Carcinoma of the esophagus is a rare but fatal carcinoma. It is more prevalent in males, and commonly affects the lower socioeconomic group. Read the article to know about its causes, types, symptoms, and treatment.
The esophagus is nothing but a hollow muscular tube responsible for migrating the food from the throat to the belly. Esophageal carcinoma is the cancer of the muscular tube that runs from the throat to the stomach. It can happen when a cancerous tumor forms in the covering of the esophagus. As the tumor progresses, it can alter the deep tissues and muscle of the esophagus. Cancer can appear anywhere along the esophagus's length, even where the esophagus and the stomach meet.
Types of esophageal cancer are:
1. Squamous Cell Carcinoma - incidence is reducing gradually.
2. Adenocarcinoma - incidence is increasing gradually.
What are the Causes of Esophageal Carcinoma?
The causes of esophagus cancer are:
Excess alcohol intake and smoking (synergist role).
Carcinogen exposure such as nitrates smoked opiates.
Mucosal damage from ingestion of tea.
Chronic gastric reflux.
Tylosis palmaris et plantaris (palmoplantar keratosis).
Dietary deficiencies of zinc, molybdenum, and selenium. Celiac disease.
Cervical esophagus - 10%.
Middle esophagus - 35%.
Lower esophagus - 55%, the most common.
The patient may experience progressive dysphagia and weight loss in a short duration. Dysphagia (painful or difficult swallowing) is more for solids than liquids, soft diet, odynophagia, and pain may radiate to the chest or back.
Lymphadenopathy (supraclavicular lymph node).
Metastasis (lung, pleura, bone, liver).
Blood in stool.
Heartburn that worsens or awakens you from sleep.
A sensation of food stuck in your esophagus.
Persistent sore throat, sour taste in your mouth.
Involuntary weight loss.
Hoarseness of voice.
Stages of esophageal cancer may include:
Stage 0 - Abnormal cells (not still cancer) are found only in the esophagus' lining layers.
Stage I - Cancer cells are observed only in the layer that lines the esophagus.
Stage II - Cancer has spread to the muscle layer or the outer wall of the esophagus. Also, cancer may have reached 1 to 2 nearby lymph nodes.
Stage III - Cancer has reached deeper into the inner muscle layer or the connective tissue wall. It may have spread to more lymph nodes near the esophagus or beyond the esophagus into the surrounding organ.
Stage IV -This is the most advanced cancer stage. Cancer will spread to lymph nodes far from the esophagus and other organs in the body.
Achalasia may have to be ruled out in malignant tumors due to the presence of ulcerations. Ulcerations are not commonly seen in benign tumors.
Chromoendoscopy: Lugol's iodine (for squamous cell carcinoma) and methylene blue (for adenocarcinoma) are recommended in areas of the high prevalence of carcinoma in the esophagus.
Endoscopy (especially to rule out small resectable tumors) and cytological screening (multiple biopsies of at least 4 to 8 times to increase the yield) are essential.
CT chest and abdomen and EUS (endoscopic ultrasound scan) are used to detect spread to mediastinum and lymph nodes.
USG neck to detect lymph nodes in the neck.
Bronchoscopy to detect tracheoesophageal fistulas that are commonly formed in this condition.
PET scan to help assess the resectability.
One of the main goals of treatment is to stop or reduce the development of Barrett's esophagus by treating and managing acid reflux. Esophageal cancer is a treatable condition in most cases, but it is rarely curable. An overall 5-year survival rate in patients responsive to definitive treatment varies from 5% to 30%. The particular patient with a very early disease has a better possibility of survival.
Make changes in your diet by avoiding fatty foods, chocolate, spicy foods, caffeine, and peppermint, which may aggravate the reflux.
Avoid caffeinated drinks, alcohol, and tobacco.
Lose weight because being overweight may increase your risk for reflux.
Keep your head elevated while sleeping; that may help limit the acid in your stomach from seeping up into the esophagus.
Do not lie down to sleep for at least 3 hours after eating.
Take the medications with plenty of water.
1) Surgical Resection:
Endoscopic mucosal resection.
Esophagectomy by various approaches.
Cisplatin (platinum) containing chemotherapy.
Proton pump inhibitors will decrease the production of stomach acid.
Antacids neutralize stomach acid.
H2 blockers reduce the release of stomach acid.
Drugs like promotility agents speed up the passage of food from the stomach to the intestines.
3) Radiofrequency ablation, which applies heat to eliminate abnormal esophagus tissue. It may be recommended after endoscopic resection.
4) Cryotherapy utilizes an endoscope to use a cold liquid or gas to irregular cells in the esophagus. The cells are permitted to warm up and later are frozen again. The period of freezing and thawing destroys the abnormal cells.
5) Palliative Therapy:
Management of malnutrition.
Management of tracheoesophageal fistula.
Management of dysphagia.
Repeated endoscopic dilatation.
Gastrostomy or jejunostomy.
Expansive metal stent.
Endoscopic fulguration of tumors by lasers.
Attempted chemoradiotherapy followed by a surgical resection may yield better results.
Barrett's esophagus is a premalignant condition, and there is no reliable non-histological marker of developing carcinoma or dysplasia. Bisphosphonates may increase the occurrence of Barrett's esophagus. Barrett's esophagus increases the risk of acquiring adenocarcinoma, the most prevalent type of esophageal cancer. But if Barrett's esophagus does transform into cancer, it is a gradual process that takes many years. The risk is small, also in people who have precancerous alterations in their esophagus cells. Luckily, most of the people with Barrett's esophagus will nevermore develop esophageal cancer. Factors that aggravate Barrett's Esophagus are:
Repeated use of NSAIDs or Aspirin.
Eating large portions at meals.
Diets rich in saturated fats.
Moving to bed less than four hours after eating.
People who are more prone to acquire Barrett's esophagus are:
Middle-aged or older.
Family history of esophageal cancer.
Family history of Barrett's esophagus.
Heartburn symptoms for more than 10 years.
Gastroesophageal reflux disease (GERD).
Yes, the patient feels ill due to a persistent cough. The patient also has chest pain, hoarseness of voice, loss of weight, and breathing problems. If the problem persists for a longer time, you have to contact your doctor immediately.
Cancer in the esophagus is a very aggressive condition. The main problem with this type of cancer is that no symptoms are expressed until cancer reaches a severe stage. The grade three cancer spreads more quickly and in an aggressive manner.
The risk factors of esophageal cancer are:
- People aged between 45 and 70 years.
- Male gender.
Esophageal cancer is the seventh most common cause of death in men. In the United States of America, only one percent of the cases are recorded to be esophageal cancer. The rate of occurrence of esophageal cancer was noted to be higher in other Asian and African countries.
The spreading of cancer begins in the esophageal walls and slowly enters the lymph nodes surrounding the esophageal region. Esophageal cancer then proceeds into a more complicated stage involving the lung, bones, liver, brain, and adrenal glands.
The symptoms of esophageal cancer are:
- Difficulty in swallowing.
- Unintentional weight loss.
- Chest pain.
In some patients, excessive burping can be an indicating sign of esophageal cancer or any other type of cancer. However, it is not possible to make a confirmatory diagnosis with the burping sign. If the patient is experiencing excessive burping, the patient has to check with the doctor to identify the exact cause.
The different types of esophageal cancer are:
- Squamous cell carcinoma.
- Small cell carcinoma.
The various diagnostic methods for the detection of esophageal cancer are:
- Endoscopic ultrasound.
- Positron emission tomography.
- Computerized tomography.
If the esophageal cancer is causing anemia due to the excessive bleeding from the tumor, in such cases, blood tests can be helpful for suspecting the condition of esophageal cancer. If you are confused about the diagnosis, you can get help from icliniq.com.
The condition of esophageal cancer can be identified only in the later stages. After the spreading of the disease starts, the symptoms become noticeable. Some patients are known to die within a year of diagnosis because the symptoms are usually subtle to be identified at an earlier stage.
It is not possible to completely cure the conditions. The symptoms can be controlled and managed in an effective manner if the treatment is started at an early stage. The average lifespan of the patients affected by esophageal cancer is about five years.
The most recommended treatment options for esophageal cancer are:
- Radiation therapy.
- Targeted drug therapy.
In most advanced stages of cancer, surgical methods would be helpful.
Last reviewed at:
21 Apr 2022 - 5 min read
Query: Hi doctor, I am contacting you regarding an uncle of mine. He is 40 years old. His health issues are related to alcohol (beer). He drinks quite a few times a week. When he starts drinking, he drinks a few liters before stopping. He also smokes, but only sometimes. He finds heavy breathing after ju... Read Full »
Article Overview: Estimates suggest that by 2025 more than 365 women will die due to cervical cancer every day. Cervical cancer is usually caused by HPV (Human Papillomavirus) and will mainly affect young women. Read Article
Trivia: Cervical cancer is the second largest cancer affecting women's health. What Is Cervical Cancer? Cervical cancer is a type of cancer that begins in the cells in the cervix, present in the lower part of the uterus (womb). The cervix connects the uterus's body (the upper part where a fetus g... Read Article
Query: Hi doctor,My mother is suffering from well-differentiated squamous cell carcinoma. Her age is between 55 to 60. What treatment can cure her? Read Full »
Most Popular Articles
Do you have a question on Palliative Therapy or Barrett's Esophagus?Ask a Doctor Online