Esophagus, is a hollow muscular tube (the food pipe) that runs between your throat and the stomach. It carries the food you swallow from mouth to your stomach through movements known as peristalsis. The wall of the esophagus is made of several layers of tissue.
In esophageal cancer, a malignant tumor forms in the inner lining of the esophagus and then it advances and spreads. It is found more commonly in men than women. You might be surprised to know that esophageal cancer is the sixth most common cause behind cancer deaths globally.
Types of Esophagus Cancer
Esophageal cancer can be divided into subtypes based on microscopic examination (histopathology) and location of tumor in the esophagus.
- Histopathology: Adenocarcinoma and squamous cell carcinoma
- Location: Upper, mid and lower esophageal cancer
Risk factors
Any factor causing long term chronic irritation to the mucous lining of esophagus is thought to induce cancerous changes in the cells. These factors include
- Smoking
- Gastroesophageal reflux disease (GERD)
- Alcohol intake
- Obesity
- Drinking very hot liquids
Symptoms
These cancers like most other gastrointestinal cancers are asymptomatic in initial stages. The symptoms when occur would include:
- Difficulty in swallowing (Dysphagia)
- Unintentional weight loss
- Chest pain
- Worsening indigestion or heartburn
Diagnosis
Diagnosis of esophageal cancer is established by doing an endoscopy. Endoscopy is a procedure in which a flexible thin tube with camera is passed and esophagus is seen from inside. If any abnormality is seen then a small sample from it is obtained called as biopsy and examined under microscope confirming the diagnosis.
The causes of laryngeal cancer are not very clear. Although, it could be due to changes in some cells of the larynx. Most of the cancers begin due to alterations in the cell’s DNA.
DNA or genetic material provides necessary instructions which stimulate the functions of the body such as growth, reproduction, etc. A change in the genes can cause modifications in these instructions, which may cause the cells to grow continuously, thereby producing masses of a tumour and eventually cancer.
Treatment
Treatment will depend upon stage of tumor and fitness of patient to undergo major surgical procedure. Treatment can be broadly categorised into curative and palliative.
Palliative treatment is designed to relieve symptoms, and improve quality of life. Palliative treatment is considered when tumor is too advanced or disseminated. A patient unfit for major surgery is also treated with palliative intent. Difficulty in swallowing (dysphagia) is treated by inserting esophageal stent. Chemotherapy can provide symptomatic relief along with prolonging life.
Curative treatment aims to eradicate the disease. To obtain best results for advanced tumors chemotherapy, radiotherapy and surgery are combined in an approach called multimodal treatment.
Chemotherapy is use of special drugs to kill cancer cells. Radiotherapy is use of high-powered X-ray beams to kill cancer cells.
Surgery involves esophagectomy, which is a procedure of removing part or most of the esophagus along with lymph nodes and reconstructing the same using another part of gastrointestinal tract, most commonly stomach.
Currently the standard of care is administration of chemotherapy or chemoradiotherapy first called neoadjuvant treatment, followed by surgery.
Esophagectomy used to be done as an open procedure with large incisions. Now this surgery can be performed with minimally invasive techniques in which special surgical tools are inserted through small holes commonly known as thoracoscopic esophagectomy. This results in faster recovery and reduced pain compared to the conventional open surgery.
