Contents
What is esophageal cancer?
Esophageal carcinoma is a malignant neoplasm that develops from epithelial cells located in the mucous membrane. To date, this oncological disease is most common in elderly people, whose age exceeds 60 years. The male half of the population is several times more likely to experience this malignant neoplasm. According to available medical statistics, esophageal cancer accounts for 40% of all existing cancers.
Currently, in patients diagnosed with esophageal cancer, there are several types of this malignant neoplasm:
carcinoma;
adenocarcinoma;
squamous cell carcinoma of the esophagus.
A cancerous tumor can be localized in any part of the esophagus:
most often (in 55% of cases) a malignant neoplasm is detected in the lower esophagus;
in 35% of cases, cancer is detected in the middle part of the esophagus;
the upper esophagus accounts for only 10% of cancers.
In most cases, this category of patients is faced with tumors identified:
in the stomach;
in the larynx;
in the nerve trunks of the diaphragm and chest.
Modern medicine in diagnosing cancerous neoplasms of the esophagus uses the following classification:
endophytic cancer. This type of neoplasm grows in the submucosal layer of the walls of the esophagus;
exophytic cancer. This type of neoplasm grows and fills the lumen of the esophagus. Over time, it begins to rise above the mucous membrane of the esophagus;
mixed cancer. Ulcers often form at the site of this type of cancer, since the neoplasm itself is prone to rapid decay.
How long do people live with esophageal cancer?
With the timely diagnosis of esophageal cancer, patients have rather bright prospects for a full recovery.
The main problem of this cancer is its slow and often asymptomatic course. Most patients seek help already in the later stages of the development of a malignant neoplasm. At an advanced stage of esophageal cancer, even with good care and high-quality treatment, doctors determine the life span of patients not exceeding 6 years.
When metastasizing the patient’s body, doctors in most cases no longer prescribe surgical treatment, since this makes no sense. The only treatment method that can prolong the life of a patient for at least a year is radiation therapy.
According to statistics published in specialized media, patients who have had a cancerous tumor surgically removed, as well as courses of radiation and chemotherapy, have the following life expectancy:
patients who have been operated on stage 1 esophageal cancer – in 90% of cases recover completely;
patients who have been operated on for stage 2 esophageal cancer recover in 50% of cases;
patients who underwent surgical treatment for stage 3 esophageal cancer survive in 10% of cases, and their life expectancy is more than 5 years.
Symptoms of esophageal cancer
In the initial stage of the development of a malignant neoplasm in the esophagus, patients may not show any symptoms. The patient feels well, and does not notice any deviations from the norm.
At a later stage of the development of this disease, the following symptoms are observed:
difficulty in swallowing food;
spasms in the esophagus;
hoarseness;
hiccups;
pain in the chest;
squeezing sensations in the chest;
sharp pain syndrome;
a feeling of pain or burning that occurs while eating;
due to the narrowing of the esophagus, the patient can only swallow liquid food;
severe malnutrition (occurs due to malnutrition and lack of essential nutrients by the body);
constant feeling of hunger;
weakness, lethargy;
loss of working capacity;
blockage of the esophagus (as a result of swallowed food comes back);
an unpleasant (sometimes fetid) smell from the patient’s mouth appears;
nausea;
nervousness;
vomiting reflex;
congestion in the esophagus;
plaque on the tongue;
belching;
sore throat;
the appearance of a tracheoesophageal fistula;
cancer cachexia;
development of hypersalivation;
heart rhythm disorder;
asthma attacks;
the appearance of signs of stridor breathing;
an increase in the size of the lymph nodes, etc.
With metastasis of a tumor of the esophagus, the following symptoms may be observed:
pain in the chest;
severe shortness of breath that occurs even with little physical effort;
swelling is formed, the place of localization of which is the supraclavicular fossa;
strong and prolonged cough, etc.
In the event that metastases have affected other internal organs of the patient, he may experience the following symptoms:
lethargy;
fatigue;
prostration;
drowsiness;
pain sensations;
slight increase in temperature;
apathy;
depressive states, etc.
For successful treatment of a malignant neoplasm of the esophagus, it is necessary to diagnose this disease in a timely manner. That is why it is important for patients to identify the first alarming symptoms of esophageal cancer in order to receive quality medical care. The sooner a tumor is detected, the greater the chances for a successful recovery and survival of patients.
Causes of esophageal cancer
To date, modern medicine has managed to determine the main causes of the development of malignant neoplasms in the esophagus.
Causes of esophageal cancer include the following:
excess weight (any stage of obesity) has a direct impact on the functioning of the digestive tract. Overweight people have increased pressure in the abdominal cavity. Over time, they develop reflux, against which a burn of the walls of the esophagus with hydrochloric acid is formed (food is thrown into the esophagus from the stomach, along with concentrated gastric juice);
passion for various diets that negatively affect not only the organs of the gastrointestinal tract, but also the entire human body as a whole;
frequent consumption of spicy, peppery and pickled foods;
infatuation with too hot food, from which a burn of the walls of the esophagus can occur;
accidental ingestion of liquids that can cause a chemical burn of the walls of the esophagus (in some cases, the consequences of a chemical burn may appear after several years);
bad heredity. Numerous studies of esophageal cancer, conducted by scientists from around the world, have shown that the likelihood of developing esophageal cancer increases several times due to the p53 gene mutation. Due to the fact that tissues cease to receive proper protection and malignant neoplasms begin to develop in the esophagus;
any mechanical impact on the esophagus (injuries resulting from swallowing solid food that can damage the walls of the esophagus) can provoke the degeneration of epithelial cells into cancer cells;
smoking and drinking alcoholic beverages. Among patients who have been diagnosed with cancer of the esophagus, there is a large number of people suffering from alcoholism (this addiction has become the main cause of their disease). Frequent alcohol intake thins the esophageal mucosa, resulting in the destruction of its cells. The same situation is with another addiction – smoking. Carcinogenic substances that enter the patient’s lungs cause irreversible changes in the epithelial cells. When lighting his first cigarette, each person should remember that he consciously falls into the risk group, and may soon get esophageal cancer;
papillomavirus, found in human blood, can cause malignant neoplasms in the esophagus (scientists attribute this to a mutation in the cells of the esophagus, which is caused by this virus);
insufficient amount of vitamins, minerals and other useful substances that must be daily supplied to the human body. The cells of the esophageal mucosa lose their ability to perform the functions assigned to them, as a result of which they can be reborn, etc.
Stages and grades of esophageal cancer
Modern medicine defines 4 stages of esophageal cancer:
At the first stage, the patient may not notice any changes in his body. When eating solid food, he has to drink liquid so that the food can reach the stomach.
In the second stage of esophageal cancer, the patient may begin to have nutritional problems. Many patients at this stage of cancer switch to liquid foods, mashed potatoes and cereals.
In the third stage of esophageal cancer, patients have a narrowing of the alimentary canal, which makes even the process of swallowing liquid difficult and painful.
At the fourth stage of cancer, the patient has a complete obstruction of the esophagus.
Esophageal cancer grade 1
The first stage of esophageal cancer is often not accompanied by pronounced symptoms. The malignant neoplasm is very small and practically does not bother the patient. At this time, the mucous membranes of the walls of the esophagus, as well as the submucosa, are affected. A cancerous tumor in the first stage does not grow into the muscular layer of the esophagus and therefore responds very well to surgical treatment. Patients do not have a narrowing of the lumen of the esophagus, they can fully eat, as they do not experience discomfort either during meals or after meals.
Esophageal cancer grade 2
At the 2nd stage of the development of esophageal cancer, the following organs are affected:
mucous membranes of the walls of the esophagus;
muscle membranes;
submucosal base.
At this time, the malignant neoplasm does not extend beyond the affected esophagus. In many patients, the lumen of the esophagus narrows, and therefore, they have to switch to liquid food. When examining a patient, specialists can detect single metastases that affect regional lymph nodes.
Esophageal cancer grade 3
At the 3rd stage of development, a malignant neoplasm grows into all layers of the walls of the esophagus. In patients, the tumor affects the serous membrane, as well as the periesophageal tissue. Against the background of the development of cancer, the lumen of the esophagus narrows and patients have a problem with nutrition, as it becomes problematic for them to swallow solid foods. In parallel, the tumor metastasizes (metastases are found in the regional lymph nodes). The organs adjacent to the esophagus at this stage of cancer development are not damaged.
Esophageal cancer grade 4
At the 4th stage of esophageal cancer in patients, tumor metastasis occurs, in which both regional and distant lymph nodes are affected. The cancer has spread to the periesophageal tissue. A malignant neoplasm also captures the walls of the esophagus, the serous membrane and adjacent organs. Most patients at this stage of cancer develop an esophageal-tracheal or esophageal-bronchial fistula.
Esophageal cancer treatment
Before prescribing treatment to a patient who has symptoms characteristic of oncological diseases, a thorough examination should be carried out by the attending physician.
The patient is assigned a series of diagnostic measures that will allow determine the exact type of tumor, its stage of development and localization:
X-ray (it is carried out with the help of a contrast agent, which makes the esophagus visible on an x-ray). With the help of this study, specialists determine the localization of a malignant neoplasm, its shape and size. Thanks to the x-ray, the oncologist can foresee possible complications that the type of cancer under study will cause;
Laparoscopy. This type of diagnosis allows you to identify metastases in the internal organs of the patient;
Ultrasound examination. Through this study, specialists determine the exact size of the malignant neoplasm, as well as the presence of lymph nodes that are affected by metastases;
Tomography (performed when the optical sensor is activated). This technique was relatively recently developed by scientists and almost immediately began to be used in specialized medical institutions. Through the endoscope, the specialist examines the structure of the neoplasm. Thanks to the latest equipment, it is possible to determine the structure of tumor tissues to a depth of 1,5-2 mm. All information collected by the sensor is transmitted to a computer, after which it is decrypted by a specialist. In the case when such equipment is installed in a medical institution, patients may not be biopsied, since the obtained data on the neoplasm is sufficient to prescribe therapy. Also, patients are prescribed positron emission tomography. Immediately before the study, the patient is injected with glucose (radioactive). Its property is that it can selectively accumulate in cancer cells. The patient is placed in the center of a specially equipped room, and a scanner begins to rotate around him, which takes pictures of a cancerous tumor (it recognizes neoplasms, the size of which is 5-10 mm);
Laparoscopy. With this diagnostic technique, the patient is punctured in the abdominal cavity (near the navel) with a laparoscope needle, after which a tube with an optical device is inserted into the hole. Specialists have the opportunity to determine the localization of a malignant neoplasm, its exact dimensions, and also take biological material, which is immediately transferred for histological examination;
Bronchoscopy. It is prescribed in the case when the doctor suspects that the larynx, trachea, bronchial tree, etc., are affected by metastases;
Esophagogastroduodenoscopy. When conducting this type of examination, specialists carefully examine not only the esophagus, but also other organs of the digestive tract. Thanks to the endoscope, it is possible to examine the inner surface of the esophagus, as well as take biological material for laboratory research (it is carried out under a microscope). With the help of esophagogastroduodenoscopy, it is possible to detect a malignant neoplasm at an early stage of development and timely prescribe treatment to the patient, etc.
Without fail, patients are assigned a complete laboratory examination, in which the following is performed:
blood chemistry;
clinical blood test;
general urine analysis;
histological analysis of the biopsy;
tumor markers SCC, CYFRA 21-1, TRA.
To date, patients who have been diagnosed with a malignant neoplasm in the esophagus are prescribed the following treatment methods:
surgery;
radiation therapy;
chemotherapy;
complex therapy (this technique includes surgical treatment, medication, radiation and chemotherapy);
combined method (it combines surgical manipulations with radiation components).
During abdominal surgery, patients partially or completely remove the esophagus. The surgeon carefully examines the lymph nodes that are affected by metastases and performs their removal. In the event that during the removal of a malignant neoplasm it is not possible to save the patient’s esophagus, the surgeon uses the tissues of the small or large intestine to restore this organ of the digestive tract.
During surgical treatment, patients manage to restore the lumen of the esophagus. A malignant neoplasm can be completely removed if it is located in the middle or lower part of the esophagus. In some cases, the surgeon removes part of the esophagus and along with the upper stomach. The remaining part of the esophagus is sewn to the stomach and after a series of rehabilitation measures it begins to function fully. According to statistics, the mortality rates of patients who underwent surgical treatment fluctuate within 10%.
Not all cancer patients can undergo surgical removal of a malignant neoplasm of the esophagus. There are the following restrictions:
cancer metastasis to the lymph nodes and other internal organs;
the age of the patient should not exceed 70 years;
the presence of severe chronic diseases;
problems with the heart, blood vessels and lungs, etc.
With the localization of a malignant neoplasm in the middle part of the esophagus, a hole is created on the anterior wall of the peritoneum (during surgical intervention). Subsequently, the patient will be fed through a tube that will be inserted into this hole. With this location of the tumor, in most cases, the esophagus is completely removed along with the lymph nodes affected by metastases. A year later, after the surgical intervention, the patient undergoes a thorough examination to detect metastases. If they are not found, a second operation is prescribed, the purpose of which is to create an artificial esophagus (for it, tissues of the patient’s small intestine can be used).
Endoscopic surgery. In the early stages of the development of a malignant neoplasm, patients can undergo more gentle surgical treatment – endoscopic surgery. During a surgical procedure, an endoscope tube is inserted through the patient’s mouth, at the end of which an optical device is attached. With the help of special tools, the specialist performs bougienage, the purpose of which is to restore the lumen of the esophagus.
Radiation therapy. One of the modern methods of treatment of malignant neoplasms of the esophagus is radiation therapy. This technique is ideal for the category of cancer patients who are contraindicated in surgical intervention (this is due to diseases of the bronchopulmonary or cardiovascular system, etc.). Radiation therapy is often carried out in the postoperative period, due to which the number of relapses of the disease is significantly reduced in patients and the process of metastasis of the body is prevented. It is also worth noting that in inoperable patients, after radiation therapy, malignant neoplasms are greatly reduced in size. During radiation therapy, healthy cells of the patient’s body are not negatively affected, and patients do not experience severe side effects.
In the combined treatment of esophageal cancer, patients are prescribed a course of radiation and chemotherapy for several weeks before surgery. This combination significantly increases the chances of successful treatment. In parallel, patients are being developed a complete diet, which includes vitamins, protein preparations, as well as various nutrient fluids. Doctors recommend that cancer patients drink natural juices and fruit drinks. If patients are unable to swallow even liquid food, then they are fed through a tube.
Diet. To increase the chances of a patient to successfully treat esophageal cancer, he needs to provide proper care and proper nutrition. An insufficient amount of useful substances, vitamins and microelements can lead to a violation of the mental state of an oncological patient and the appearance of various complications. The patient should eat semi-liquid food, in which there will be no particles that can close the lumen of the esophagus. Food should be varied, nutritious and rich in vitamins and minerals. Patients diagnosed with esophageal cancer should eat 8-10 small meals a day.
It is strictly forbidden for this category of patients to consume: fried and smoked foods, fatty foods, alcohol and carbonated drinks. It is also necessary to give up another addiction – smoking. In addition to proper nutrition, the patient must strictly observe personal hygiene.
Properly selected treatment in 70% returns patients the opportunity to return to a full life and eat solid foods.
Chemotherapy for esophageal cancer
In the treatment of oncological diseases, in addition to surgical interventions, chemotherapy brings a great effect. When it is carried out, patients, depending on the location and etiology of the malignant neoplasm, are given special drugs. The main purpose of these drugs is the destruction of cancer cells. For cancer of the esophagus, chemotherapy is usually prescribed from the 2nd stage of this disease.
Properly selected drugs for chemotherapy can not only slow down the growth of a malignant tumor and prevent its cells from dividing, but also work to completely destroy them. Unfortunately, any chemotherapy has a number of side effects and has a negative impact on healthy cells in the body. In most cases, while taking such drugs, patients develop problems with bone marrow cells, hair (their follicles are destroyed and baldness occurs), intestines, oral mucosa, etc.
Chemotherapy for esophageal cancer is carried out when a certain form of malignant neoplasm is diagnosed in a patient:
small cell carcinoma of the esophagus;
low-grade form of esophageal cancer.
Chemotherapy is almost always carried out in parallel with other treatment methods. According to statistics obtained as a result of many years of research by scientists from around the world, the greatest effect is achieved in the treatment of a cancerous tumor of the esophagus when radiation therapy is performed along with chemotherapy. This method of treatment is completely aimed at the destruction of cancer cells, while the malignant neoplasm is significantly reduced in size.
Special drugs can be prescribed to patients, both before surgery and after surgery. During chemotherapy, drugs can be administered either orally or intravenously.
Chemotherapy is prescribed for cancer patients as follows:
starting from the 2nd and 3rd stages of esophageal cancer, special preparations prevent the further development of cancer and destroy cancer cells. Chemotherapy is prescribed to patients in the preoperative and postoperative period;
starting from the 4th stage of esophageal cancer, patients undergo palliative treatment. The main task of this therapy is to slow down the growth of a malignant neoplasm. All these therapeutic measures can prolong the life of the patient.
During chemotherapy, patients who have been diagnosed with esophageal cancer are prescribed anticancer drugs:
Bleomycin;
Windezine;
Mitomycin;
Pharmorubicin;
5-fluorouracil, etc.