Esophageal Cancer

Esophageal Cancer Definition

Esophageal cancer occurs in the esophagus, which is a long, hollow tube that runs from the throat to the stomach. The esophagus carries food swallowed to the stomach to be digested.Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus. More men than women get esophageal cancer.

Esophageal Cancer Symptoms

• Difficulty swallowing (dysphagia)
• Sudden weight loss
• Chest pain or burning sensation
• Aggravated indigestion or heartburn
• Coughing or gruffness of voice
• Early esophageal cancer typically causes no signs or symptoms

Esophageal Cancer Risk Factors

It’s thought that chronic irritation of the esophagus may contribute to the DNA changes that cause esophageal cancer. Factors that cause irritation in the cells of the esophagus and increase the risk of esophageal cancer include:

• Alcohol consumption
• Bile reflux
• Consuming very hot liquids frequently and fewer fruits and vegetables
• GERD
• Obesity
• Smoking

Complications

• Obstruction of the esophagus
• Pain
• Bleeding in the esophagus

Esophageal Cancer Diagnosis

Tests and procedures used to diagnose esophageal cancer include:

Upper GI Endoscopy is done. Using the endoscope, doctor examines the esophagus, looking for cancer or areas of irritation.

During endoscopy tissue samples are taken for biopsy as well.

If the patient has been diagnosed with Barrett’s esophagus, a precancerous condition that increases the risk of esophageal cancer caused by chronic acid reflux, ask the doctor what signs and symptoms to watch for that may signal that the condition is worsening.

Esophageal Cancer Staging

When diagnosed with esophageal cancer, the doctor works to determine the extent (stage) of the cancer. The cancer’s stage helps determine the treatment options and the tests used in staging esophageal cancer include CT scan and PET scan.

The stages of esophageal cancer are:

• Stage I: This cancer occurs in the superficial layers of cells lining the esophagus
• Stage II: The cancer has invaded deeper layers of the esophagus lining and may have spread to close by lymph nodes
• Stage III: The cancer has spread to the deepest layers of the wall of the esophagus and to nearby tissues or lymph nodes
• Stage IV: The cancer has spread to other parts of the body

Esophageal Cancer Treatment

Treatments for esophageal cancer are based on the type of cells involved in the cancer, the cancer’s stage, the overall health and the preferences for treatment.

Chemotherapy

Chemotherapy drugs are typically used before or post surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.

Radiation Therapy

Radiation can come from a machine outside the body that aims the beams at the cancer (external beam radiation). Or radiation can be placed inside the body near the cancer. Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It can be used before or after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to the stomach.

One of the advanced forms of radiation therapy is proton therapy which targets and destroys the tumour with utmost precision. With proton therapy, the oncologist will be able to irradiate just the tumour while sparing the healthy structures such as the spinal cord, lungs, stomach etc. Proton Therapy is available at Apollo Proton Cancer Centre, Chennai.

Surgery

Surgery to remove the cancer can be used alone or in combination with other treatments. Operations used to treat esophageal cancer include:

• Surgery to remove very small tumors
• Surgery to remove a portion of the esophagus (esophagectomy)
• Surgery to remove part of the esophagus and the upper portion of the stomach (esophagogastrectomy)

Surgery to remove the esophagus can be performed as an open procedure using large incisions or using minimally invasive methods.