What is Esophageal Cancer?
Esophageal Cancer starts in the cells of the Esophagus. The Esophagus is a hollow, muscular tube that carries food and drink from the back of mouth to the stomach. It is located behind the windpipe and in front of the spine. When you swallow food the muscles of the esophagus contract to push food down into the stomach. The point where esophagus joins the stomach is called gastroesophageal (GE) Junction. The muscle at the junction opens to allow food to enter the stomach. This muscle normally keeps stomach acid from flowing back up into the esophagus and causing heartburn.
Cancer of the esophagus can start anywhere along the length of the esophagus. There are two main types of esophagus cancer. Each develops in a different kind of cell.
- Squamous Cell Carcinoma starts in the squamous cells that line the esophagus. These cancers are usually found in the upper and middle part of the esophagus.
- Adenocarcinoma starts in the glandular cells in the lower part of the esophagus. Treatment is similar for both types of Esophageal Cancer.
Before esophageal cancer develops the cells of the esophagus start to change and become abnormal. These abnormal cells are precancerous, meaning they are not cancer. Having these precancerous changes in the esophagus is called Barrett’s Esophagus.
What is Barrett’s Esophagus?
Barrett’s esophagus is a condition in which the tissue lining the esophagus - the muscular tube that carries food and liquids from the mouth to the stomach—is replaced by tissue that is similar to the intestinal lining. This process is called intestinal metaplasia.
Barrett’s esophagus may be caused by years of gastric reflex. Gastric reflux is when the stomach acid backs up into the esophagus and causes heart burn.
People with Barrett’s esophagus are at increased risk for a rare type of cancer called Esophageal Adenocarcinoma.
Causes of Esophageal Cancer
Most people diagnosed with cancer of the esophagus are over the age of 60. Men are more likely to be diagnosed with cancer of the esophagus than women.
- Smoking or chewing tobacco
- Drinking alcohol
- Diet: Studies suggest that having a diet that's low in fruits and vegetables may increase the risk of esophageal cancer
- Irritation or damage caused by exposure to chemicals or drinking very hot liquids often.
- Acid reflux may damage the esophagus and over time cause a condition known as Barrett esophagus.
- Achalasia - Having difficulty swallowing because of an esophageal sphincter that won't relax
*Some people develop esophageal cancer without any of these risk factors.
Symptoms of Esophageal Cancer
Esophageal cancer often does not cause any signs of or symptoms in its early stages. Most people do not have symptoms until the tumour blocks the esophagus, making it difficult to swallow. As the cancer grows, symptoms may include:
- Fatigue – feeling very tired
- Coughing or hoarseness
- Heartburn or indigestion
- Loss of appetite
- Frequent choking or painful swallowing while eating
- Weight loss
- Pain in the throat or back, behind the breast bone or between the shoulder blades
- Chest pain, pressure or burning sensation
Diagnosing Esophageal Cancer
After talking with you about your health and completing a physical examination, your doctor may suspect you have esophageal cancer. To confirm the diagnosis, your doctor will arrange special tests.
These tests may also be used to “stage” the cancer. You may have one or more of the following tests.
Imaging Studies:You may have a series of the esophagus and stomach called an upper gastrointestinal (GI) series, or swallow barium. You will ask to drink thick chalky liquid called barium. The barium that temporarily coats the inside lining of the esophagus, stomach and small intestine, so the lining shows up clearly on the X-rays. The doctor looks for many changes in the shape of the esophagus on the x-ray picture. If there are signs of cancer, the doctor will also look to see if it has spread to the stomach.
Blood tests:Blood is taken and studies to see if the different types of blood cells are normal in number and appearance. The results show how well your organs are working.
Esophageal endoscopy:Esophageal endoscopy uses a thin, flexible tube with a light at the end (called an endoscope). The tube is placed down your throat to look inside the esophagus. During an endoscopy, your throat will probably be sprayed with a mild anesthetic (freezing) and you may be given a mild sedative to help you relax. You will have a sore throat afterwards. This is normal and should disappear after a couple of days.
Biopsy:If an abnormal area is found during an endoscopy, the doctor can take several samples of tissue through the endoscope for examination under a microscope. Removing cells from the body to check them under a microscope called a biopsy. A biopsy is usually necessary to make a definite diagnosis of cancer. If the cells are cancerous, they may be studied further to see how fast they are growing.
Further testing:If the diagnostic tests show that you have cancer of the esophagus, your doctor may order more imaging studies to find out if the cancer has spread. Imaging studies allow tissues, organs and bones to be looked at in more detail. Using x-rays. Ultrasounds, CT scans, MRIs or bone scans, your doctor can get a picture of the size of the tumour and see if it is spread.
Once a definite diagnosis of cancer has been made and your healthcare team has the information it needs, the cancer will be given a stage.
The cancer stage describes the tumour size and tells whether it has spread beyond the place where it started to grow.
For esophageal cancer, there are five stages.
Stage 0: Cancer cells are found only in the innermost layer of the lining of the esophagus. Stage 0 is also called carcinoma in situ.
Stage l: Cancer has spread beyond the innermost layer of cells to the next layer of tissue in the wall of the esophagus.
Stage l1: Cancer has spread to deeper layers of the esophagus or to nearby lymph nodes. It has not spread to other parts of the body.
Stage lll: Cancer has spread more deeply into the wall of the esophagus or to tissue or lymph near the esophagus. It has not spread to distant parts of the body
Stage lV: Cancer has spread to lymph nodes and /or other parts of the body, such as the liver, lungs, brain or bone.
It is important to know the stage of the cancer. This information helps you and your healthcare team choose the best treatment for you.
Treatments Esophageal Cancer:
Treatments affect everyone in different ways. It’s hard to predict which side effects you will have. Your healthcare team will tell you what to expect with each treatment. They will let you know what side effects you should report right away and which ones you can wait to tell them about at your next appointment.
For esophageal cancer, you might receive one or more of the following treatments.
Surgery:Surgery is the most common for treatment for esophageal cancer. A decision to have surgery depends on the size of the tumour and where it is. Surgery is done under general anesthetic (you will be unconscious) and you will stay in the hospital for a week or more after surgery.
There are different types of surgery for cancer of the esophagus. An operation to remove all parts of the esophagus is called an esophagectomy. How much of the esophagus is removed depends on the stage of the cancer, the location of the tumour and whether or not it has spread.
The surgeon removes the tumour in the esophagus and some healthy tissue above and below it. Nearby lymph nodes are removed at the same time. Sometimes, all or part of the stomach is removed. This is esophagogastrectomy. If only the upper part of the stomach is removed, the surgeon will pull up the stomach and connect it to the healthy part of the esophagus that remains. If it’s not possible to join the stomach to the remaining part of the esophagus, a section of the intestine will be used to make a new esophagus.
If the tumour cannot be removed and is blocking the esophagus, a hollow tube (called a stent) may be put in the esophagus to keep it open. This will make eating and swallowing easier.
A Stent Fixed
*After surgery you may have some pain or nausea, or may have a bad taste in your mouth. These side effects are temporary, and can be controlled. During the recovery period after surgery, you may need help with:
Breathing:You may need to be on a ventilator (respirator) for a short time to help you breathe. Your healthcare team can teach you special breathing and coughing exercises to help you keep your lungs clear.
Drainage:Drainage tubes may be inserted into your chest to remove any fluids that collect around the lungs. These will be removed a few days after surgery.
Eating:Swallowing tests will be done to make sure that the place where the esophagus has been rejoined to the stomach is healing. An intravenous (IV) drip into a vein or a feeding tube in your nose or your abdomen will be used to give you liquids and nutrients until you are able to eat and drink on your own. It will be a few days before you are able to drink and gradually start eating soft foods.
Chemotherapy is drug treatment that uses chemicals to kill cancer cells.
Radiation and chemotherapy may be given at the same time to treat esophagus cancer before surgery, after surgery or instead of surgery.
In external beam radiation therapy, a large machine is used to carefully aim a beam of radiation at the tumour. The radiation damages the cells in the path of the beam – normal cells as well as cancer cells. Chemotherapy may be given as pills or by injection.
Chemotherapy drugs interfere with the ability of cancer cells to grow and spread, but they also damage healthy cells.
* The chemotherapy side effects you experience depend on which chemotherapy drugs you receive. Side effects tend to be more severe when you are treated with chemotherapy and radiation at the same time. Radiation for esophageal cancer may irritate your mouth and throat, making them dry and sore. This can make it difficult to swallow. These side effects are result of damage to normal cells. The side effects will usually go away when treatment is over and the normal cells repair themselves.
Chemotherapy can cause nausea, vomiting, loss of appetite, fatigue, diarrhea and an increased risk of infection.
Follow-up care helps you and your healthcare team monitor your progress and your recovery from treatment.
The end of cancer treatment may bring mixed emotions.
Stay connected to friends and family they can provide a crucial support network for you during your cancer treatment.
Maintaining a Healthy Diet: After the treatment for esophageal cancer, you may need to make changes to your diet and the eating habits. You will need to eat several small meals and snacks throughout the day, rather than eating three large meals. It is important to eat well so that you get enough calories and protein to control weight loss and maintain your strength both during and after your cancer treatments.
Article By:- eHealthhut Webmaster