Cancer of the Esophagus - Types, Symptoms, Diagnosis, and Treatment

Introduction:

Esophageal cancer is a serious and life-threatening condition whose incidence has increased in the past 40 years. It is the eighth most common cancer in the world. Though there has been much development in treatment and diagnostic techniques, the incidence of esophageal cancer is expected to increase by many folds. It is the cancer of the esophagus, which is also known as a food pipe. It is called a food pipe since it carries the food from the mouth to the stomach. This cancer starts in the innermost lining of the esophagus wall and proliferates outwards through other layers.

What Are The Types Of Esophageal Cancer?

There are two types are esophageal cancer:

1. Adenocarcinoma.

2. Squamous cell carcinoma.

What Is Adenocarcinoma?

Esophageal adenocarcinoma (EAC) is the cancer of the distant or bottom part of the esophagus. When the gland cells undergo a cancerous transformation, EAC is formed. Though the reason for the metastatic change is not known, various risk factors have been identified, such as chronic acid reflux, gastroesophageal reflux disease (GERD), and Barrett's esophagus. GERD, when left untreated, leads to Barrett's esophagus due to chronic damage to the lining caused by constant reflux of acids.

Esophageal adenocarcinoma may also be caused by multiple genetic abnormalities such as mutational inactivation of p16 and p53 genes, cell cycle abnormalities, and aneuploidy (addition or deletion of one or more chromosomes leading to chromosomal instability). It occurs more commonly in men than women. As the age increases, the risk of developing EAC also increases.

What Is Squamous Cell Carcinoma?

This is the most common esophageal cancer in the world. It has its prevalence equally between the middle and upper parts of the esophagus. A combination of tobacco chewing and alcohol consumption increases the risk of squamous cell carcinoma. While alcohol is responsible for cellular DNA damage, the carcinogens from tobacco can then easily penetrate the cellular membrane and can cause damage to the squamous epithelium. Blacks are more likely to be affected than whites.

What Are The Signs And Symptoms Of Esophageal Cancer?

The esophagus is the food pipe that helps carry food from mouth to stomach. When there is a mutation at the cellular level, dysfunctional features are developed. While there are plenty of signs and symptoms, symptoms are not experienced till the tumor has grown large enough to interfere with eating, swallowing, or digesting food.

• Trouble Swallowing (Odynophagia and Dysphagia): This is the first and the most common warning sign of esophageal cancer. The patient will feel like food is stuck in the throat even after swallowing. This happens due to the growth of tumors in the esophagus that obstructs the movement of food. Swallowing discomfort can be reduced by taking small bites and eating soft foods.

• Chest Pain: When the food reaches the tumor site in the esophagus, the patient experiences pain in the middle chest. Similar pain is experienced by patients with chronic gastric reflux and gastroesophageal reflux disease, which causes a burning sensation in the middle of the chest.

• Weight Loss: Most patients with esophageal cancer lose their weight either due to swallowing problems, loss of appetite, or increased metabolism.

• Hoarseness of Voice and Cough: An increase in the size of a tumor can damage laryngeal nerves that cause hoarseness of voice and persistent cough.

• Hemoptysis: Due to forceful and persistent cough, the patient might vomit blood that may have originated from the lungs or bronchial tubes.

• Hematemesis: Vomiting of blood due to internal bleeding.

How Is Esophageal Cancer Diagnosed?

1. Barium Test: Barium is a soft, alkaline earth metal that is used for the diagnosis of esophageal cancer. The patient is asked to drink this fluid before the X-ray is captured. This fluid lines the esophageal lining that helps in locating and determining the size of the tumor mass. The barium test also helps in detecting other complications of esophageal cancer, such as tracheoesophageal fistula. This fistula is a connection created by a hole caused due to damage caused by a tumor between the esophagus (food pipe) and trachea (windpipe).

2. Computed Tomography (CT): Computed tomography is a series of cross-sectional images taken at a time. The patient is asked to drink oral contrast that lines the esophagus and intestines. The changes caused by this fluid are studied, which helps in determining the spread of cancer to nearby organs and lymph nodes. CT is also used as a guide during the biopsy.

3. Magnetic Resonance Imaging (MRI): This scan uses radio waves and magnetic waves to capture pictures of the esophagus.

4. Positron Emission Tomography (PET): A radioactive form of sugar or dye is injected into the bloodstream, which gets accumulated mainly in cancer cells. These accumulated areas are considered radio activities. Hence the presence and spread of cancer can be determined. This test is not useful for detecting cancer in the brain and spinal cord.

5. Endoscope: The endoscope is a narrow tube with a tiny camera that can be passed through the esophagus to diagnose and determine the extent of the spread of cancer.

6. Bronchoscopy: This test can be done in the upper esophagus to see whether cancer has spread to the trachea or the bronchi.

7. Thoracoscopy and Laparoscopy: This test enables the doctor to study lymph nodes and other organs near the esophagus. This test uses a hollow pipe with the camera. When the pipe is inserted through a cut made on the side of the chest wall, it is called thoracoscopy. When the pipe is inserted via a cut that is made on the abdomen, it is called laparoscopy. These tests are used to perform a biopsy for the study of sample tissues.

8. Blood Tests: Complete blood count (CBC) and liver enzymes are checked to diagnose cancer.

What Is the Treatment for Esophageal Cancer?

• Nutrition Therapy: Intravenous nutrients are given to build and regain the strength to undergo cancer treatment.

• Radiation Therapy: This therapy is used to shrink the size of the tumor.

• Chemotherapy: This therapy involves the use of anticancer drugs that kill cancer cells. Chemotherapy and radiotherapy are used in combination before surgery.

• Surgery: Various types of surgeries performed to treat esophageal cancer are as follows:

1. Transhiatal Surgery - This procedure is performed by placing an abdominal and cervical incision and mobilizing the stomach. It is indicated in patients with achalasia, pancreatic cancer, and strictures.

2. Ivor-lewis Surgery - The tumor is removed from an abdominal incision and thoracic incision on the chest wall. The esophagus is reconnected to the stomach at the level of the upper chest.

3. Minimally Invasive Esophagectomy - The tumor is removed through a small abdominal incision and small incisions on the right chest. In this procedure, a part of the entire esophagus may be removed. The reconnection is located in the upper chest, the same as in Ivor Lewis surgery.

4. Robotic Surgery - In this approach, the tumor is removed from the esophagus with the assistance of a robot. Robotic-assisted surgeries are minimally invasive and precise when compared to traditional surgical procedures.

Conclusion:

The treatment aims to kill the cancer cells and stop them from spreading. 100 % treatment might not be possible in aggressive tumors. It is hard not to worry about cancer returning but talking about it to a doctor can help relieve the stress. Talk to a doctor about scheduled visits and periodic investigations. Take the help of support groups in case of depression, anxiety, or worry. It is normal to have such emotions after treatment. Talk about your emotions with family, friends, and a professional counselor.