Esophageal Cancer
Esophageal cancer is not very common in family practices because most patients are either warded in hospital or undergoing special treatment in the hospitals.
I used to see some cases in the general surgery wards.
However esophageal cancer is not a common cancer.
Any one who smokes or drinks alcohol is a potential victim of this form of cancer.
What is Esophageal cancer?
Esophageal cancer is the abnormal growth of malignant cells in the lining and wall of the
esophagus which mutate and proliferate giving rise to the esophageal cancer growth.
Esophageal Cancer can spread to the surrounding organs like liver, pancreas and colon.
Once in the blood stream it can spread to the brain, bones and kidneys.
What are the types of Esophageal cancer?
There are 2 main types of esophageal cancer:
1. Adenocarcinoma - more common 50% and present in lower one third of the gullet.
2. Squamous Cell Carcinoma – 25% and present in upper one third of gullet
The remaining 25% are rare undifferentiated cancer.
What are the causes of Esophageal cancer?
Causes:
1. Age 65 or older
2. Male: men are three times more likely as women to develop esophageal cancer.
3. Smoking: smokers are more likely to develop esophageal cancer.
4. Heavy drinking: increases the risk of squamous cell carcinoma of the esophagus.
5. Diet: meat and carbonated drinks increases the risk of adenocarcinoma
6. Obesity: increases the risk of adenocarcinoma of the esophagus.
7. Acid reflux: may lead to adenocarcinoma of the esophagus in some people.
8. Some pollutants and chemicals
9. Tooth loss
What are the symptoms of Esophageal cancer?
In the early stages, esophageal cancer may have no symptoms.
As it spread it can cause the following symptoms:
1. Pain on swallowing
2. Pain in the chest
3. Heartburn
4. Hoarse voice
5. Loss of weight
How is the diagnosis of Esophageal cancer made?
Diagnosis is by:
1. Medical history and complete physical exam.
2. Barium meal swallow shows obstruction in the gullet
3. Endoscopy: a thin, lighted tube is put into the mouth and passed down to the esophagus.
4. Biopsy: During endoscopy, a small piece of the suspicious cancerous tissue is taken to check for cancer cells.
This is called a biopsy sample which is then examined under a microscope for cancer cells.
5. MRI and PET CT scans can detect any lymph nodes that are malignant.
What is the treatment of Esophageal cancer?
Treatment for esophageal cancer may include surgery, chemotherapy or radiation therapy, or a combination of these treatments.
The treatment of esophageal cancer is dependent on whether the cancer is just in the esophagus or if it has spread to other places in the body.
The choice of treatment is also based on the person’s age and overall health.
The cancer is usually staged or graded before treatment.
A. Surgery
Surgery is still the best form of treatment for esophageal cancer.
For smaller cancers -partial removal of the esophagus is done.
In early stages the cure rate is about 90%.
For later stages of cancer, the whole esophagus and surrounding tissues may be removed and a feeding tube is placed in the small intestine
B. Chemotherapy
Chemotherapy is used as an adjuvant therapy together with surgery in the later stages of cancer and given though the veins
C. Radiation treatment:
Radiation can help to kill the cancer cells surrounding the esophageal cancer as well as to relieve pain.
External and internal radiation may be done before or after surgery
