Esophageal Cancer: Symptoms, Causes and Treatment

Overview

Esophageal cancer is a disease where the tissues of the tube-like structure that connects the throat to the stomach become malignant. The cancer starts at the inner layer of the esophagus and can spread throughout the other layers of the esophagus and to other parts of the body.

There are two main types of esophageal cancer: squamous cell carcinoma, which can occur along the entire esophagus, and adenocarcinoma, which develops from gland cells.

Esophageal cancer is the sixth most common cause of cancer deaths worldwide. In the United States, about 16,980 new esophageal cancer cases are diagnosed each year. Overall incidence is about 5 in 100,000.

Causes

The
exact cause of esophageal cancer is not yet known. However, it is believed to be
associated with the mutations in the DNA of the cells related to the esophagus.
These mutational cells multiply more rapidly than normal cells. These
mutations can also disrupt the signal for these cells to die, which causes them
to accumulate and become tumors.

There
are many factors that increase the risk of suffering from esophageal cancer,
which include:

  • Smoking
  • Obesity
  • Heavy alcohol use
  • Gastroesophageal reflux disease (GERD)
  • Barrett’s esophagus

In addition, certain groups, such as men and the elderly, are at increased risk for esophageal cancer. Adenocarcinoma of the esophagus is more common in white men, but squamous cell carcinoma of the esophagus is more likely to be found in Asian men and men of color.

Symptoms

Sometimes,
people with esophageal cancer do not have any obvious symptoms at early stage. As
the cancer progresses, you may experience:

  • Difficulty in swallowing
  • Weight loss
  • Chest pain, pressure or burning
  • Pain behind the breastbone or in the throat
  • Worsening indigestion or heartburn
  • Vomiting
  • Coughing or hoarseness
  • Hiccups

Diagnosis

Tests
and procedures used to diagnose esophageal cancer include:

  • Barium swallow X-ray. The doctor will ask the patient to drink a liquid that coats the esophagus. Then the esophagus will be shown on the X-ray so that the doctor can identify certain problems.

  • Endoscopy. During endoscopy, the doctor will pass a thin, lighted tube with video lens down the throat into the esophagus to examine it. Endoscopic ultrasound uses sound waves to provide more detailed information about the extent of tumor or areas of irritation.

  • Biopsy. In this procedure, the doctor can collect a sample of tissue or cells from the patient’s esophagus. The sample is examined under a microscope for checking whether there is a cancer.

Other tests, including computed tomography (CT) scans, positron emission tomography (PET) scan, thoracoscopy, laparoscopy, and nuclear bone scans may be performed to determine if the cancer has spread, or metastasized, outside of the esophagus. The doctor needs this information in order to plan treatment for the patient.

Treatment

Treatment for esophageal cancer depends on the
stage of the cancer and the overall health of the patient. There are some
common treatment options:

  • Chemotherapy and radiation

Chemotherapy and radiation therapy will be conducted
prior to surgery to help shrink the tumor. Chemotherapy and radiation therapy
started after surgery are not certain to increase survival. However, they may
offer a benefit to survival.

  • Targeted therapy

Targeted medications can attach specific protein sites on the tumor cells and inhibit tumor growth. It can kill only tumor cells. Ramucirumab is a type of targeted therapy called “monoclonal antibody”, and it bonds to a protein called VGEF, which helps make new blood vessels.

  • Photodynamic therapy

It involves injecting the tumor with a photosensitive drug that attacks the tumor when exposed to light. Photodynamic therapy is used to treat esophageal cancers that are small in size and have not spread. However, this type of treatment is limited because light cannot penetrate deeply into the body and is effective in only small tumors.

  • Surgery

Surgery to remove the esophagus can be performed as a treatment option using large incisions or with special surgical tools inserted through several small incisions in the skin. The risks of surgery can include pain, bleeding, lung complications, difficulty swallowing, nausea, heartburn, and infection.

Keywords: Esophageal cancer

Leave a Reply