What Is Esophageal Cancer?
The esophagus is a tube-like structure located in the neck and the chest that carries food from the mouth to the stomach. Esophageal cancer is an uncontrolled growth of abnormal tissue in the esophagus.
This cancerous tissue is composed of malignant cells that no longer live and function normally. Instead, these cells grow uncontrollably, invading adjacent structures and damaging the organ and, ultimately, the whole body.
What Causes Esophageal Cancer?
The exact cause of esophageal cancer is still unknown. However, we do know some risk factors and genetic predispositions. This means that certain conditions predispose people to develop esophageal cancer. These are:
- Gastroesophageal Reflux Disease (GERD)
- Barrett’s esophagus.
- Alcohol consumption.
- Tobacco use.
- High nitrosamine content in the diet (highly processed meats).
- Small amounts of fruits and vegetables in the diet.
- Regular intake of hot beverages.
- Other rare conditions.
What Are the Types of Esophageal Cancer?
There are two common forms of esophageal cancer and a few rare forms of cancer:
- Squamous Cell Carcinoma: this type is the most common worldwide. It is highly associated with alcohol drinking, tobacco use, and poor dietary habits.
- Adenocarcinoma is more common in the U.S. and other Western countries, like Western Europe. It is associated with GERD, and one of its consequences: Barrett’s esophagus (chronic severe damage to the esophageal lining).
- Rare types of esophageal cancer include sarcoma, lymphoma, and small-cell carcinoma.
What Are the Symptoms of Esophageal Cancer?
Esophageal cancer may present with the following symptoms:
- Progressive difficulty swallowing, initially starting with just solid foods.
- Unintended weight loss.
- Chronic fatigue.
- Pain, burning, or heaviness in the chest.
- Low red blood cell or low iron counts.
- Cough or hoarseness.
- Black stools due to bleeding from the esophagus.
- Worsening indigestion.
It is worth noting that esophageal cancer grows slowly, presenting mainly in people over age 50. Early stages usually do not produce significant symptoms.
The above symptoms do not always mean a diagnosis of esophageal cancer. This is because many conditions share these manifestations.
Therefore, it is crucial to consult your doctor when experiencing a concerning symptom.
How Is Esophageal Cancer Diagnosed?
The physician will start by taking a complete medical history of the patient, including:
- Age and biological sex.
- Prior history of medical conditions.
- Habits, such as diet, exercise, smoking, or using illicit drugs.
- The patient’s current symptoms.
- The patient’s family history of medical conditions.
The following step is a physical examination, which looks for physical signs of disease. This process will include:
- Visual observation of the neck, chest, and abdomen.
- Physical palpation of the abdomen.
- Auscultation of the chest and abdomen.
Depending on the suspected condition, the doctor may order several studies.
They can assess the function of several organs and systems, such as the liver, kidneys, blood, and overall metabolism.
Upper Digestive Tract Endoscopy
Also known as esophagoduodenoscopy or simply upper endoscopy, it is the study of choice for assessing the esophagus, stomach, and duodenum (the first segment of the small intestine).
During this procedure, medication can be given to relax or to fall asleep (moderate or deep sedation). A thin, flexible tube with a camera on its end is inserted through the mouth, and the inside structures are assessed by video.
Upper endoscopy permits the doctor to visualize any abnormalities in the mentioned organs and take a tissue sample (biopsy) to perform further investigations.
This method can be part of the upper endoscopy. A probe is inserted into the mouth and through the esophagus to visualize the surrounding structures.
This particular type of sonography is performed when doctors need to evaluate chest lymph nodes and related structures.
Abdominal and Chest Computed Tomography (CT)
CT uses a method where X-rays are involved, obtaining images as if one were sliced from top to bottom. It permits the assessment of almost every structure in the chest and abdomen.
Often, an oral or intravenous medication called contrast is given to “light-up” blood vessels and enhance important structures. Contrast-enhanced images permit a better analysis of the bodily structures in interest.
Barium Swallow Test
The patient swallows a barium fluid in this procedure, and several chest X-rays are taken. The barium fluid helps to visualize the inside of the esophagus.
How Is Esophageal Cancer Treated?
There are several strategies doctors can use to treat this condition. Ultimately, the treatment plan and specific approach are decided by the treating medical team after a careful individual evaluation.
Depending on its location and severity, there are different surgical approaches that are used to remove the tumor. These surgeries are typically complex, due to many vital structures located next to the esophagus; however, many patients are candidates for minimally invasive approaches, requiring only small incisions.
Various medications that are toxic to the cancer can be used to intervene with the tumor’s growth and decrease its size. They are often given in combination with other treatments.
A targeted radiation dose can be used to shrink or destroy a tumor.
Other methods of destroying cancer cells include laser beam and electric current. One of the newest cancer treatments is immunotherapy – chemicals that help your immune system fight cancer.
What Is the Prognosis of Esophageal Cancer?
Unfortunately, esophageal cancer has a poor prognosis. This is because of the aggressive nature of the condition and concealed growth over the years. People with this condition usually present symptoms when there is substantial disease. Nevertheless, the exact prognosis depends ultimately on individual factors such as age, the extent of the disease, and the treatment strategies available.
How to Prevent Esophageal Cancer?
There are several strategies to prevent this condition. Talk to your doctor to understand your individual condition and predisposing factors, and make a plan to improve your overall health.
- Increasing awareness of the condition.
- Quitting tobacco use.
- Decreasing alcohol consumption.
- Considering weight-loss strategies, including a healthy diet.
- Increasing healthy physical activity.
- Controlling GERD symptoms.
- National Comprehensive Cancer Network. NCCN guideline for patients–esophageal cancer. NCCN Guidelines for Patients: Esophageal Cancer
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