour is visualized and the extent of block can be made out. Samples of tissue from suspicious areas are taken for biopsy to detect cancer

Barium Swallow X-Ray

This test is rarely done these days. Here you are asked to drink a particular liquid, containing Barium solution. This particular liquid coats your layer of esophagus, while the X-Rays are being taken.

CT scan

CT scan of chest and abdomen are taken to know the exact location and extent of the disease and the relation of the tumour to the surrounding structures. CT scan will tell if the tumour is early or advanced.

Treatment of Esophageal Cancer

Management of esophageal cancer depends on the location of the cancer, stage of the disease and the physical wellbeing and personal preferences of the patient.

Surgery

Surgery involves removal of the esophagus, which can be done by laparoscopy or open surgery. The stomach or large intestine can be mobilized to the chest cavity to carry out the function of the esophagus.

Chemotherapy and Radiation

A combination of chemotherapy and radiation is usually given to patients who do not prefer to undergo surgery and who have squamous type cancer. This combination treatment may also be given after surgery depending on the stage of the disease.

Endoscopic Therapy

This involves insertion of self-expanding metallic stent across the tumour. This usually is done in patients who have advanced tumour that may not be amenable to cure.

Other forms of therapy include photodynamic therapy, laser coagulation of the tumour.