Esophageal Cancer - a Rare Fatal Cancer

What Is an Esophageal Carcinoma?

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.

What Are the Types of Esophageal Carcinoma?

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.

• Fungal toxins.

• Mucosal damage from ingestion of tea.

• Lye.

• Radiation exposure.

• Chronic achalasia.

• Chronic gastric reflux.

• Plummer-Vinson syndrome.

• Tylosis palmaris et plantaris (palmoplantar keratosis).

• Dietary deficiencies of zinc, molybdenum, and selenium. Celiac disease.

What Is the Predisposition of Esophageal Carcinoma?

1. Cervical esophagus - 10%.

2. Middle esophagus - 35%.

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3. Lower esophagus - 55%, the most common.

What are the Clinical Features of Esophageal Carcinoma?

• 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.

• Emesis.

• Aspiration pneumonia.

• Lymphadenopathy (supraclavicular lymph node).

• Metastasis (lung, pleura, bone, liver).

• Hypercalcemia.

• Vomiting.

• Blood in stool.

• Heartburn that worsens or awakens you from sleep.

• A sensation of food stuck in your esophagus.

• Bad breath.

• Persistent sore throat, sour taste in your mouth.

• Involuntary weight loss.

• Coughing.

• Ingestion.

• Hoarseness of voice.

What Are the Stages Of Esophageal Cancer?

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.

What are Investigations to be done for an Esophageal Carcinoma?

• 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.

What are the Treatment methods for Esophageal Carcinoma?

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:

1. Endoscopic mucosal resection.

2. Esophagectomy by various approaches.

2) Chemotherapy:

• 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:

1. Management of malnutrition.

2. Management of tracheoesophageal fistula.

3. Management of dysphagia.

4. Repeated endoscopic dilatation.

5. Gastrostomy or jejunostomy.

6. Expansive metal stent.

7. Endoscopic fulguration of tumors by lasers.

Attempted chemoradiotherapy followed by a surgical resection may yield better results.

What is Barrett's esophagus?

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:

• Alcohol.

• Smoking.

• Repeated use of NSAIDs or Aspirin.

• Eating large portions at meals.

• Diets rich in saturated fats.

• Spicy foods.

• Moving to bed less than four hours after eating.

People who are more prone to acquire Barrett's esophagus are:

• White.

• Male.

• Obese.

• 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).

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