Esophageal cancer is a subset of cancer that develops within the tissues of the esophagus. The esophagus is a tube comprised of muscle that connects the throat (trachea) to the stomach. The esophagus is lined by mucous membranes that aid in the digestive processes of swallowing and chemically breaking down food before it reaches the stomach.
Esophageal cancer has an extremely high mortality rate because it does not become symptomatic until it reaches its advanced stages. Most individuals do not realize they have cancer and consequently do not seek help. By this time, the cancer has most likely metastasized and spread to the lymph nodes and/or other body parts, notably the lungs. Around 16,080 people die from esophageal cancer each year – this number has remained stable over the years.
Who is at Risk for Esophageal Cancer?
The development of esophageal cancer is influenced by multiple different factors:
- Smoking tobacco products
- Age – More than 85% of cases develop in individuals older than 55 years of age
- Gender – Males are more likely than females to develop esophageal cancer
- Preexisting issues with the Gastrointestinal Tract – Gastroesophageal reflux disease (GERD) and Barrett’s Esophagus are risk factors. Both conditions involve acid reflux that eventually erodes the lining of the various parts of the GI tract, notably the esophagus.
- Obesity and poor nutrition habits
- Genetic predispositions (Achalasia, Tylosis, Plummer-Vinson syndrome)
- Environmental exposure to harmful substances, such as lye, or external damage done to the esophagus
- Excessive alcohol consumption
Given its mortality rate, taking care to not expose oneself to controllable risk factors is crucial in preventing esophageal cancer.
Esophageal Cancer Types
Most variations of esophageal cancer are types of squamous cell carcinomas, accounting for 90% of all cases worldwide. This type of cancer effects the surface cells of the middle and upper portions of the esophagus.
Esophageal adenocarcinomas are not as common as squamous cell carcinomas worldwide but are the most prevalent variant of esophageal cancer in the United States. Adenocarcinomas originate in mucus-secreting glands of the lower esophagus. Interestingly it impacts Caucasian males the most.
All variants of esophageal cancer are dangerous because they are asymptomatic in their early stages. In advanced stages, individuals with esophageal cancer may exhibit the following:
- Difficult and painful swallowing – This symptom progresses until even liquids are painful to consume.
- Unexplained weight loss
- Sudden heartburn that is untreatable with medication
- Chest pain
- Blood loss through coughing
These symptoms are indicative of advanced-stage esophageal cancer and should be addressed with haste to determine individual prognosis.
Diagnosing Esophageal Cancer
Exhibiting any of the symptoms listed above is cause for examination by a primary care physician. Physical exams are necessary to first diagnose the potential of either variant or esophageal cancer.
- Oral examination – Oral examination is conducted by the doctor to detect any lumps or abnormalities that could indicate esophageal cancer or disease.
- Palpation – Palpation, or light pressing, is done to determine if lymph nodes are abnormally sized or tender.
Diagnostic exams are necessary when esophageal cancer is suspected due to its advanced staging when symptoms begin to appear.
- X-rays – Chest x-rays are conducted to determine if any tumors have spread to the chest.
- Barium swallow – A barium swallow is a subset of x-ray in which an edible barium solution is ingested. This chemical is traceable throughout the GI tract, allowing the doctor to identify any potential tumors in this part of the body.
- Esophagoscopy – An esophagoscopy requires inserting a thin tube with a camera into the esophagus – this provides a clear picture of any tumors on the esophagus.
- Complete blood cell count (CBC) – This test involves drawing blood and analyzing the sample for abnormalities.
After diagnosis, the doctor will assign one of the following stages to the patient:
- Stage 0 – In this initial stage, cancer cells are only present on the surface layer of cells of the esophagus, and has not begun to spread.
- Stage 1 – Cancer cells spread to the layer of cells underneath the surface of the esophagus or it has spread to the thick, main layer of esophageal muscle tissue.
- Stage 2 – Cancer cells have spread to the outer layer of the esophagus, but has not yet spread to the lymph nodes or it has spread to several lymph nodes and the sub layer of the esophagus.
- Stage 3 – Cancer cells have spread to multiple layers of the esophageal skin cells and 6 lymph nodes, but has not spread to other organs or has spread to the pleura of the lungs, and only 2 lymph nodes
- Stage 4 – Cancer cells have spread to the pleura or the trachea and 6 lymph nodes or any layer of the esophagus and 7 lymph nodes.
Treating the Condition
Esophageal cancer requires prompt treatment. To prevent further damage done to the body, the following treatments are considered:
- Surgery – Esophagectomy with lymphadenectomy are considered when the cancer is caught in intermediate staging. This involves removing a portion of the esophagus and/or the effected lymph nodes. Surgery on the esophagus can cause gastric issues but is effective in halting the spread of cancer cells.
- Radiotherapy /Chemotherapy– Radiotherapy used in conjunction with chemotherapy (radiation and cytotoxic drugs combined) are used to kill the malignant cancer cells in advanced staging. The survival rate of chemotherapy, even when used in conjunction with surgery, is no higher than 8.7%.
- Stents - Metal stents can be used to open the esophagus and relieve some of the discomfort associated with eating/swallowing. This does not treat the condition itself.
Despite the success of treatment options like surgery, post-operative complications arise 30%-50% of the time. And as mentioned above, chemotherapy via radiation does not hold promising results – this explains the high mortality rate of individuals who develop esophageal cancer. Understanding individual health history and refraining from activities like drinking and smoking will help prevent esophageal cancer from developing.