Esophageal cancer is the disease which begins inside the lining of the esophagus-a muscular tube that carries food from throat to stomach. Esophageal cancer may arise from any part of the esophagus but it mostly starts from the innermost lining and spreads outwards
More men than women suffer from this cancer of the esophagus. The known risk factors are tobacco use, a history of acid reflux, and old age. Esophageal cancer accounts for 1% of all cancers in the United States.
Symptoms of esophageal cancer typically only appear in the advanced stages and often include difficulty swallowing, chest pain, and unintentional weight loss. Esophageal cancer is curable; treatment options include surgery, chemotherapy, radiation therapy, and immunotherapy.
Types
There are two major types of esophageal cancer: adenocarcinoma and squamous cell carcinoma. The two types tend to occur in different parts of the esophagus.
Adenocarcinoma
One type of cancer is an adenocarcinoma, which originates from the gland cells producing mucus. Adenocarcinoma usually arises from the lower third part of the esophagus. Nonetheless, certain medical conditions, such as Barrett’s esophagus, are regarded as risk factors for the occurrence of adenocarcinoma. Barrett’s esophagus is formed once the lower part of the esophagus becomes damaged due to a recurrent exposure of stomach acid; this happens, for instance, during acid reflux.
Adenocarcinoma can also originate in the gastroesophageal junction, which is where the esophagus meets the stomach.
Squamous Cell Carcinoma
Squamous cell carcinoma begins with the squamous cells. The esophagus is comprised of three layers, and the squamous cells are the inner layer. Squamous cell carcinoma can develop at any location within the esophagus, but is most commonly diagnosed in the neck and the upper chest. In the United States, squamous cell carcinoma accounts for less than 30 percent of all cases of esophageal cancer.
Symptoms of Esophageal Cancer
Symptoms of cancer of the esophagus usually interfere with eating and food intake. Cancer of the esophagus is not prone to causing symptoms early in cases. Once the cancerous cells have spread the full length of the esophagus, the following can become possible symptoms:
● Difficulty in swallowing: The most frequent cause of esophageal cancer is difficulty in swallowing, which is also termed dysphagia. Sometimes, you may feel food goes up your throat. Normally, this symptom progresses as the cancer advances.
● Vomiting: If you are vomiting because food tends to lodge in the oesophagus, this results in an inability to consume, and hence, it requires visiting a doctor immediately.
● Chest pain: Many patients with esophageal cancer experience chest pain or burning. This is most commonly misdiagnosed as heartburn (acid reflux).
● Weight loss: Esophageal cancer makes it difficult for patients to eat and has a poor appetite. Since the patients are not even trying, it is very normal to lose weight.
● Chronic cough: Esophageal cancer can lead to chronic coughing and hoarseness.
● Bleeding: In case of bleeding in the esophagus, your stool will turn black. It may lead to anemia, which is a shortage of red blood cells, if it persists.
● Fatigue: Anemia is very often accompanied by fatigue or tiredness that lasts for the whole day.
What is the cause of Esophageal Cancer?
The true cause of esophageal cancer is not known; however, many of the risk factors have been determined by researchers. Esophageal cancer develops when there are changes in the DNA of cells. Certain risk factors can be responsible for DNA damage resulting in genetic changes that cause cancer.
Inherited Gene Mutations
Genetics rarely contribute to the causation of this condition known as esophageal cancer. These relate to mutations that are hereditarily or inherited from one’s parents through DNA. Here is what is considered genetic, which relates the association of the occurrence:
● Tylosis: RHBDF2 gene mutation
● Bloom syndrome: Mutation of BLM gene
● Fanconi anemia: Mutation in the FANC genes
● Barrett’s esophagus :exact genes involved is not established
Discuss genetic testing and genetic counseling with your healthcare provider to learn if any of these conditions may be present in your family.
Acquired Gene Mutations
Apart from the inherited gene mutations, acquired gene mutations can also contribute to your risk of developing esophageal cancer. Acquired mutations develop spontaneously during your lifetime and are not passed down from parent to child. Acquired mutations are often related to known risk factors
Risk Factors
There are numerous known risk factors for esophageal cancer. Fortunately, some of these factors may be changed to reduce the risk. Risk factors include:
● age: More than 85% of esophageal cancer cases are found in people older than age
● Sex: Males are more likely to be diagnosed with esophageal cancer than females.
● Tobacco use: The more a person uses tobacco products, the higher his risk of esophageal cancer. Smoking at least one pack per day doubles his risk of esophageal cancer.
● Reflux: In people suffering from gastroesophageal reflux disease (GERD), stomach acid rises up into the esophagus. This frequently results in heartburn and discomfort. GERD increases the risk of adenocarcinoma.
● Barrett’s esophagus: It is a condition resulting from prolonged exposure of the lower part of the esophagus to stomach acid. The squamous cells are replaced by gland cells, thus increasing the possibility of adenocarcinoma of the esophagus.
● History of cancer: History of oropharyngeal, oral cavity, or lung cancers is related to the risk of developing esophageal cancer. This may be because smoking is an established cause of all these types of cancers.
● Obesity: An obese person has a greater chance of developing adenocarcinoma. They also are at a greater risk for GERD.
● Diet: Large consumption of highly processed meats may increase the risk of developing esophageal cancer.
● Physical activity: Lack of physical activity is linked to an increased risk of esophageal cancer.
● Achlasia: This is a disorder in which the muscle of the bottom of the esophagus fails to relax. Consequently, food and liquids cannot pass easily into the stomach; this stretches the esophagus and irritates its cells.
● Tylosis: Tylosis is a very rare condition. Tylosis causes the development of growths in the esophagus and increases the risk for squamous cell carcinoma.
● Lye exposure: Lye is a chemical. It appears in some household cleaners. Inadvertent consumption of lye causes damage to the esophagus and results in an increased risk for cancer.
● Human papillomavirus (HPV): A previous diagnosis with HPV increases the risk for multiple cancers including throat, anal, cervical, and esophageal cancers.
Diagnoses
There are several tests for the diagnosis of esophageal cancer. In most cases, esophageal cancer is diagnosed by a person who notices some symptoms and visits his healthcare provider.
When you visit your doctor, he or she will start with a very elaborate history and physical. They will ask when you started noticing your symptoms and for how long. Your doctor will also inquire if your symptoms have deteriorated over time. They will then perform a physical check-up to look for any cancerous signs.
They will refer you to an oncologist, meaning a medical doctor that specializes in cancer.
Diagnostic procedures of esophageal cancer, include imaging tests and are going to
- Barium swallow test. It presents with abnormal areas of the esophagus
- Computed tomography (CT) scan: To see whether the esophagus cancer has spread to the organs surrounding it.
● Magnetic resonance imaging (MRI): Determines if the cells of cancer have spread into the brain or the spinal cord
● Positron emission tomography (PET) scan: To find cancer cells in the esophagus
● An endoscopy is a form of test, which makes use of a flexible tube with a small camera for visualizing the esophagus and taking biopsies if necessary. Among the types used to diagnose esophageal cancer may be listed the following
● Upper endoscopy: Determines whether there are abnormal regions of the esophagus
● Endoscopic ultrasound: Determines the size and extent of the esophageal cancer
● Bronchoscopy: Detects whether the cancer cells have spread to the trachea and bronchi (breathing tubes)
● Biopsy: Test tissues from the esophagus for the presence of cancer cells.
Treatments for Esophageal Cancer.
For esophageal cancer treatment, several treatment procedures are undertaken. The proper treatment is available for you and mainly according to the type and category of esophageal cancer, and also according to health. Most of them in cancer treatment depend on advanced degrees so that there will not be any major damage after the diagnosis.
Esophagectomy in surgery; this surgical practice is about the removal of a certain section of the esophagus part.
● Radiation therapy destroys tumor and cancerous cells found at one of these energy X-rays places using strong radiation sources.
● Chemotherapy: Chemotherapy applies powerful drugs that can break down cancerous cells. It can be given concurrently with radiation therapy.
● Opening of the esophagus: Laser therapy or electrocoagulation may be applied to break a tumor (a mass of cancerous cells) in the esophagus and maintain the lumen of the esophagus open and free.
● Immunotherapy: Immunotherapy is applied to enhance the body’s immune response in fighting against cancer cells.
● Targeted therapy: Targeted therapy uses drugs and other substances to mark cancer cells so that they are easier to identify and destroy.
Prevention
Esophageal cancer cannot always be prevented. However, it is possible to lower your risk by avoiding certain risk factors.
Smoking and not exercising regularly are common risk factors for esophageal cancer.
National Cancer Institute. Esophageal cancer prevention.
Avoiding these factors will lower your risk of developing esophageal cancer. Talk to your healthcare provider if you need support quitting smoking.
Research studies demonstrate that using NSAIDs might reduce the risk of developing esophageal cancer. Nonetheless, chronic use of NSAIDs has been associated with heart disease, stroke, and bleeding disorders.14 Talk to your healthcare provider before beginning a new NSAID program.
Comorbid Conditions
Comorbid conditions refer to the medical conditions that can be at a higher risk of being developed when suffering from esophageal cancer. A study that was conducted in 2019 showed that typical
The goal is remission in esophageal cancer treatment. Mostly, esophageal cancers do not cause symptoms even at the early stages of it. Therefore, they are discovered usually in later stages wherein treatment is more difficult as well. The 5-year survival rate for an esophageal cancer is reported to be 60%.
Comorbid conditions with esophageal cancer include heart diseases, hypertension, pulmonary disease, and diabetes.
This does not mean that these conditions are caused by the esophagus. Only that individuals who suffer from esophageal cancer can also have these other disorders. This could be a result of the fact that obesity tends to increase the risk of suffering from esophageal cancer and its common comorbidities.
Living with Esophageal Cancer
Many patients suffering from esophageal cancer can be cured and lead healthy lives. You will continue to see your healthcare team periodically after completing treatment for esophageal cancer. In case of new symptoms or concerns, you should immediately inform your oncologist. They can advise you on a routine schedule of imaging studies to ensure that there is no recurrence of cancer cells.
It may be quite difficult to live with some of the symptoms of esophageal cancer. Inability to swallow properly makes living a good life hard. If one is unable to eat easily, they can be aided to get methods for making their food easier to swallow. In cases of chest and throat pain, you may be advised by your health provider to consult pain control experts.