Esophageal cancer – symptoms, prognosis, treatment and causes

Proven content

Esophageal cancer, like most cancers, is likely caused by adverse environmental and dietary influences. Cancer attacks men much more often than women. Cancer-promoting factors are those that cause food to remain in the esophagus, such as narrowing of the esophagus. The symptoms of the disease resemble esophageal cramps and are accompanied by pain.

Esophageal cancer – definition

It is a malignant tumor that affects the esophagus. It can be located in the upper and middle part of the esophagus (then it is usually of squamous cell origin) or in the lower part of the esophagus, then we are talking about the glandular form of the tumor. Like most cancers, esophageal cancer occurs due to factors that cause food to remain in the esophagus: chemical or mechanical.

Esophageal Cancer Causes

The main factors influencing the development of esophageal neoplasms are:

1. excessive alcohol consumption (usually causes cancer of the esophagus)
2. smoking,
3. gastroesophageal reflux,
4. improper diet (using spicy spices and consuming hot drinks),
5. a small amount of vitamins A, B2, C and E in the diet (also magnesium, zinc and manganese),
6. mechanical trauma to the esophagus,
7. thermal or chemical burn,
8. people infected with Helicobacter pylori,
9. the existence of other neoplasms, such as the pharynx or the larynx.

Esophageal cancer symptoms

The symptoms of cancer resemble those of esophageal spasm, but there is a marked progression of pain and difficulty swallowing. The first symptoms of esophageal cancer (this concerns 90% of patients) are problems with swallowing, in other words – dysphagia. Trouble swallowing occurs when the tumor has spread to 2/3 of the esophagus. There are several degrees of dysphagia, namely:

1. Stage I – the patient has problems swallowing solid food,
2. XNUMXnd degree – the patient can only swallow fragmented food,
3. Stage III – swallowing only liquids is involved,
4. Stage IV – there is a complete inability to swallow (this also applies to saliva).

In more than half of patients, the pain that occurs when swallowing radiates to the back. In the advanced form of esophageal cancer, there are additional symptoms in the form of bloody vomiting, spitting blood, hoarseness (infiltration of the tumor on the laryngeal nerves), and esophageal bronchial fistula. In addition, many patients experience significant weight loss, which is closely related to problems swallowing food. In addition, in advanced disease, the patient may develop dyspnoea, e.g. in the case of lung metastases, and jaundice (in the case of liver metastases).

Diagnosis of esophageal cancer

Before the specialist treatment is implemented, the doctor assesses the patient’s general health, the degree of dehydration and malnutrition, and checks whether the lymph nodes located above the collarbones and in the neck have enlarged. It is also important to determine if the patient is coughing as this may indicate the presence of an oesophageal bronchial fistula. In addition, it is important to determine whether the patient has hoarseness and an enlarged liver.

Patients with swallowing problems should undergo endoscopic examination of the esophagus and stomach (gastroscopy). During this examination, the doctor takes a sample, which is then sent for microscopic examination. In addition, during endoscopy, the doctor is able to reveal neoplastic changes at an early stage of advancement.

The diagnosis of esophageal cancer also includes:

1. radiographic examination of the esophagus with contrast – a test to determine the size and type of the neoplastic tumor,
2. x-ray of the lungs – to help reveal possible metastases,
3. esophagoscopy – a test to determine the location of the tumor and the degree of esophageal narrowing,
4. Abdominal cavity and neck ultrasound – allows you to accurately visualize the liver and sub-diaphragmatic lymph nodes as well as the supraclavicular and cervical area,
5. computed tomography – performed when the tumor image is unclear,
6. blood and urine tests and assessment of the circulatory system – are the basic diagnostic tests,
7. tumor markers typical of esophageal cancer,
8. magnetic resonance imaging,
9. positron emission tomography.

Esophageal cancer – treatment

The type of treatment that can be given to a patient with esophageal cancer depends on the stage of the cancer. The treatment of choice is usually removal of the esophagus. Unfortunately, because most patients see a specialist when the disease is very advanced, only 30% of patients can undergo surgery. The rest can be offered palliative or conservative treatment.

Qualification for surgery is carried out according to special schemes that take into account:

1. general condition of the patient,
2. no distant metastases,
3. proper functioning of the hematopoietic system,
4. proper functioning of the kidneys and liver.

In addition, the patient must consciously consent to radical surgery.

In the case of cancer located in the cervical esophagus, the treatment of choice is radiochemioterapia. If the patient has a narrowing of the esophagus, which prevents complete nutrition – the narrowed section is cleared with, for example, stents (special expansion tubes). Another alternative procedure performed to narrow the esophagus is nutritional jejunostomywhich connects the small intestine with the skin. As a result, the patient is fed with food fed directly into the intestine.

In patients with adenocarcinoma of the lower esophagus, chemotherapy is first used, and then surgery is performed.

If the operation cannot be performed in a given patient, radical radiotherapy or combination therapy is introduced, which consists in the use of radio- or radiochemotherapy before the surgery. The most frequently used palliative procedures include:

1. laser therapy,
2. bipolar coagulation,
3. self-expanding esophageal prostheses,
4. enteric micro-passage aid in feeding,

In turn, the most effective way to make it easier for a patient to swallow is laser restoration of the esophagus and the use of radiotherapy (tele- or brachytherapy).

Important! Studies on the appropriate management of patients with esophageal cancer are still ongoing. However, the most important element of treatment is esophagectomy (excluding the cervical part of the esophagus).

Esophageal cancer – What is the prognosis?

Badly. Only 10 percent. all patients with esophageal cancer survive five years. Of course, it is important to diagnose and treat as early as possible, then the effectiveness of treatment is greater. Therefore, if you have problems swallowing loupes, persistent heartburn – do not hesitate and consult a doctor!

Esophageal cancer prevention

For prophylaxis of esophageal cancer, the following should be avoided:

1. thermal and chemical burns,
2. mechanical damage,
3. nutritional and ecological harmfulness,
4. drinking and eating very hot foods and fluids (in your daily diet).