Esophageal cancer

What’s that?

Esophageal cancer is a malignant neoplasm originating from transformed cells of this organ’s inner (epithelial) layer. It is characterized by late diagnosis and aggressive course – one-third of patients die within a year after detection of the disease. At the same time, esophageal cancer is often manifested by nonspecific symptoms and / or develops on the mucosa already predisposed to the cancer process. Therefore, a careful attitude to your health, regular follow-up with a doctor in the presence of any pathology of the digestive organs, and passing preventive examinations will help to identify the malignant process at the initial stage and successfully cope with it.

About the disease

According to statistics, this disease is prevalent – it ranks first in incidence among all neoplasms of the gastrointestinal tract and eighth in causes of death from oncology. Men have esophageal cancer 3.5 times more often than women; the peak incidence is between 50 and 60 years of age.

Due to the absence of clinical manifestations at the initial stage of the process, almost 70 percent of patients seek medical help and clarification of diagnosis already at the III-IV stages of the disease.

Types

Based on the structure of the tumor cells, esophageal cancer is distinguished into:

squamous cell cancer
glandular cancer
another type (neuroendocrine cancer, neuroendocrine tumor, and so on).

The prognosis depends not on the cellular structure of the neoplasm but on the degree of its differentiation: highly differentiated cancer morphology is very similar to healthy cells, runs more favorably, well succumbs to therapy, low-differentiated runs aggressively, and poorly responds to treatment.

Oncologists widely use the classification of esophageal cancer according to the TNM system, where T characterizes the primary tumor, N indicates the degree of cancer cell involvement of lymph nodes, and M indicates the presence or absence of distant metastases. Taking into account the combination of these characteristics, four stages of esophageal cancer are distinguished:

I – tumor reaches submucosal layer, lymph nodes are not affected, no metastases;
II – the neoplasm sprouts through the entire thickness of the organ wall, but the surrounding tissues are not affected, lymph nodes are not affected, and there are no metastases;
III – the tumor affects up to 6 lymph nodes located near the esophagus;
IV – the neoplasm affects nearby tissues, and metastases in distant lymph nodes and internal organs are determined.

Symptoms

In most cases, the initial stages of esophageal cancer are asymptomatic – the disease does not manifest itself in any way, and the patient does not suspect that he is ill. Sometimes, the pathology debuts with a complex of “small,” nonspecific signs. Patients complain of:

feeling of discomfort, heaviness, non-intense burning, pain behind the sternum during swallowing;
burping;
heartburn;
unexplained weight loss;
some swallowing disorders.

The tumor gradually grows, penetrating deeper into the tissue or the lumen of the organ, shrinking it. As it progresses, the leading symptom and manifestation of esophageal cancer in women and men is swallowing disorders, or dysphagia. Patients experience significant difficulties swallowing food – at first, only hard food (they need to drink water), then soft and liquid food.

The ulceration of the neoplasm is accompanied by salivation, regurgitation of food, pain at first when swallowing, and then – constant admixture of blood in the saliva.

When the malignant process spreads to other organs and tissues, the symptomatology becomes more diverse:

when the recurrent nerve is affected, there is dysphonia, aphonia;
when the stomach is affected, there is nausea, vomiting, rapid satiety, decreased to complete lack of appetite, weight loss;
when the tumor process involves the diaphragm, mediastinum pain becomes excruciating, and patients note it constantly;
lesion of blood vessels is accompanied by bleeding, the volume of which depends on the size of the damaged artery or vein.

The tumor metastasizes hematogenously, affecting the kidneys, adrenal glands, liver, and lungs, which is accompanied by appropriate symptomatology.

Reasons

Unfortunately, the exact causes of esophageal cancer are not yet definitively clear.

The following factors affecting the mucous membrane of the organ increase the risk of its development:

genetic predisposition;
regular consumption of very hot or cold food or drinks;
inhalation of toxic substances;
ingestion of caustic chemicals;
regular inhalation of industrial dust;
esophageal radiation exposure;
performing sclerotherapy;
regular consumption of large amounts of alcohol;
smoking;
unbalanced, irregular diet, frequent overeating;
immunodeficiencies.

Several diseases contribute to the development of cancer, including GERD, esophageal hernia, Barrett’s esophagus, achalasia cardia, hereditary hyperkeratosis, keratoderma, and obesity.

Damage to cells and frequent inflammatory processes in them are the basis of repeated genetic mutations, which one day become the acquisition of transformed cell ability to uncontrolled division – the formation of a cancer cell.

Diagnosis

The main red flag for the doctor is the patient’s complaints of swallowing disorders – dysphagia. It is a direct indication for urgent esophagoscopy. Even before this study, the specialist will clarify other complaints, find out how long ago they occurred, how they changed over time, and what the patient did to help himself, and what result was achieved by his actions.

Conducting an objective examination, the oncologist examines the patient, paying attention to his weight, fat and muscle tissue ratio, enlarged lymph nodes, skin color, visible mucous membranes, and other characteristics.

To clarify the diagnosis of suspected cancer pathology of the esophagus, the patient will be appointed:

clinical blood test;
biochemical blood test;
coagulogram;
a blood test for cancer markers;
clinical urin test;
endosonography (allows the assess the depth of the tumor lesion of the organ wall and the degree of involvement of the nearest lymph nodes in the process);
X-ray fluoroscopy of the esophagus with contrast (allows you to detect a tumor in the esophagus, to determine the degree of narrowing, to determine the rate of passage of food through the affected area);
Ultrasound of lymph nodes (allows you to identify their metastatic lesions);
bronchoscopy (used if metastases are suspected in the bronchopulmonary system);
computed tomography or magnetic resonance imaging (examines the organs of the thoracic or abdominal cavity, depending on the purpose of the study, usually pre-injected contrast, the method allows you to accurately determine the state of the tumor, identify and characterize metastases);
Whole-body positron emission computed tomography (will detect any distant metastases).

Treatment

Treatment tactics for esophageal cancer include a combination of surgical, radiation, and drug treatment methods, depending on the peculiarities of the course of the disease in a particular patient. Different specialists determine it: gastroenterologist, oncologic surgeon, radiologist, chemotherapist.

Surgical treatment usually includes subtotal resection of the esophagus – removal of most of the organ and replacing it with a fragment of the stomach or colon. Regional lymph nodes are removed at the same time.

Chemotherapy or radiation therapy is administered after surgery to destroy any remaining malignant cells that may remain. Sometimes, these treatments are also used before the operation – the result is that the tumor size is reduced, and it is easier to remove.

If there are contraindications to surgery in the late stages of the process, chemotherapy and/or radiation therapy can be used as independent methods of palliative treatment. In that case, they will slightly alleviate the patient’s condition and briefly prolong his life.

Palliative care also involves the patient taking medications for symptomatic treatment – painkillers, anti-emetics, antibiotics, etc.

In case where resection of the esophagus is not possible, the patient may be recommended surgery to install a stent in the localization of the neoplasm. This unique device will widen the lumen and facilitate swallowing.

A patient depleted by prolonged malnutrition needs a complete, high-quality diet. He is prescribed a diet containing 1 g / kg protein daily, a total energy value of 20-30 kcal/kg daily. Special high-protein therapeutic mixtures are used.

All these treatment options are available in more than 850 hospitals worldwide (https://doctor.global/results/diseases/esophageal-cancer). For example, total esophagectomy can be performed in 23 clinics across Turkey for an approximate price of $13.1 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/total-esophagectomy).

Prevention

It is 100% impossible to prevent the development of esophageal cancer – there is no primary prevention. Reduce the risk of this pathology will help to minimize the impact on the mucous membrane of the organ-provoking factors:

avoiding smoking and alcohol;
consumption of mechanically and thermally gentle food;
maintaining body weight within normal limits;
regular preventive examinations of the digestive organs;
timely quality treatment of precancerous lesions.

Rehabilitation

After surgery, the patient is in the hospital under the constant supervision of medical staff, undergoes regular check-ups with a doctor, and receives supportive treatment, particularly antibiotic therapy. He is fed parenterally until the damaged tissues heal (nutrient solutions are administered directly into the blood by infusion).

After completing the course of anti-tumor treatment, the patient is on outpatient dispensary registration with an oncologist – with the frequency recommended by the doctor- and visits the dispensary, undergoes examinations, and has a minimum of necessary tests. This approach allows monitoring of the patient’s condition and timely detection in case of disease relapse.