Esophageal Cancer

Esophagus is the organ that connects your throat with the stomach. It consists of thin long tube measuring about 10 inches that carries whatever food you eat to the stomach for digestion. Esophageal cancer occurs when the soft delicate lining of the esophagus gets affected and it can develop on any part of the esophagus. Esophageal cancer is of 2 types caused by squamous (affecting the upper part) cell carcinomas and adenocarcinomas (affecting the lower part of esophagus). Men are more affected than women. This type of cancer develops in 5 stages ranging from mild to most severe.

Esophagus consists of the following layers of muscular tube :-

Inner lining of mucosa is very moist so that food can easily pass to the stomach. Next comes the submucosa and the function of this is to secrete mucus to keep the inner layer moist. Next one is the muscle layer that helps in pushing the food down and the last is the outer layer that covers the esophagus superficially.

Cell is the fundamental unit of your body which produces tissues and other organs. Normally cells grow old and die following which new cells are formed. But for cancer patients the reverse happens. Old cells will not die and more and more new cells are formed leading to building up of extra cells which takes form of a tumor.

Cell growth can be malignant (cancer causing) or benign (non cancerous). Benign growth of cells is not of importance for life and they do not disturb the tissues that surround them. They will not spread to other organs also, whereas malignant growth of cells can affect and damage the neighboring tissues and spread to other parts of your body.

Symptoms :

Esophageal cancer begins initially with difficulty in swallowing food. You may have problem in chewing and swallowing some food items. It can cause chest pain or burning sensation in your chest (can be due to other reasons also). There would be loss of weight, tiredness and choking (while eating) and frequent indigestion problems. It can cause irritant cough when food particles gets stuck inside the esophagus. Some people may feel pain while swallowing and change in voice which does not go away even after taking medications. For many people, esophageal cancer does not show any early symptom.

Risk Factors :

Still doctors cannot explain why particular person develops this cancer and others do not. Some of the risk factors are being male, being aged (above 65 years), smoking and drinking regularly, being overweight and having acid reflux problem. Prolonged acid reflux problem can cause Barrett esophagus leading to adenocarcinoma. Research indicates that diet less in vegetables and fruits can make you prone to esophageal cancer.

Types :

Two types of esophageal cancer are:

Adenocarcinoma which affects the lower portion of the esophagus which is the common type of cancer and Squamous carcinoma which affects the thin lining of esophagus affecting the middle portion. In rare cases, esophageal cancer can cause bleeding and severe weight loss.

Tests :

The doctor will examine the symptoms and order for endoscopy. In this procedure, a thin tube is passed through the throat to examine the inner portion of the esophagus through the lens. Barium liquid is given to you to drink and series of X-rays are taken immediately. The resulting X-ray will underline the extra growth of the cells inside. For some cases, a biopsy is done by removing small tissue sample from the esophagus.

Stages of Esophageal Cancer :

  • It is very helpful for the doctor to decide on the treatment options once he knows about the right stage of your cancer.
  • First stage of cancer affects only the topmost layer of the lining of esophagus.
  • Second stage of cancer invades deep into the esophagus lining spreading to the lymph nodes also.
  • Third stage of esophageal cancer will spread to the deepest part of the layer affecting tissues.
  • Fourth or final stage of cancer is widespread and usually affects other body parts also.

Treatment :

Treatment depends on the age, health condition and how far the cancer cells have spread. Number of methods like chemotherapy, radiation therapy and surgery is available. Normally a team of doctors like gastroenterologist, thoracic surgeon, and oncologist and radiation therapists. You may need from the dietician also if you have problems in swallowing. You can always get a second opinion from other doctor before commencing the treatment.

Surgery :

Usually a combination of treatment along with surgery is recommended for treating esophageal cancer. In case the cancer cells are very small (affecting only the superficial layer) your surgeon will remove the cancer cells alone using endoscopic procedure. If the cancer is in the second stage (spreading till the lymph nodes) your surgeon will consider removing small portion of your esophagus. He would use a small portion of the colon for replacing the missing portion of your esophagus.

In case if the cancer cells have advanced esophagogastrectomy is to be done for removing most of the upper part of the esophagus. The stomach region will be pulled up to attach with the balance portion of the esophagus. Any of the surgery mentioned above carries risk of getting infected or leakage. And depending on the intensity of the disease it can be successful or not. For minor forms of esophageal cancer the tube is widened to place a metal stent inside the esophagus. For some people a small feeding tube is inserted into the stomach directly for getting nutrition.

Chemotherapy :

Chemotherapy is given before or after surgery for treating esophageal cancer. Suitable drugs are given orally for destroying cancer causing cells. These drugs can also attack healthy cells causing infections and bleeding. It may also cause adverse effects like joint pain, rash, tingling sensation in the hands and feet.

Radiation Therapy :

Radiation is given for killing cancer cells either externally or internally. The surgeon would apply local anesthetic for numbing your throat and puts in a thin tube through which he sends radioactive rays. In many cases combination of chemotherapy and radiation gives the desired effect. Clinical trials have become the recent addition for treating esophageal cancer.

Lifestyle Changes :

You need to cope with variety of problems like difficulty in swallowing and loss of weight due to cancer. Doctors would suggest you to be on liquid diet or with tube feeding until the area are completely healed. Eat foods that are soft and easy to swallow and eat small frequent meals rather sticking on to two larger meals. Include vitamin supplements in your diet with consultation of your doctor.

Variety of alternate treatments like acupuncture, hypnosis, yoga and relaxation techniques are available for getting relief from pain.

Living with Cancer :

There would be strong feelings of sadness and shock when you are diagnosed with cancer. Learn fully about the stage of cancer from your doctor. Stay connected with your family and friends. Join a support group to share your feelings and for getting encouraged that you are not alone.

Prevention :

You can reduce the risk of developing esophageal cancer by quitting smoking and quitting drinking. Include plenty of liquids, vegetables and fruits in your diet. Do regular exercise and stay on healthy weight.

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