Esophageal cancer is an illness where cancer cells that develop in the inner layer of the esophagus (mucosa). The top layer is made up of squamous cells (flat and thin cells), and so it is called a squamous mucosa. The esophagus (food pipe or gullet) is a muscular tube that is lined with squamous mucosa connecting the throat to the stomach.
Esophageal cancer begins in the cells lying inside the lining of the gullet or it can happen anywhere along the gullet.
Cancer of the esophagus (esophageal cancer) is the sixth (6th) a common cause of cancer mortality worldwide that can be linked to tobacco and alcohol use. The incidence of this disease is much higher in men compared to women.
There are 2 main types of esophageal cancer, the Squamous cell carcinoma (SCC) and the adenocarcinoma.
Squamous cell carcinoma begins to develop in the cells of the esophagus where it is lined with squamous cells. Most often, SCC arises in the upper and middle part of the esophagus. It is the most prevailing esophageal cancer worldwide
Adenocarcinoma is a type of esophageal cancer that starts in the cells that produce and release mucus and other fluids. This cancer usually happens in the lower part of the gullet.
Most of the symptoms of esophageal cancer can be manifested in a later part when it is in the advanced stage and is harder to treat.
Difficulty in swallowing (dysphagia)
This the most common manifestation of esophageal cancer. There is a sense of feeling that a food is stuck in the throat making the client difficult to swallow foods.
When it gets worst, the opening inside the esophagus becomes smaller and without realizing it, the client has already changed in his or her eating habits like taking little bites and chewing the food slowly.
As it gets worse, some would already choose to take in softer food and avoid foods that get typically stuck like meat and bread or might opt to switch to a liquid diet.
Burning sensation in the chest.
This symptom is rarely seen as an indicator that a person might have esophageal cancer because this might be caused by other problems like heartburn. Just after swallowing and as the food or liquid passes the tumor and having a problem passing in, a pain or a burning sensation may be felt in the chest.
Loss of weight.
The client may have decreased appetite and due to the problem when swallowing, the client may not eat properly for weight maintenance.
Other signs and symptoms include:
The cause of the esophageal cancer is still unknown but there are several risk factors that contribute to it.
Tobacco and heavy alcohol use.
Smoking cigars, cigarettes, pipes and chewing tobacco and betel-nut is a major risk for cancer of the esophagus. Smoking can damage the DNA cells lining the inside of the gullet or the esophagus.
This is a disease in which stomach contents and acid back up into the esophagus which will increase the chance of having adenocarcinoma of the esophagus.
Clients with this type of condition are at higher risk than those who have none. If the lining of the esophagus is damaged, the squamous cells that make up the lining of the esophagus will be replaced with gland cells that are more resistant to stomach acid. If the client has chronic reflux, more likely he will develop Barrett’s esophagus.
Men and the elderly
White men have a higher risk of developing adenocarcinoma of the esophagus; Asian men and men with dark skin (men in color) are at risk for squamous cell carcinoma.
A common complication of esophageal cancer is the difficulty of swallowing due to the presence of the growing tumor that might lead to a total obstruction of the esophagus.
The following are other common complications of cancer of the esophagus:
Metastases (in advanced esophageal cancer)
The tumor may start spreading or metastasize to lymph nodes, organs surrounding the esophagus and eventually to nearby areas of the body like the liver, the lungs, and the brain.
Tracheoesophageal fistulas (holes)
These fistulas (holes) that develop between the windpipe and esophagus creates leakage for food and drinks to pass down the windpipe and possibly goes into the lungs causing the client to be choked or a cough during swallowing. These holes can be corrected with surgery or making use of a stent to cover these fistulas.
Advanced esophageal cancer causes the client to bleed heavily. Overtime, when too much blood is lost, it might lead to anemia due to the few red blood cells
The client cannot take in enough food and nutrients which are needed for his or her body’s weight maintenance. Due to the growing tumor in the esophagus, the client may have difficulty swallowing food and will have decreased appetite which leads to weight loss.
This happens when the food, liquids, saliva enters the lungs which are supposed to be being swallowed into the esophagus and stomach.
Initially, the doctor will gather data to prove the diagnosis. There is the review of the signs and symptoms, medical history and the doctor will also conduct physical examination giving special attention to the neck and chest area. Sometimes, if the results are abnormal, the doctor will order some blood tests and x-rays.
Sometimes this is the first test done to determine what causes the trouble in swallowing. This uses a thick and chalky liquid called barium that is being swallowed to coat the walls of the esophagus (gullet). The barium clearly layouts the esophagus when x-rays are taken. The barium swallow test can also show any odd areas of the inner lining of the esophagus and can also use to diagnose trachea-esophageal fistula, a serious complication of esophageal cancer.
Computed tomography (CAT or CT) scan
X-rays are used to produce accurate 2-dimensional images of the body. This scan helps reveal if cancer has metastasized to adjacent organs and lymph nodes or to other areas of the body.
Magnetic Resonance Imaging (MRI)
MRI scans use magnets and radio waves in place of x-rays and it uses a contrast material that is to be injected into a vein before the scan for better viewing of the area. This can be used to see unusual areas in the brain and spinal cord that causes cancer spread.
Positron emission tomography (PET) scan
This uses fluorodeoxyglucose or FDG, a form of radioactive sugar that is introduced into the blood. Cancer cells absorb higher loads of the radioactive sugar compared to normal cells. This test aids doctors to see if cancer has penetrated other area of the body.
An endoscope is used to visualize the inside of the body. This instrument is a narrow and flexible tube with a small video cam and light on the end that passes down the throat and into the gullet and stomach. This procedure helps diagnose cancer of the esophagus and to find out the extent of metastasis.
A probe that emits sound waves is used in this procedure together with the upper endoscopy test. This determines the size of the esophageal cancer and how it spread to adjacent areas like the lymph nodes. If the lymph nodes became enlarged, the doctor performs a biopsy where he or she take samples of the tissue for laboratory testing.
This procedure helps the doctor view the airway of the client and to see if the cancer has metastasized in the trachea-bronchial tree (windpipe and lungs).
Thoracoscopy and laparoscopy
These are performed to see if the tumor has spread farther the esophagus. This is called “staging.” These procedure aids the doctor to see lymph nodes and other organs inside the chest and abdomen through thoracoscopy and laparoscopy using a lighted tube to view the area around the esophagus. The procedures are performed in an operating room under general anesthesia.
8Stages of esophageal cancer
Stage 0. There are abnormal cells that are found only in the inner lining of the esophagus. Sometimes, doctors call this high-grade dysplasia (HGD) or carcinoma in situ (CIS).
Stage I. There is already the existence of cancer cells seen only in the layer of cells that line the gullet.
Stage II. Cancer has already metastasized to the outer layer of the esophagus affecting one or two lymph nodes.
Stage III. It has gotten deeper into the inner muscle layer or the connective tissue wall and may have reached the nearby organ and more lymph nodes near the esophagus.
Stage IV. This is considered as the advanced stage since cancer has metastasized to other organs in the body and to the lymph nodes away from the esophagus.
The management of this disease depends on the stage of cancer and health of the client.
Surgery is done to remove very small tumors, remove a portion of the esophagus (esophagectomy) and remove a part of the esophagus and the upper part of the stomach (esophagogastrectomy).
This is done to eliminate cancer cells with the use of x-ray beams.
This procedure uses drugs which are powerful to aim cancer cells in the body.
The prognosis for esophageal cancer differs depending on how far it has metastasized,
the age and general health of the client.
If the tumor is still small, it may be possible to remove it completely. But since the symptoms of cancer of the esophagus can only be detected until the late stage, the treatment is hard since cancer has already spread.
To reduce the risk of esophageal cancer, the following can be done.
- Avoid or quit smoking. Seek help from the doctor or undergo counseling on how to quit smoking.
- Stop drinking heavy alcohol or drink in moderation.
- Maintain healthy diet and healthy weight. Eat a variety of fruits and vegetables.
- If there is persistent heartburn, consult a physician. This may indicate gastroesophageal reflux disease (GERD).
- Have a regular exercise and avoid becoming overweight.
- Consider regular screening for situations that can lead to cancer of the esophagus.