Esophageal Cancer
Overview of Esophageal Cancer
The esophagus is a long muscular, hollow tube that runs from the throat to the stomach. It is approximately 8 inches long. Its main function is to help move food and fluids from the mouth to the stomach. Esophageal cancer is cancer of the lining of the esophagus.
Esophageal cancer (Ghazai Naali ka Cancer / غذائی نالی کا کینسر) occurs when cancer cells are present in the esophagus. The first layer to be affected by cancer cells is the inner layer of the esophagus.
The cancer cells can metastasize and spread throughout the other layers of the esophagus and other parts of the body.
Esophageal cancer can occur in any part of the esophagus. The prevalence in men is higher than in women. It is the 6th most common cancer that kills people in the world. Genetics plays a big role in the manifestation of esophageal cancer.
Occurrence Rate of Esophageal Cancer
The 5-year survival rate of esophageal cancer is approximately 20 percent worldwide. In the case of metastasis, the survival rate is 5 percent.
The prevalence of esophageal cancer in Pakistan is high. In Quetta, it is the 3rd most common cancer in men. It is the 7th most common cancer in men and the 6th most common cancer in women.
In Pakistan, the 5-year survival rate is 10 percent.
Signs and Symptoms of Esophageal Cancer
Cancer is usually discovered at a later stage. Symptoms generally manifest at a progressive stage. As cancer progresses, the following symptoms are frequent:
- Heartburn
- Difficulty and pain while swallowing
- Nausea and vomiting
- Indigestion
- Pressure or burning in the chest
- Chest pain
- Chronic cough
- Weight loss (unintentional and unexplainable)
- Food coming back up the esophagus
Types of Esophageal Cancer
There are two common types of esophageal cancer depending on location:
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Squamous Cell Carcinoma
Cancer present in the squamous cells of the esophagus is called squamous cell carcinoma. The upper and middle part of the esophagus is affected by cancer cells.
Squamous cells are flat, thin cells that make up the lining of the esophagus.
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Adenocarcinoma
Adenocarcinoma is a cancer of the lower part of the esophagus. The cancer cells develop in the glandular cells and tissue of the esophagus.
Glandular cells are responsible for fluid products such as mucus.
Causes of Esophageal Cancer
The exact origin of cancer is still unknown. The most common conclusion is a mutation in the DNA of the esophagus cells. This leads to the rapid multiplication of cells.
Risk Factors of Esophageal Cancer
Certain factors increase the risk of esophageal cancer. Some of these factors are as follows:
- Ages between 45 and 70
- Men are thrice likely to develop esophageal cancer
- Alcoholism
- Tobacco
- Smoking
- Individuals suffering from GERD (gastroesophageal reflux disease)
- Barrett's esophagus which develops due to chronic GERD
- Black people are more prone to developing esophageal cancer
- Lack of fruits and vegetables in the diet
- Individuals with achalasia
- Obesity
Health Complications of Esophageal Cancer
If a person is dealing with esophageal cancer he or she may be prone to the following health complications:
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Anemia
When a person bleeds too much due to esophageal cancer, he or she might have to deal with anemia. Paleness and tiredness are some of the common symptoms of anemia. Red blood cells transfusions is a famous treatment method for anemia
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Sudden Weight Loss
When the tumor growth escalates, the food passage can be interrupted. This can cause a person to lose weight.
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Pneumonia
Esophageal cancer can cause aspiration pneumonia in people. Bacterial infections can cause this severe type of pneumonia.
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Metastases
When cancer progresses it can metastasize to other areas of the body. Starting with the lymph nodes several other regions are also affected.
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Tracheo-oesophagal Fistulas
The formation of holes in the windpipes or esophagus leads the food to escape the food pipe and enter into the lungs. This causes choking, gauging, or severe coughing.
Certain factors increase the risk of esophageal cancer. Some of these factors are as follows:
- Ages between 45 and 70
- Men are thrice likely to develop esophageal cancer
- Alcoholism
- Tobacco
- Smoking
- Individuals suffering from GERD (gastroesophageal reflux disease)
- Barrett's esophagus which develops due to chronic GERD
- Black people are more prone to developing esophageal cancer
- Lack of fruits and vegetables in the diet
- Individuals with achalasia
- Obesity
Health Complications of Esophageal Cancer
If a person is dealing with esophageal cancer he or she may be prone to the following health complications:
-
Anemia
When a person bleeds too much due to esophageal cancer, he or she might have to deal with anemia. Paleness and tiredness are some of the common symptoms of anemia. Red blood cells transfusions is a famous treatment method for anemia
-
Sudden Weight Loss
When the tumor growth escalates, the food passage can be interrupted. This can cause a person to lose weight.
-
Pneumonia
Esophageal cancer can cause aspiration pneumonia in people. Bacterial infections can cause this severe type of pneumonia.
-
Metastases
When cancer progresses it can metastasize to other areas of the body. Starting with the lymph nodes several other regions are also affected.
-
Tracheo-oesophagal Fistulas
The formation of holes in the windpipes or esophagus leads the food to escape the food pipe and enter into the lungs. This causes choking, gauging, or severe coughing.
Prevention
Given below are some of the preventive measures that can reduce the risk of esophageal cancer:
- Quit smoking
- Limit your alcohol intake
- Engage more in physical activities
- Make healthy lifestyle choices
- Avoid passive smoking
- Consult with your doctor on a regular basis
Diagnosis
Cancer is a very serious condition. Many tests are done to give a final diagnosis. It is important to find whether cancer has spread to other parts of the body or is localized in a specific region. This tells about the severity of the condition.
A detailed physical examination is done and the following tests are performed to diagnose esophageal cancer:
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Barium Swallow
The chemical barium is swallowed in liquid form which coats the inner lining of the esophagus. An X-ray is then performed to check for any abnormalities lining the esophagus using the barium as an indicator. This process is also called an esophagram.
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Endoscopy
The lining of the esophagus is seen by the endoscope. This process is called Upper Endoscopy or Esophagus-Gastric-Duodenoscopy (EGD).
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Endoscopic Ultrasound
This is usually done alongside upper endoscopy. Ultrasound outlines any tumor growth in the wall of the esophagus and the clinical features of the tumor.
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Biopsy
During Biopsy, a sample of tissue is taken and sent to the lab for further tests.
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Scan
A CT scan, PET scan, or MRI is done to see the spread of cancer to other parts of the body.
All the above-mentioned diagnostic tests are done in Pakistan.
Treatment of Esophageal Cancer | When to Consult a Doctor
The type of treatment done depends on the stage of the cancer. There are usually four stages of cancer.
- Stage 0 indicates the site of cancer and hasn’t spread
- Stage 1 means the cancer is small with no spread
- Stage 2 means cancer has grown but is yet to spread
- Stage 3 means large cancer that may have spread to lymph nodes and surrounding tissues
- Stage 4 means that the cancer has metastasized
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Surgery
For stage 1 cancer, surgery is recommended. Surgery can be performed by a minimally invasive approach. Generally, a portion of the esophagus is removed and the esophageal tube is reconstructed.
The post-surgery stage is more difficult and the body needs a long time to heal. There are many risks of surgery as well including bleeding and stomach issues.
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Chemotherapy
In chemotherapy, drugs are used to attack cancer cells. A combination of chemotherapy and radiotherapy can be given to the patient.
Chemotherapy has visible side effects because the drugs also kill healthy cells alongside cancer cells. Side effects of chemotherapy are:
- Hair loss
- Nausea
- Vomiting
- Neuropathy
- Fatigue
- Extreme pain
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Radiation Therapy
The radiation beam is used to kill cancer cells in radiation therapy. Radiation can be administered both externally and internally. A combined treatment of both therapies has long-lasting and severe side effects including:
- Sunburned skin
- Fatigue
- Extreme pain
- Pain or difficulty while swallowing
- Painful ulcers formation in the lining of the esophagus
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Targeted Therapy
In this therapy, a specific protein in cancer cells that is HER2 protein is targeted. In other cases, other proteins are targeted. These proteins help the cancer cells to grow.
Other therapies include photodynamic therapy, in which a photosensitive drug is injected into the tumor which attacks the cancer cells when exposed to light.
Esophageal cancer comes with many health complications. Post-surgery complications and the risk of infection are also high. Therefore, you need to visit your healthcare provider regularly for follow-ups.