Overview
What is the Esophagus ?
The esophagus is a hollow tube that transfers food from the throat to the stomach, that is the "food tube". The tube starts just below the "epiglottis", the flap that keeps food from going into our trachea (air pipe) when we swallow. It ends at where it joins with the upper portion of the stomach, called the "cardia". The actual area of coinage is called the "gastroesophageal junction.
esophagus is muscular, to help propel food downward with swallowing. It has a complex array of nerves ("plexus") that work to coordinate the swallowing motion. The upper 2/3 of the esophagus has a inner lining ("mucosa") of a special type of cell, called "squamous" cells, which are also found in the mouth and anal region. These cells resist abrasion and heat and are able to heal quickly if damaged, say by the sharp edges on food. The lower 1/3 of the esophagus has an inner lining of a different type of mucosa called "columnar" cells.
What is Esophagus Cancer ?
The esophagus, like all body tissues, is made up of individual cells. Normally, cells within the forming esophagus divide and grow very rapidly in the womb, in early childhood, and through puberty. In adulthood, new cells are only formed to replace those which have died from injury, old age or disease.
The division of cells to produce new ones is under tight control by the "genes" within each cell. These genes are made up of DNA, and if it becomes damaged, the cell may start dividing out of control.Esophagus cancer starts in a single cell which has become abnormal. This cells produces millions, and eventually billions, of copies of itself.
The copies are called"clones". These clones fail to function as normal esophagus tissue, but instead divert resources from healthy cells to fuel their own growth. When there are about 1 billion cells, they form a clump, or "tumor" 1/2 inch across. A "tumor" merely means a swelling, it can be caused by infection, inflammation, cancer or whatever.
If a tumor only grows in it's local area (even very large) but does not have the capacity to spread to distant body areas, it is called"benign" and isnot cancer. If, however, the tumor has the ability to spread to distant body areas, it is called "malignant" andthis is cancer. The actual process of spread is called"metastasis", and can occur to any area of the body.
What are the Types of Esophagus Cancer ?
The most common type had always been "squamous cell carcinoma" arising from the upper 2/3 of the esophagus. Now, however, there has been a dramatic increase in another type, called "adenocarcinoma", which tends to arise in the lower 1/3 of the esophagus. Currently, the number of each of these two types of cancer cases is about equal, and together they make up nearly 100% of today's esophagus cancers. White men tend to get the disease more commonly in the lower esophagus, while Black men get it in the middle and upper esophagus.
There are occasional rare cancers found in the esophagus, such as "sarcomas" which arise from the muscular wall, "cylindroma" which begins from glands, and "lymphoma" that starts from the body's immune system cells within the esophagus.
Staging the disease
If 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 : -
- The cancer is found only in the top layers of cells lining the esophagus.
- 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.
- 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.
- 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.
- Bronchoscopy. The doctor puts a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the windpipe to look into the breathing passages
Complications
Esophageal dilation is usually performed effectively and without problems. However, some complications can occur. A small amount of bleeding almost always happens at the treatment site. At times, it can be excessive, requiring evaluation and treatment. An uncommon but known complication is perforation of the esophagus. The wall of the esophagus is thin and despite the best efforts of the physician, can tear. An operation may be required to correct this problem.
Treatment
Treatment for esophageal cancer depends on a number of factors, including the size, location, and extent of the tumor, and the general health of the patient. Patients are often treated by a team of specialists, which may include a gastroenterologist (a doctor who specializes in diagnosing and treating disorders of the digestive system), surgeon (a doctor who specializes in removing or repairing parts of the body), medical oncologist (a doctor who specializes in treating cancer), and radiation oncologist (a doctor who specializes in using radiation to treat cancer).
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