The esophagus is the tube that connects the mouth with the stomach and runs through an area called the mediastinum located in the centre of the chest, between the two lungs. Esophageal cancer is rare cancer which generally appears in people over 50 years of age and whose prognosis is not good unless it is detected very early.
There are two types of esophageal cancer, squamous cell carcinoma and adenocarcinoma. The latter appears in the lower part of the esophagus and represents 7 out of 10 cases of esophageal cancer.
What are the causes of esophageal cancer?
Several causes related to esophageal cancer have been identified:
- Excessive alcohol consumption.
- Smoking. It acts synergistically with alcohol to increase risk.
- Consumption of some toxins.
- Physical damage to the esophagus from drinking boiling tea, radiation to the chest area, or the presence of achalasia.
- Chronic gastroesophageal reflux leads to Barrett’s esophagus.
Symptoms of esophageal cancer
The main symptoms of esophageal cancer are:
- Progressive difficulty swallowing ( dysphagia ). Difficulty swallowing solids initially occurs and later appears when consuming semi-solid and liquid foods. Sometimes it is accompanied by pain when eating (odynophagia).
- Chest or back pain.
- Other symptoms include vomiting, frequent choking that can lead to aspiration pneumonia, etc.
Cancer spreads through the nodes and can metastasise to the liver, lungs, pleura, and bone.
How is esophageal cancer diagnosed?
The diagnosis of esophageal cancer is made by esophagoscopy and biopsy. When faced with esophageal cancer, it is necessary to evaluate its extension. For this, several tests may be required:
- A TAC.
- An endoscopic ultrasound assesses how far the tumour penetrates the oesophagus wall.
- A PET with or without associated CT to see possible lymph node involvement or metastasis.
- Sometimes a bronchoscopy is required.
Is esophageal cancer hereditary?
Esophageal cancer is not hereditary, although, in some areas of the planet, a higher risk has been observed in certain families.
Prevention of esophageal cancer
The only way to prevent esophageal cancer is to avoid smoking and excessive alcohol consumption. Patients with Barrett’s esophagus have a high risk of developing esophageal cancer, so the necessary check-ups for early detection should be carried out.
What is the prognosis for esophageal cancer?
The prognosis of esophageal cancer is, in general, poor since they are usually diagnosed when the size of the tumour is vast. When the tumour is small, it does not produce symptoms, and more than half of the circumference of the oesophagus must be infiltrated for difficulty swallowing to begin. Only 1 in 20 people with esophageal cancer is alive after five years. The stages in which this type of cancer is divided are:
Stage 0. The tumour is limited to the layer of the esophagus most in contact with the light (with the area through which food passes).
Stage I. Cancer penetrates the submucosal layer.
Stage II. Cancer penetrates the muscle layer of the esophagus or its outer layer, or two or fewer nodes are involved in the area.
Stage III. Cancer affects more nodes or invades neighbouring organs.
Stage IV. Cancer metastasises to other organs or distant lymph nodes.
Treatment of esophageal cancer
Treatment is similar in patients with squamous cell carcinoma or adenocarcinoma of the esophagus.
Treatment, if possible, is surgery, removing all or part of the esophagus. The operation has high mortality and a high risk of subsequent complications. In cases of small and very superficial cancers (that do not penetrate far into the esophagus wall), resection can be done through endoscopy.
Achieves the same response as surgery in terms of prognosis and with fewer risks, but with less resolution of symptoms, mainly difficulty swallowing.
It can also be associated with previous treatments. When the tumour affects the depth of the esophagus wall or there are affected nodes, some doctors recommend it associated chemotherapy and radiotherapy and later decide if it is possible or convenient to operate. More and more treatments are being used that combine surgery with radiotherapy and chemotherapy.
In cases where cancer cannot be operated on, radiotherapy and chemotherapy are recommended.
Biopsies of esophageal cancers
Should look for markers since a positive presence of some of them can recommend a specific treatment, for example, treatment with trastuzumab in patients positive for the HER-2 quality.
Many patients require palliative treatment to allow them to eat and prevent dysphagia. To do this, dilation of the esophagus in the tumour area, placement of metal tubes (stents) or opening of space through the tumour with a laser can be performed, all aimed at allowing the passage of food. They can also have a gastrostomy (a hole from the wall of the abdomen into the stomach) through which they receive food.