What is Esophageal Cancer?
The esophagus is a hollow tube that extends from the mouth to the stomach. Since the cancer is formed in the esophagus, it is considered as esophageal cancer. The task of the esophagus is to help to digest food by carrying it to the stomach. Cancer that occurs in this tube generally starts in the cells located on the inner surface of the esophagus. Cancerous cells can occur in any part of the esophagus.
What are the symptoms of Esophageal Cancer?
Symptoms of esophageal cancer can be listed as difficulty in swallowing, namely dysphagia, unexplained weight loss, pain or burning in the chest, feeling of pressure, indigestion or heartburn, coughing, hoarseness. If you have a persistent sign or symptom in your esophagus, we recommend making a doctor’s appointment. Attention should also be paid to Barret’s esophagus, a condition that increases the risk of esophageal cancer in patients with reflux. At this point, follow-up and analysis should be done well.
What are the causes of esophageal cancer?
The factors that cause esophageal cancer are not certain. However, some determinations and analyzes have been made together with the studies carried out so far. It is believed that esophageal cancer is caused by mutations in the DNA structures of cells in the esophagus. These changes cause unhealthy division and development of normal cells. The increased number of cells invades the esophagus and nearby structures and becomes a tumor. The appearance of these cells in tissues and organs far from the esophagus of the body is called metastasis.
What are the risk factors for esophageal cancer?
It has been suggested that chronic irritation may contribute to mutations that cause esophageal cancer. The factors that cause irritation and increase the risk of cancer are listed below.
- Gastroesophageal reflux disease (GERD)
- Smoking and tobacco use
- Pre-cancerous changes in the esophagus cells (Barrett’s esophagus),
- Alcohol consumption
- Having bile reflux,
- Difficulty swallowing due to a non-relaxing esophageal sphincter (achalasia)
- Consistently drinking very hot liquids
- Not eating enough fruits and vegetables
- Receiving radiation therapy from the chest or upper abdomen
What are the diagnostic methods for esophageal cancer?
Diagnostic methods may include the application of endoscopy to examine the esophagus. In this procedure, a tube with a video camera at the end is inserted through the throat into the esophagus. In this way, cancer regions and abnormal conditions can be detected.
One of the most important diagnostic methods in cancer disease is biopsy. In this procedure, a suspicious tissue is taken and examined in the pathology laboratory. Biopsy can also be done during endoscopy. According to the test results, the characteristics of the tumor are discovered.
How is the spread (stage) of esophageal cancer determined??
After the diagnosis of cancer is made, the stage of determining the spread and the characteristic of the tumor is carried out. Additional tests may be requested in this process. Among the imaging methods, endoscopic ultrasound, computed tomography, positron emission tomography (PET) can be used.
These imaging methods are used to determine the stage of cancer. The phases start from 0 and go up to IV with roman numerals. In the lowest stage, the cancer is only in the esophagus. As the stage progresses, there is primarily spread to the esophagus, spread to the lymph node, and in stage IV, there is spread to different organs in the body, that is, metastasis. Staging is important in treatment selection.
What are the treatment options for esophageal cancer?
Treatment options vary depending on the type, stage and characteristics of the cancer, taking into account the general condition of the individual.
It is the process of removing cancerous cells from the body. It can be applied alone as well as support from other treatments. If the tumor is small, the cancerous tissue is removed from the body. This process can also be applied with the help of an endoscope.
If your doctor has decided to remove a part of the esophagus, the part containing the tumor is removed and the remaining part is reconnected to the stomach. This procedure is called esophagectomy. Another procedure is esophagogastrectomy. In this application, part of the esophagus and the upper part of the stomach are removed. Reconnection is achieved by pulling the stomach upwards. Attention should be paid to the reconnection point in terms of infection, bleeding and leakage. Removal of the esophagus can also be done laparoscopically, that is, with special surgical instruments.
Treatments can be applied for obstruction in the esophagus or dysphagia, that is, difficulty in swallowing. If cancerous cells have created an obstruction (occlusion) in the esophagus, a stent is placed and the procedure is performed. In addition, if there is difficulty in swallowing, the use of a feeding tube can be provided. In this way, the nutrients are transmitted directly to the stomach.
It is a drug treatment applied to destroy cancer cells. Chemical drugs are applied. It can be applied as a neoadjuvant before surgery or as an adjuvant after surgery. It can also be applied in combination with radiotherapy. It is aimed to reduce the complaints of the patients by applying chemotherapy in advanced patients. In this way, the life quality is increased.
It is the process of sending X-rays with high energy to kill cancerous cells. With the development of technology, the beam is sent by targeting the region where the tumor is located in the body through machines. In this way, cancerous cells can be destroyed. It is usually applied in combination with chemotherapy. It is used to facilitate the procedure before surgery and in some cases to remove residual cells after surgery. Side effects such as skin reactions, weakness, difficulty in swallowing may take place.
Combining radiotherapy and chemotherapy can increase the effectiveness of treatments. This combined treatment can be applied alone. It can also be applied to shrink the tumor before the surgical operation. One of the disadvantages of this combined therapy can be counted as the increase in side effects.
The treatment method to be chosen in esophageal cancers should be determined according to the general condition, age and expectation of the patient. Likewise, since the patient may have complaints after both surgery and radiochemotherapy, the patient’s nutrition, psychology, adherence to treatment are important in terms of the curability of the disease, life quality and non-relapse in the following period. For this reason, it should be evaluated by a multidisciplinary team, including a psychologist and dietitian. In esophageal cancers, it may sometimes be an option to apply no oncological treatment and only give supportive treatment.