Cancer

Esophageal Cancer - a Rare, but Fatal Cancer

Written by Dr. Saumya Mittal and medically reviewed by iCliniq medical review team.

 
Image: Esophageal Cancer - a Rare, but Fatal Cancer

Carcinoma of the esophagus is a rare, but fatal carcinoma. It is more prevalent in the males than in females. It is commonly seen in the lower socioeconomic group.

Types of Esophageal Carcinoma:

The two main types of esophageal cancer are,

  1. Squamous cell carcinoma - incidence is reducing gradually.
  2. Adenocarcinoma - incidence is increasing gradually.

Causes:

The causes of esophagus cancer are excess alcohol intake and smoking (synergist role), carcinogen exposure such as nitrates, smoked opiates and fungal toxins, mucosal damage like ingestion of tea, lye and exposure to radiation, chronic achalasia, chronic gastric reflux, Plummer-Vinson syndrome, tylosis palmaris et plantaris (palmoplantar keratosis), dietary deficiencies of zinc, molybdenum, and selenium and celiac disease.

Esophageal Carcinoma Predisposition:

  1. Cervical esophagus - 10%.
  2. Middle esophagus - 35%.
  3. Lower esophagus - 55%, the most common.

Clinical Features of Esophageal Carcinoma:

Progressive dysphagia and weight loss in short duration. Dysphagia more for solids than liquids and soft diet and odynophagia, the pain may radiate to chest or back. Also, emesis, aspiration pneumonia, lymphadenopathy (supraclavicular lymph node) and metastasis (lung, pleura, bone, liver) and hypercalcemia, a feature of squamous cell carcinoma.

Achalasia may have to be ruled out in cases of malignant tumor, due to the presence of ulcerations. Ulcerations are not commonly seen in benign tumors.

Investigations:

  • Chromoendoscopy- Lugol's iodine (for squamous cell carcinoma) and methylene blue (for adenocarcinoma) is recommended in areas of high prevalence of carcinoma of the esophagus.
  • Endoscopy (especially to rule out small resectable tumors) and cytological screening (multiple biopsies of at least 4-8 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.

Treatment:

1) Surgical Resection:

  1. Endoscopic mucosal resection.
  2. Esophagectomy by various approaches.

2) Chemotherapy:

Cisplatin (platinum) containing chemotherapy.

3) 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.

Barrett's esophagus:

Barrett's esophagus is a premalignant condition. There is no reliable non-histological marker of developing carcinoma or dysplasia. Bisphosphonates may increase the occurrence of Barrett's esophagus.

To know more about esophageal cancer, consult an esophageal cancer specialist online --> https://www.icliniq.com/ask-a-doctor-online/surgical-oncologist/esophageal-cancer

Last reviewed at: 07.Sep.2018

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