Some tumors developing in the esophagus may be cancerous in nature.

If diagnosed early enough, esophageal cancer can be treated with better outcome.

• Cancers of the esophagus generally originate from the lining of the esophageal wall.
• Inflammatory disorders of the esophagus, some infections, and tobacco usage and alcohol abuse, increase the risk of esophageal cancer.
• Dysphagia, pain and discomfort and weight loss are the usual symptoms.
• Endoscopy of the esophagus confirms the diagnosis of esophageal cancer.
• Fatality rate in people with esophageal is extremely high if the cancer is not detected early and treated appropriately.
• chemotherapy, radiotherapy,  and surgery may provide relief from distressing symptoms and prolong life

There are different types of cancers affecting the esophagus. Some of the commonly occurring esophageal cancers are adenocarcinoma and squamous cell carcinoma originating from the lining of the esophageal wall. They can appear in different forms such as

• A stricture or narrowing of the esophageal passage
• A lump protruding into the esophagus
• A plaque or a flat area of tissue
• A fistula connecting the esophagus and the trachea or air pipe

Other types of cancer affecting the esophagus are leiomyosarcomas, lymphomas, rhabdomyosarcomas, malignant melanomas which occur less frequently. Cancers which have originated in other parts of the body may spread to the esophagus; it is termed as metastatic cancer.

The esophageal cancers vary in their distribution depending on racial group, gender and geographical region. While over fifteen thousand people are diagnosed with esophageal cancer in the United States every year, the incidence is higher in the United Kingdom and many Asian countries like china, India and Japan and countries surrounding the Caspian Sea.

In the United States, blacks are more affected by squamous cell carcinoma while the incidence of adenocarcinoma is more in whites. Both types occur more frequently in men than in women. Squamous cell carcinoma which occurs in the lower esophagus used to be more common earlier, but the incidence of adenocarcinoma, which generally affects the upper esophagus, is increasing faster.

Risk Factors

People who use alcohol and tobacco products are found to be more prone to esophageal cancers, especially squamous cell carcinomas. Those who already have other cancers in the neck or head are also predisposed to cancer of the esophagus. Some viral infections, such as by the human papilloma virus and radiation exposure are some of the other risk factors raising cancer risk.

Esophagus already damaged due to various reasons makes it more vulnerable to the development of cancer. In people who have  GERD, the lining of the esophagus gets constantly irritated by the stomach acids which enter the esophagus with the reflux. This repeated exposure to acids result in a condition called Barrett’s esophagus which is often found to be a pre-cancerous stage of esophageal cancer. Ingestion of corrosive chemicals like strong alkalis and acids damage the lining of the esophagus and causes it to become narrowed and eventually develop cancer.  Other disorders of the esophagus which cause difficulty in swallowing, such as the motility disorder achalasia, and the Plummer-Vinson syndrome characterized by webs in the esophagus, are also considered premalignant conditions as they increase the risk of cancer.

Symptoms

Esophageal cancer is asymptomatic in early stages, and due to this reason they often go undiagnosed at a time they can be treated better. Dysphagia  is usually the first symptom of esophageal cancer; it happens due to the narrowing of the esophagus resulting from the growth of the cancer. Initially it may start as a difficulty in swallowing harder solid foods only, but this condition may deteriorate fast, and within weeks, swallowing of soft foods and eventually liquids and even saliva may become extremely difficult. Noticeable reduction in weight is another symptom, and patients may feel pain in the chest, and also the feeling that the pain is moving to the back of the chest.

With the progression of the esophageal cancer, other tissues, nerves and various other organs become affected by the spreading cancer growth. Voice may become hoarse due to the compression of the nerve regulating the vocal cords. Horner’s syndrome is another symptom that usually develops as the disease progresses, and it results in hiccups and spinal pain caused by the cancer pressing on the surrounding nerves. When the esophageal cancer spreads to the lungs, shortness breath may result and when liver is affected, symptoms like bloating of the abdomen and pain may appear. When it starts affecting the intestines, it can cause vomiting, bloody stools, and anemia resulting from blood loss. Confusion, headaches and even seizure may occur if the cancer metastasizes to the brain. Complete blockage of the esophagus develops in the later stages of the cancer and drooling from the mouth is common resulting from the inability to swallow even saliva. The later stages of the disease cause severe distress and weakness and medical intervention is unavoidable during this time.

Diagnosis

Endoscopic viewing of the esophagus is the diagnostic test of choice, for suspected cases of esophageal cancer. The endoscope is a flexible tube which is inserted into the esophagus through the mouth so that the interiors of the esophagus can be observed. Biopsy sample of the esophageal tissue also can be extracted during the endoscopic procedure.

Barium swallow, followed by X-ray imaging, is another diagnostic tool used to determine the location and size of the tumor. During this procedure, the patient is given the radio opaque barium solution to swallow, which would show up on the X-ray taken immediately afterwards, showing the abnormalities in the esophageal lining.

Ultrasonography scan with the scanning probe inserted into the esophagus with the help of an endoscope is also done sometimes. CT scan is another diagnostic option which can provide accurate details about the tumor.

Prognosis and Treatment

The prognosis for people with esophageal cancer is not very bright, mainly because of late diagnosis. Consequently, fatality rates are high, most of those diagnosed with the condition dying within a year from the onset of symptoms. Survival rate beyond 5 years is as low as 5%. Because of the almost certain fatal outcome, the focus of treatment is ensuring quality of life while trying to slow down the pace of progression of the disease. Dysphagia and odynophagia (pain while swallowing) are both highly distressing conditions for the patient as well as the caregivers. Through various medical procedures and drug treatments, doctors try to reduce the symptoms and help maintain normalcy for as long as possible.

Surgical removal of the cancerous tissue is the most effective treatment which can greatly relieve the symptoms like dysphagia and odynophagia. However, surgery does not cure the cancer if it has become widespread. Chemotherapy may destroy some of the cancer cells and can retard the progress of the disease. Combined with radiation therapy, it can help prolong life, if only for a few months. Radiotherapy and chemotherapy are usually done prior to surgery to increase the chances of a better outcome.

To make swallowing easier, the portion of the esophagus narrowed due to the cancer may be dilated and a stent may be fitted to keep it open. The cancer affected area can be bypassed using a portion of the intestine, thus providing an alternate route for the passage of food. The cancerous tumors growing into the esophagus can be destroyed by laser phototherapy in which high energy light is used to incinerate the cancer tissue and open up the esophageal passage. These measures taken to widen the esophagus give temporary relief from the symptoms, but they do not help in arresting the growth of the cancers.

Photodynamic therapy is a very effective procedure in relieving symptoms and it is the ideal treatment for people too weak to undergo surgery. It can destroy esophageal lesions and other obstructing tissues much faster than the other treatments such as radiation therapy as well as chemotherapy. In this procedure, a dye which is sensitive to light is administered intravenously two days prior to the procedure. The cancer cells absorb more quantity of the dye compared to the healthy cells. When the laser light is focused on the affected area, the dye in the cancer cells causes their destruction while the surrounding healthy tissue is spared.

The role of nutrition in keeping the patient strong enough to tolerate the treatment procedures is very important. If the patient is on liquid foods, food supplements in concentrated form should be incorporated into diet. Intravenous supplementation or tube feeding may have to be established for those patients who cannot swallow even liquid food.

The outcome of esophageal cancer being extremely poor, especially when it is diagnosed late, the patient should be helped to put his affairs in order and may be to prepare his will. The patient should be advised about the choices available for end- of- life care and should be encouraged to express his choice regarding continuing medical care.

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