What is the esophagus?
The esophagus is a hollow tube that carries food and liquids from the throat to the stomach. When a person swallows, the muscular walls of the esophagus contract to push food down into the stomach. Glands in the lining of the esophagus produce mucus, which keeps the passageway moist and makes swallowing easier. The esophagus is located just behind the trachea (windpipe). In an adult, the esophagus is about 10 inches long.
What is cancer?
Cancer is a disease that affects cells, the body's basic unit of life. To understand any type of cancer, it is helpful to know about normal cells and what happens when they become cancerous.
The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells when they are needed. This process keeps the body healthy and functioning properly. Sometimes, however, cells keep dividing when new cells are not needed. The mass of extra cells forms a growth or tumor. Tumors can be benign or malignant.
Benign tumors are not cancer. They usually can be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.
Causes & Risk FactorsThe exact causes of esophageal cancer are not known. However, studies show that any of the following factors can increase the risk of esophageal cancer: -
- Age - Esophageal cancer is more likely to occur as people get older; most people who develop esophageal cancer are over age 60.
- Sex - Cancer of the esophagus is more common in men than in women.
- Tobacco Use - Smoking cigarettes or using smokeless tobacco is one of the major risk factors for esophageal cancer.
- Alcohol Use - Chronic and/or heavy use of alcohol is another major risk factor for esophageal cancer. People who use both alcohol and tobacco have an especially high risk of esophageal cancer. Scientists believe that these substances increase each other's harmful effects.
- Barrett's Esophagus - Long-term irritation can increase the risk of esophageal cancer. Tissues at the bottom of the esophagus can become irritated if stomach acid frequently "backs up" into the esophagus a problem called gastric reflux. Over time, cells in the irritated part of the esophagus may change and begin to resemble the cells that line the stomach. This condition, known as Barrett's esophagus, is a premalignant condition that may develop into adenocarcinoma of the esophagus.
- Other Types of Irritation - Other causes of significant irritation or damage to the lining of the esophagus, such as swallowing lye or other caustic substances, can increase the risk of developing esophageal cancer.
- Medical History - Patients who have had other head and neck cancers have an increased chance of developing a second cancer in the head and neck area, including esophageal cancer.
What are the symptoms of esophageal cancer?
Commonest symptom of esophageal cancer is difficulty in swallowing. We will discuss various symptoms of esophageal cancer below: -
- Difficulty in swallowing : -This is the most common symptom of esophageal cancer and is caused by the obstruction to the flow of food and liquid to the stomach. Early stages of esophageal cancer usually do not produce this symptom. As the disease progresses, it may cause difficulty in swallowing. Initially the difficulty in swallowing is present only with solids, but later as the disease progresses it may extend to swallowing liquids as well.
- Weight loss : -Weight loss may occur in esophageal cancer due to decreased food intake or due to the direct effect of the tumor. Cancer may produce various chemical substances, which may suppress the appetite and lead to weight loss.
- Pain in the chest : -In some patients the esophagus cancer can cause pain in the chest similar to the pain produced by heart disease. Esophageal cancer can cause discomfort or burning sensation that may be mistaken for heartburn or GERD (gastroesophageal reflux disease). Patients may develop pain during swallowing, but this is not usually seen in earlier phases of the disease.
- Pain during swallowing : -Pain during swallowing may occur due to obstruction caused by the esophageal cancer. This is usually a late symptom of esophageal cancer.
Other symptomsPatients with esophageal cancer may present with many other symptoms including Hoarseness or voice, vomiting, hiccups chronic cough, pneumonia, coughing blood, pain in the back and high blood calcium levels.
Diagnosing esophageal cancer
To help find the cause of symptoms, the doctor evaluates a person's medical history and performs a physical exam. The doctor usually orders a chest x-ray and other diagnostic tests.
These tests may include the following: -
- A barium swallow (also called an esophagram) is a series of x-rays of the esophagus. The patient drinks a liquid containing barium, which coats the inside of the esophagus. The barium makes any changes in the shape of the esophagus show up on the x-rays.
- Esophagoscopy (also called endoscopy) is an examination of the inside of the esophagus using a thin lighted tube called an endoscope. An anesthetic (substance that causes loss of feeling or awareness) is usually used during this procedure. If an abnormal area is found, the doctor can collect cells and tissue through the endoscope for examination under a microscope. This is called a biopsy. A biopsy can show cancer, tissue changes that may lead to cancer, or other conditions.
Staging the diseaseIf the diagnosis is esophageal cancer, the doctor needs to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. Knowing the stage of the disease helps the doctor plan treatment. Listed below are descriptions of the four stages of esophageal cancer.
- Stage I. The cancer is found only in the top layers of cells lining the esophagus.
- Stage II. The cancer involves deeper layers of the lining of the esophagus, or it has spread to nearby lymph nodes. The cancer has not spread to other parts of the body.
- Stage III. The cancer has invaded more deeply into the wall of the esophagus or has spread to tissues or lymph nodes near the esophagus. It has not spread to other parts of the body.
- Stage IV. The cancer has spread to other parts of the body. Esophageal cancer can spread almost anywhere in the body, including the liver, lungs, brain, and bones.
Some tests used to determine whether the cancer has spread include: -
- CAT (or CT) scan (computed tomography). A computer linked to an x-ray machine creates a series of detailed pictures of areas inside the body.
- Bone scan. This technique, which creates images of bones on a computer screen or on film, can show whether cancer has spread to the bones. A small amount of radioactive substance is injected into a vein; it travels through the bloodstream, and collects in the bones, especially in areas of abnormal bone growth. An instrument called a scanner measures the radioactivity levels in these areas.
HOW IS ESOPHAGEAL CANCER TREATED?
The treatment of any cancer depends in part on the stage of cancer at the time it is diagnosed. Other considerations include the overall condition of the patient and specific symptoms the patient is having. Most cancers of the esophagus are diagnosed at a relatively late stage because symptoms of swallowing difficulty don't begin until many months after the cancer begins to grow.
For patients in whom the cancer has not spread to other organs, and thus is potentially curable, surgery to remove the majority of the esophagus is the main form of therapy. Many patients also receive chemotherapy (intravenous drug therapy) and radiotherapy (x-ray treatments) after surgery although there is little information to prove that these additional treatments are useful. Many cancers centers are investigating the usefulness of giving chemotherapy or chemotherapy combined with radiotherapy prior to surgery for patients who are potentially curable.
ChemotherapyChemotherapy uses a combination of drugs to destroy cancer cells. It is a systemic treatment (i.e., affects cells throughout the body) and may be used in combination with radiation to relieve symptoms. It is not used as a primary treatment for esophageal cancer. Common side effects include the following:
- Hair loss
- Loss of appetite
- Mouth and lip sores
- Nausea and vomiting
- Skin rash and itching
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