Esophageal Cancer

What is esophageal cancer?

Esophagus is food pipe, a hollow organ connecting mouth to the stomach. The esophagus propels food swallowed into the stomach. Esophageal cancer arises from the lining of the esophagus.

What causes esophageal cancer?

Chronic irritation and resulting inflammation and faulty repairs causes cancer. Having gastroesophageal reflux disease (GERD), Smoking, Barrett’s esophagus, being obese, excess and chronic alcohol, bile reflux, achalasia which is an esophageal sphincter that won’t relax, steady habit of drinking very hot liquids, lack of fruits and vegetables and having undergone radiation treatment to the chest or upper abdomen

What are the types of esophageal cancer?

There are two kinds of esophageal cancer based on cells of origin. First kind is squamous cell cancer, which most commonly arises from the proximal two thirds  of the esophagus. Second is adenocarcinoma, which arises from the lower 3rd of the esophagus. Rare other cancers small cell carcinoma, sarcoma, lymphoma and melanoma

What are the symptoms of esophageal cancer?

Signs and symptoms of esophageal cancer include difficulty swallowing (dysphagia), unintentional weight loss, chest pain, pressure or burning, worsening indigestion or heartburn and coughing or hoarseness of voice.

How is esophageal cancer diagnosed?

Usually patients develop symptoms of obstruction, pain and or bleeding resulting in an upper endoscopy. Endoscopy is able to diagnose the cancer and tissue biopsies confirm the diagnosis. Occasionally patients get imaging studies in the form of CT scan and barium swallow which also diagnoses presence of esophageal cancer.

What is esophageal cancer staging?

Esophageal cancer staging is important for planning treatment. Endoscopic ultrasound, CT scan and PET/CT scan are used in the staging process.

Esophageal cancer stages include:

  • Stage in situ. Cancerous cells involving the lining of the esophagus and have not invaded the deeper parts of the inner lining of the esophagus.
  • Stage I. Cancer starts in the superficial layers and invades the first layers of the inner lining of the esophagus and may have spread to the lymph nodes nearby
  • Stage II. Cancer has invaded deeper muscular layers of the esophagus and may have spread to the lymph nodes nearby.
  • Stage III. Cancer has spread to the deepest layers of the wall of the esophagus and invades into the tissues and/or lymph nodes nearby.
  • Stage IV. The cancer has spread to other parts of your body.

What is the treatment of esophageal cancer?

Treatment is multimodality depending on the staging of the cancer. Treatment involves surgery, chemotherapy and radiation therapy.

If the cancer is small and limited to the superficial layers and has no evidence of spread, it can be removed via endoscopic surgery. Surgery may include partial or complete removal of the esophagus called esophagectomy. Occasionally surgery may also include partial removal of upper end of the stomach along with the esophagus and is called esophagogastrectomy.

Drug treatment using medications to kill cancer cells Is called chemotherapy. Cemotherapy for esophageal cancer can be used before surgery called neoadjuvant chemotherapy, or after surgery called adjuvant chemotherapy. In people with advanced cancer, chemotherapy can be combined with radiation therapy. However if the esophageal cancers has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.

Radiation therapy uses high-powered X-ray beams to kill cancer cells. Radiation typically can be from a machine outside the body that aims the beams at the cancer called external beam radiation. Radiation therapy can also be placed inside the body, near to the cancer called brachytherapy. Radiation therapy is typically used before surgery, or occasionally after surgery and is also used to relieve complications of advanced esophageal cancer. Treatment can last from two to six weeks of daily radiation treatments. Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.