Esophageal Cancer: Symptoms, Causes, Diagnosis and Treatment Methods

Esophageal cancer is a type of cancer whose incidence is increasing worldwide. This cancer, which is mostly seen in men, can cause serious consequences and negatively affect the person’s quality of life when diagnosed at an advanced stage.

What is Esophageal Cancer?

The esophagus, also known as the esophagus, is a long, thin structure that connects the mouth and stomach. Cancer develops with the uncontrolled proliferation of cells in the esophagus. Esophageal cancer can occur at any point in this organ. The treatment of this cancer, which is more common in men than women, is based on the stage of the disease.

Esophageal cancer can be of different types depending on the cell from which it originates. These subtypes are as follows:

• Adenocarcinoma: Adenocarcinoma originates from the mucus-secreting glands in the esophagus. Adenocarcinomas develop especially in the lower part of the esophagus.

• Squamous Cell Carcinoma: Squamous cells are flat cells that line the inner part of the esophagus. Squamous cell carcinoma is mostly seen in the upper and middle parts of the esophagus. Squamous type is the most common type of esophageal cancer worldwide.

• Other Types: Small cell carcinoma, sarcoma, lymphoma, and melanoma are also among the rare types of esophageal cancer.

What are the symptoms of esophageal cancer?

Esophageal cancer may not cause any symptoms in the early stages. Symptoms caused by esophageal cancer are as follows:

• Difficulty in swallowing (dysphagia)

• unintentional weight loss

• Pain, burning or pressure feeling in the chest

• Indigestion

• heartburn

• Cough, hoarseness of voice

How Is Esophageal Cancer Diagnosed?

If there are symptoms that may suggest esophageal cancer, the patient is examined in detail. The following methods that can help diagnose cancer can also be used during the diagnosis phase:

• Barium Swallow Test: For this test, the patient is made to drink a liquid containing barium and then serial films of the patient are taken. Barium lines the inside of the esophagus. Thus, a change in the esophageal structure can be revealed by this test.

• Endoscopy: This method, in which a thin tube-shaped instrument with a camera at the end is advanced from the mouth to the stomach, allows the presence of a possible tumor in the esophagus to be seen.

• Biopsy: If a suspicious lesion is seen during endoscopy, a tissue sample can be taken from this area. By examining this tissue sample in the pathology department, it can be determined whether there are cancer cells in the esophagus.

After esophageal cancer is diagnosed, various methods such as bronchoscopy, endoscopic ultrasound, computerized tomography (CT), and positron emission tomography (PET) can be used to see how much the disease has spread throughout the body.

What are the Risk Factors for Esophageal Cancer?

Chronic inflammation of the esophagus may predispose to the development of cancer. Conditions that increase the risk of esophageal cancer by causing irritation in the esophagus are as follows:

• Gastroesophageal reflux disease (GERD)

• Smoking

• Presence of precancerous lesions in the esophagus (Barrett’s esophagus)

• being obese

• alcohol consumption

• bile reflux

• Difficulty in swallowing due to malfunction in the esophageal sphincter (achalasia)

• Habit of drinking very hot drinks

• Not eating enough vegetables and fruits

• Having previously received radiation to the upper abdomen

Stages of Esophageal Cancer How to Treat It?

Esophageal cancer is staged according to its spread in the body:

• Stage 0: Abnormal cells are limited only to the epithelium lining the esophagus.

• Stage I: Cancer cells are located only in the epithelial layer lining the esophagus.

• Stage II: Cancer cells have reached the muscle layer or outer wall of the esophagus. The cancer has spread to 1 or 2 nearby lymph nodes.

• Stage III: Cancer cells have reached the muscle layer and connective tissue around the esophagus. The cancer has progressed to surrounding organs and/or lymph nodes.

• Stage IV: It is the most advanced stage of cancer. The cancer has spread to organs and lymph nodes beyond the esophagus.

Treatment of esophageal cancer is planned according to the stage and type of the disease and the general health condition of the patient.

One of the methods used in the treatment of esophageal cancer is surgery. Surgical methods can be used alone or in combination with other treatment methods in the treatment of esophageal cancer. The methods used in surgery can be listed as follows:

• Removal of Small Tumors: Small tumors remaining in the superficial layer of the esophagus can be surgically removed along with the surrounding healthy tissue. This procedure can be done in a short time with an endoscope.

• Removal of a Part of the Esophagus (Esophagectomy): It is the complete removal of the cancerous part of the esophagus. In this procedure, the upper part of the stomach is usually removed along with the esophagus. In the final stage of the procedure, the remaining part of the esophagus is joined to the stomach. In order for this union to occur, the stomach may need to be pulled towards the upper body.

• Removal of a Part of the Esophagus and a Large Part of the Stomach (Esophagogastrectomy): This is a surgery in which a large part of the stomach and surrounding lymph nodes are removed in addition to the cancerous part of the esophagus. As in esophagectomy, the remaining part of the esophagus is joined with the remaining part of the stomach.

Esophageal cancer surgeries may carry serious complications such as infection, bleeding, and leakage from the junction area. Surgeries can be performed in two different ways: open and closed. Whether the surgery will be open or closed is a matter for the surgeon to evaluate.

Chemotherapy may also be used in the treatment of esophageal cancer. Chemotherapy is the use of drugs to kill cancer cells; It can be applied in combination with surgery and radiotherapy. The chemotherapy protocol can be given to the patient before and after surgery. In advanced stage cancer patients, chemotherapy may be used to relieve cancer-related symptoms rather than cure them.

Radiotherapy is a method that can be used in combination with other methods in the treatment of esophageal cancer. In the radiotherapy method, high-energy rays are used to destroy cancer cells. In external radiotherapy, rays are given to the patient from a device outside the body. In internal radiotherapy, known as brachytherapy, rays are emitted from a device placed in the cancerous area within the body. External radiotherapy is mostly used in the treatment of esophageal cancer. Radiotherapy can be given to patients before or after surgery or at the same time as surgery. Radiotherapy can also be applied together with chemotherapy.

Targeted therapy is another method used to treat esophageal cancer. In this method, the weak points of cancer cells are determined and drugs targeting this point are used. These drugs hit the weak point of cancer cells, causing the cells to die. Targeted therapy is often used in conjunction with chemotherapy.

Immunotherapy is a form of treatment that helps the immune system fight cancer cells. Normally, the immune system recognizes and destroys cells that divide uncontrollably. However, in cancers, there are defects in this recognition and elimination process. Immunotherapy makes cancer cells more recognizable to the immune system. Immunotherapy can be used in the treatment of advanced stage, recurrent and metastasizing cancers.

One of the biggest problems caused by esophageal cancer is difficulty swallowing. Difficulty in swallowing may also disrupt the nutrition of patients and cause the general condition to worsen. Therefore, correcting dysphagia is necessary for patients to respond better to treatment and improve their quality of life. If the difficulty in swallowing is caused by a stenosis in the esophagus, this stenosis can be opened with stents and thus the difficulty in swallowing can be eliminated. Inserting a thin feeding tube going down from the nose to the stomach can also prevent malnutrition due to difficulty swallowing. Wounds in the esophagus, if any, will heal during the time the tube is inserted.

Diagnosing esophageal cancer at an early stage allows treatment to be started earlier and thus smaller surgeries and lighter doses of drugs are sufficient for treatment. It would be beneficial for people with one or more of the symptoms of esophageal cancer to apply to the nearest health center.