Introduction about Esophageal Cancer
Esophageal cancer, like all other cancer, gets its name from the source where it first began growing.
The Esophagus is the long, hollow tube connecting the back of the mouth to the stomach. After chewing the food that becomes a soft pulp and other liquids pass through the Esophagus. Thus, foods and drinks reach the stomach for further digestion and absorption of nutrients.
Generally, Esophageal cancer occurs within the inner lining of the esophagus where the cells grow with no control.
When cancerous cells spread to other parts of the body, it is known as Metastasis. During this stage, health professionals observe abnormal Esophageal cancerous cells.
Types of Esophageal Cancer
The word ‘cancer’ is medically referred to as “carcinoma”. There are two major categories of Esophageal cancer discussed as below:
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- Adenocarcinoma
Adenocarcinoma grows in the gland cells present in the lower portion of esophagus near the stomach. These Esophageal gland cells secrete mucus in the local area of the lower esophagus.
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- Squamous Cell Carcinoma
Squamous cell carcinoma grows in the inner cell lining of the esophagus. Typically, Squamous cells are flat, thin and line the inner surface of the esophagus.
Squamous cell carcinoma grows in the upper and middle regions of the esophagus. After starting in the Esophageal cells, this cancer can spread to other parts of the esophagus.
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- Rare Esophageal cancer can arise from other types of cancers:
- Choriocarcinoma
- Lymphoma
- Melanoma
- Sarcoma
- Small cell carcinoma
- Rare Esophageal cancer can arise from other types of cancers:
History of Esophageal Cancer
Esophageal cancer (EC) is the world’s 6th leading cause of cancer death across the world. The epithelium or the inner lining of the esophagus is the main site for malignant cancer.
Throughout history, the inhabitants of Taihang Mountain ranges of Northern China in Asia developed Esophageal cancer. It was observed that the Chinese population had Squamous cell Carcinoma of Esophageal cancer.
Meanwhile, in the western countries, the inhabitants develop Adenocarcinoma Esophageal cancer. Over the past 4 decades, there has been a gradual increase in patients with Adenocarcinoma Esophageal cancer.
In the USA, for the past 20 years, Adenocarcinoma of Esophageal has risen and Squamous cell carcinoma has diminished.
People in the west tend to overeat and end up suffering from Gastroesophageal reflux (GERD).
Prolonged untreated GERD causes the development of Adenocarcinoma Esophageal cancer.
Those from Northern China suffering from GERD develop Squamous cell Carcinoma of Esophageal cancer.
Symptoms of Esophageal Cancer
Esophagus cancer is often discovered in time due to the apparent distinct signs and symptoms.
Here is the list of signs caused by the early stages of Esophageal cancer.
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- Chronic coughing
- Dysphagia – Difficulty in swallowing
- Frequently choking on food
- Heartburn and prolonged indigestion
- Hiccups
- Hoarseness
- Pain in bone, breastbone, and throat
- Pain, burning sensation and pressure in the chest
- Sudden unintentional weight loss
- Vomiting
On finding one or more signs, consult your doctor for advice.
Leaving untreated Esophageal cancer causes further complicated symptoms listed below.
Complicated Symptoms of Esophageal Cancer
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- Bleeding in the esophagus
Esophageal cancer might cause gradual or sudden severe bleeding of the esophagus.
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- Obstruction of the esophagus
Growth of tumour and cancer makes it difficult or impossible for swallowing food and liquids.
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- Pain
Similar to all other cancers, advanced esophageal cancer might be painful.
Causes of Esophageal Cancer
All cells have DNA, the genetic material that determines the functions of the newly made cells. Some genes known as Oncogenes control growth in cells, divide into new cells and die.
Another type of genes known as ion or make cells die is called the tumour suppressor genes.
These traits are normal for both the mentioned genes. Yet, when the DNA of oncogene or tumour suppressor gene gets modified, the resulting cells behave abnormally.
Cancers are caused due to “turn on” the Oncogenes or “turn off” the Tumour Suppressor Genes.
In the case of esophageal cancer, there is no gene found linked with hereditary. Yet, external stimuli have been linked as huge risk factors leading to esophageal cancer.
Risk Factors
The risk factor is anything that changes the chance of ending up with esophageal cancer.
Some of the most common risk factors are smoking, drinking alcohol, and more.
According to research studies, scientists have discovered several risk factors in connection with esophageal cancer including Adenocarcinoma or Squamous cell carcinoma.
Below is the list of risk factors:
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- Age
People over the age of 50 show signs of getting esophageal cancer. Research studies have confirmed those younger than 55 years have 15% few chances of getting the illness.
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- Gender
Research data shows that men are 3-times more likely to get esophageal cancer than women. However, the chances of developing esophageal cancer increases with age in both genders.
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- Race
Adenocarcinoma esophageal cancer is common amongst Caucasians than men from other races. Meanwhile, Squamous cell cancer of the esophagus is more common among African origins.
- Gastroesophageal Reflux Disease (GERD)
Normally, the stomach secretes high acid and enzymes for digesting the foods. In some individuals, this acid from the stomach escapes to the lower end of the esophagus. This condition is medically known as GERD or reflux.
People with GERD get heartburn or pain from the middle of the chest. These people have a slightly higher risk of ending with adenocarcinoma of the esophagus. Also, GERD causes Barrett’s esophagus.
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- Barrett’s Esophagus
People with GERD for quite some time damage the inner lining of the lower esophagus. There, the cells are replaced with glands of the stomach and the small intestine resistant to stomach acids. This illness is known as Barrett’s or Barrett Esophagus.
When Barrett esophagus is left with no treatment, it develops into dysplasia or pre-cancer. Low graded dysplasia resembles normal cells but, high graded dysplasia is abnormal. With aging and time, the high graded dysplasia develops into Adenocarcinoma Esophageal cancer.
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- Tobacco and Alcohol
Usage of tobacco in all forms (cigarettes, pipes, and chewing tobacco) cause esophageal cancer. People using longer hours of tobacco have a higher risk of getting cancer. People smoking one or more pack(s) of cigarettes per day are more prone to Adenocarcinoma than non-smokers.
This risk of getting Adenocarcinoma does not go away even when individuals completely quit using tobacco. Yet, the risk of getting squamous cell esophageal cancer decreases after quitting smoking. Drinking alcohol increases the risk factor of developing squamous cell esophageal cancer is more than Adenocarcinoma.
Those, who combine using tobacco and alcohol, have higher chances of developing esophageal cancer.
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- Obesity
People whose weight is higher than the accepted range of Body Mass Index (BMI) are considered obese. These individuals have a higher risk factor of getting Adenocarcinoma Esophageal cancer caused by GERD.
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- Diet
Studies show that eating a high quantity of processed meat can cause a higher risk factor for esophageal cancer. This could explain why there is a high rate of cancer in particular areas of the world.
It is unhealthy to drink hot liquids of high temperatures of 149° F or 65° C. This is because it can burn the inner lining of the esophagus and develop into Squamous esophageal cancer. Vitamin deficiencies also cause esophageal cancer.
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- Achalasia
Achalasia is an illness that does not allow the lower end of the esophagus (lower esophageal sphincter) to relax. This results in foods and liquids to accumulate instead of reaching the stomach. These foods in the lower esophagus cause stretching or dilating with time.
Also, the presence of the food for an extended time causes irritation at the lining of Esophagus. As a result, the individual gets esophageal cancer. Typically, this cancer is discovered after 15-20 years after developing Achalasia.
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- Tylosis
Tylosis is a rare inherited illness causing excess growth of the upper layer of the skin. Typically, it occurs on the palms of hands and soles of feet.
Individuals with Tylosis develop small growths or papillomas in the Esophagus. Thus, they have a high risk of getting squamous cell esophageal cancer.
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- Plummer-Vinson Syndrome/Paterson-Kelly Syndrome
People with this syndrome have webs in the upper region of their esophagus. The web is made of a thin membrane extending from the inner lining of the esophagus. As a result, the hollow of the esophagus is narrowed.
Generally, in most cases esophageal with webs cause no issues. However, when the web is too big and food gets accumulated causing irritation in the area. Also, these individuals have Anemia and low levels of iron, glossitis or tongue irritation, and brittle fingernails.
Sometimes they have large thyroid gland or spleen. Around 1 in 10 individuals with this syndrome end up developing squamous cell esophageal cancer.
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- Workplace Exposures
Individuals exposed to chemical fumes in industries and workplaces have risk factors of getting esophageal cancer.
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- Drinking Lye
The chemical Lye is found in drain cleaners used in the industries and homes. Lye is so corrosive that it can burn and destroy exposed human cells.
Accidentally, drinking from Lye-based bottle causes burning injury to the esophagus that becomes narrow or stricture. These individuals have a high risk of getting squamous cell esophageal cancer.
Most often, these individuals get cancer after many year and decades.
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- History of certain other Cancers
Individuals who smoke get lung cancer, mouth cancer, and throat cancer. These people also have a high risk of getting squamous cell carcinoma esophageal cancer.
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- Human Papillomavirus (HPV) Infection
HPV group includes over 100 related viruses. These are known as Papilloma group of viruses cause growth of papilloma or wart.
Scientists have connected certain type of cancers (throat cancer, anal cancer, and cervical cancer) with HPV infection.
Some esophageal cancer patients are from Asia and South Africa with HPV infection. However, HPV infection was not found amongst esophageal cancer patients of the USA.
Preventions of Esophageal Cancer
Above, we have discussed the major risk factors that people indulge in. These include various physical, lifestyle, and environmental factors.
Some people exposed to these factors end up getting esophageal cancer whereas others do not.
There are certain protective factors that can be followed to reduce the number of people dying from esophageal cancer.
Studies have indicated that there is no particular gene linked with esophageal cancer that is inherited. Similar to all other cancers, early detection of precancerous cells helps in preventing advanced stage.
Preventions are best precautionary measures that reduce the chances of getting esophageal cancer. Scientists are unsure of how to prevent esophageal cancer.
Yet, there are several suggestions to lead a healthy lifestyle to prevent getting cancer.
Below is the list to follow to prevent esophageal cancer.
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- Lifestyle
Exercise regularly to maintain the perfect body weight based on age, gender and height. Follow recommended advice below.
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- Quit Smoking
Smokers should consult their doctors to find the most suitable remedy to quit smoking. Various methods include medication, counselling and more. Non-smokers should not start using tobacco.
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- Drinking Moderately
Doctors recommend that individuals should drink alcohol in moderate amounts. Healthy adults, women of all ages and men aged over 65 can drink one glass every day. Men aged 65 and younger can drink two glasses every day.
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- Diet
Avoid eating salted foods including pickled vegetables and fruits. Avoid eating processed meat. Instead, eat more high fibre fresh fruits and vegetables rich in Vitamins, minerals and trace elements.
These foods supply the necessary Beta-carotene, Vitamin E, Iron, and Selenium preventing esophageal cancer.
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- Maintain a Healthy Weight
Never overeat such that it causes esophageal reflux and obesity with time. Those who are obese should consult their physician to seek help in reducing weight methodically. It is recommended that individuals reduce 1-2 pounds per week.
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- Treat GERD
People, who often experience frequent continuous heartburn, consult the doctor to treat Gastroesophageal reflux disease (GERD).
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- Diagnose and Treatment of Esophageal Cancer
On noticing any of the early signs and symptoms of esophageal cancer, people should consult their doctors. Sometimes the same symptoms could mean other ailments.
Using various suitable tests for esophageal cancer, the health professionals diagnose through the process of elimination.
When there is any evidence of esophageal cancer, grade and stage of ailment are determined.
Following are the various tests using the latest technologies of today:
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- Barium Swallow
This testing method is particularly carried out in individuals who complain they are having difficulties in swallowing. The patients are made to swallow Barium, a thick and chalky liquid.
Following, the patient is exposed to a series of x-ray pictures. On these x-ray photographs, Barium is visible with any lumps on the inner lining of the Esophagus.
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- Upper Endoscopy
This testing method uses a flexible and thin tube attached with a tiny light and video camera at its end. The entire tube is inserted through the mouth, passed down into the Esophagus and stomach.
On finding any abnormal spot, a small tissue sample is removed through the tube for testing.
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- CT/CAT Scan
This testing method uses x-rays for making all the detailed pictures of the inner esophagus.
Health professionals can examine these pictures to find any abnormalities or spread of esophagus cancer.
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- MRI Scan
This testing method uses radio waves along with strong magnets instead of x-rays make detailed pictures.
Generally, this method is used when lymph nodes are swollen due to the spread of cancer.
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- PET Scan
This testing method uses a special type of sugar that can be detected using the special camera inside the body.
Whenever there is cancer growing within the body, the sugar appears as “hot spots”. This test helps in observing if cancer has spread in other parts of the body.
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- Biopsy
In this testing method, the doctor removes a small piece of the tissue that looks abnormal. This item is checked for cancer cells or tumour growth.
This particular test is mandatory in determining the existence of esophageal cancer. After endoscopy, the testing Biopsy method is always carried out.
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- Grading Esophageal Cancer
After Biopsy, all cancer cells are graded (1, 2, and 3). This grading of cancer cells is based on the resemblance of the normal cells.
The cancer cells having an absolutely different appearance from normal cells get the highest grading (Grade 3).
This highest graded cancer cells grow very fast and spread to other parts of the body.
Grading esophageal cancer helps doctors to understand the stage at which the cancer cells are present. The esophageal cancer can belong to any one of the stages: 1, 2, 3, or 4.
Cancer in the lower numbered stage has little or no spread to other parts of the body. Yet, the highest stage 4 points out the most serious form of esophageal cancer.
People diagnosed with stage 4 have cancer cells spread beyond the Esophagus to other parts of the body.
Knowing the grade and stage of esophageal cancer helps experts to provide the most suitable treatment.
Treatment of Esophageal Cancer
The treatment strategies depend on the grade, stage, and age of the patient with esophageal cancer.
Here are the various methods used for treating and curing esophageal cancer.
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- Surgery for Esophagus Cancer
This method is used for removing all small tumours that have not yet spread to other parts of the body. When surgery is used to remove part or the entire Esophagus, it is known as Esophagostomy.
Best is to ask the doctor how the surgery would be carried out in the individual’s case. There are side effects and risks from all types of surgery. Only the doctor can enlighten the patient on what to expect based on other illnesses.
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- Radiation Treatments
This method uses very high energy rays including X-rays to kill cancer cells. There are two main methods of radiation that are used today.
One is the External Beam Radiation that is commonly used for treating esophageal cancer. In this method, the X-ray machine outside the body is used to focus the rays at the Esophagus.
Another method is known as the Brachytherapy of radiation seeds. Doctors use endoscopy (thin flexible tube, small light, and video camera). This is used to insert radioactive seeds close to cancer. These radioactive seeds are removed after the treatment is over.
Enquire about the side effects from doctors and health professionals. Common side effects caused by radiation include skin modifies in the radiation area. People feel exhausted, nauseated and start vomiting.
People get diarrhea, painful sores in the mouth and the throat. People end up with the dry mouth or thick saliva. Most of these side effects can be treated right away.
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- Chemotherapy or Chemo
This method uses special drugs for fighting esophageal cancer. These drugs are typically given into a vein or taken orally as prescribed medication. These drugs reach the blood and are circulated throughout the body.
Chemo is given in cycles or rounds and after each round, a break is given. Most of the time, two or more chemo drugs are given. Chemotherapy can last for several months. Often, Chemo is combined with Radiation and it is known as Chemoradiation.
Chemo can cause exhaustion, stomach sickness, and hair-fall. These symptoms disappear when the Chemo is stopped.
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- Targeted Therapy
This method uses therapy drugs for treating certain types of Esophagus cancer. These special drugs affect mainly cancer cells without affecting normal cells in the body.
These drugs work even if other treatments have failed. The side effects of these drugs differ from those caused by Chemo.
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- Clinical Trials
This method involves research studies using the latest test drugs or other treatments in individuals.
Ask the physician to recommend the best clinical trial suitable for the individual.
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- Other Treatment Methods
Besides prescribed medicines such as pills, individuals with esophageal cancer get exposed to other medical alternatives. These include treatments using herbs, vitamins, special diets, and others.
These methods are not always reliable since there is no tested evidence. Additionally, some of these items do not help at all and can be harmful. Before deciding on experimenting with these items, consult the physician for advice.
Conclusion
Initially, individuals undergo esophageal cancer treatment have to visit health centres for every 3-6 months. Following, over time their bodies become cancer-free so they need not go for cancer treatment.
Once an individual has been cured of esophageal cancer, there is no guarantee of a cancer-free life. Often, people get cancer in the same location or other parts of the body.
The doctor would require the latest reports on blood tests, barium swallows, endoscopies, and CT scans.
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