Diagnosis and Treatment of Esophageal (Eesophageal) Cancers

The esophagus is a hollow tube-shaped organ that carries food and drink from the throat to the stomach. The esophagus starts from the end of the oral cavity, continues behind the trachea in the thorax, and ends at the diaphragm level at the beginning of the stomach in the abdomen. When the person swallows, the esophageal muscle layers contract, pushing the food into the stomach. The esophagus in adults is about 25 cm. Esophageal cancer is one of the cancers with the highest geographical distribution difference according to local eating habits. High frequencies are reported in the Middle East and the Far East, especially in the eastern and southeastern Anatolia regions of our country. There are two different types in microscopic examinations (squamous (squamous cell) cancer and adenocancer). While the incidence is 170/100,000 in China, Japan and the south of Africa, this rate reaches 500/100,000 in the east of Asia. While squamous cell cancer is seen in these societies, adenocarcinoma is more common in developed countries. The ratio is 21/100,000 in the USA and European countries. In our country, esophageal cancer is more common in eastern provinces.

Esophageal Cancer Risk Factors

Environmental factors and dietary habits are responsible for esophageal cancers rather than genetic predisposition. Not storing foods in a suitable hygienic environment, consuming them for a long time, inappropriate additives, nitrosamines in smoked meat, raw foods and canned foods pave the way for cancer. Other factors are poor chewing of foods, very hot drinks, mineral deficiencies (zinc, etc.), tobacco and cigarette use, and exposure to radiation in those with poor oral health.

  • Age: Esophageal cancers are more common in middle age and older ages. People over the age of 60 are particularly at risk.

  • Gender: It is more common in men than women.

  • Tobacco use: It is one of the most important risk factors for esophageal cancer.

  • Alcohol use: Chronic or excessive alcohol use is another important risk factor.

  • Barrett’s esophagus: Some chronic changes develop in the lower end of the esophagus in people who are exposed to stomach acid for a long time. In this disease called gastroesophageal reflux, stomach acid goes into the esophagus and causes destruction in the tissues in the lower part of the esophagus. The cells in this part of the esophagus, which are irritated, are replaced by cells of the gastric mucosa. This condition, known as Barrett’s esophagus, can lead to esophageal adenocarcinomas over the years. If you have indigestion and reflux complaints, you should definitely go to the health institutions for examination.

  • Other types of irritation: Other factors predisposing to squamous cancer are achalasia, a swallowing disorder and untreated, seen in the lower end of the esophagus, human papillomavirus (HPV) infection, and esophageal strictures.

  • Children inadvertently drink caustic liquids as a result of putting caustic chemicals such as bleach, which should be especially careful at home, into different bottles. As a result, stenosis occurs in the esophagus and cancer may develop in the future. In addition, people who drink hot drinks for a long time are at higher risk. Accordingly, the incidence of esophageal cancer is higher in Van and Erzurum regions, where very hot tea drinking is common in our country.

  • History of cancer: Patients with other cancers of the head and neck region have an increased likelihood of developing a secondary cancer of the head and neck region, including cancer of the esophagus.

Protection

Environmental factors are the most important factors for prevention in esophageal cancers. In addition, stay away from tobacco and tobacco products, consume alcohol limitedly. Do not consume very hot drinks. Consume smoked and canned foods very consciously. Increasing the intake of raw vegetables and fruits reduces the possibility of esophageal cancer. Take care of your oral health. Especially keep children away from liquids such as bleach that can burn and irritate the esophagus. Take your reflux disease treatment and stomach complaints seriously. In such cases, you should definitely apply to the nearest health institution.

Esophageal Cancer Symptoms

Generally, the most common clinical symptoms are; weight loss, difficulty swallowing, and a feeling of being stuck while eating. A painful swallowing and sticking sensation occurs while eating, which starts about 6 months before applying to health institutions. There is a feeling of escaping food and pain in the upper region of the abdomen. The pain may be in the back between the shoulder blades or behind the breastbone and radiate towards the throat. Weight loss can be very noticeable. Sometimes lymph nodes in the neck may be palpable. Bone pains, weakness, dry cough and hoarseness are other less common symptoms.

Diagnosis in Esophageal Cancer

The esophagus is examined with optical light cameras called endoscopy and a piece (biopsy) is taken for pathological diagnosis. An ultrasound examination called endosonography is performed to investigate adhesions to the surrounding tissues from inside the esophagus. Advanced imaging tests called computerized tomography (CT), magnetic resonance (MR), positron emission tomography (PET) are requested if necessary. As in some cancers, there are no tumor markers and screening programs in the blood.

Staging in Esophageal Cancer

  • Stage I: Cancer cells are found only in the uppermost layer of the lining of the esophagus

  • Stage II: Cancer involves the deep layers of the esophagus or has spread to neighboring lymph nodes.

  • Stage III: The cancer has invaded deep parts of the esophageal wall or has spread to lymph nodes or tissues adjacent to the esophagus. There is no spread to other parts of the body.

  • Stage IV: The cancer has spread to other parts of the body. Esophageal cancer can spread to any part of the body, including the liver, lungs, brain, and bones.

Treatment in Esophageal Cancer

Treatment depends on the general condition of the patient, the extent, location and size of the tumor. Patients are often treated by a specialized group, such as a digestive system surgeon, a medical and radiation oncologist.

Surgical:

If the tumor is not in a widespread stage and there is no spread to other organs, the first treatment is surgical removal of the tumorous esophagus. Very successful results are obtained in our country in patients diagnosed in the early period. Complete removal of the esophagus is called esophagectomy. The surrounding lymph nodes are cleaned. The stomach and the rest of the esophagus are combined to allow the patient to swallow. The operation is completed by making the esophagus from the stomach or intestines again with different methods. The main treatment method in esophageal tumors is surgery, but the operative mortality is relatively high and 5-year survival is around 20% due to local and systematic recurrences even in cases where the tumor is removed.

Radiation Therapy (Radiotherapy):

It involves using high-energy rays to kill cancer cells. Radiation therapy only affects cells in the area being treated. Chemotherapy and radiotherapy can be combined to shrink the tumor before surgery. In some cases, radiotherapy may be given to prevent recurrences after surgery. If the tumor cannot be surgically removed, radiotherapy is often used to facilitate swallowing and reduce pain.

Chemotherapy:

It is the use of anticancer drugs to kill cancer cells. In esophageal cancers, drug treatment called chemotherapy can be applied, taking into account the general conditions of the patients before or after surgery. Chemotherapy may be used in conjunction with radiotherapy to shrink the tumor prior to surgery or as a primary treatment in place of surgery.

Palliative Treatment Methods:

By applying an expander umbrella called a stent to the area with esophageal obstruction, food can pass through, and sometimes external nutrition can be provided by placing hoses called gastrostomy in the stomach. Relief of congestion helps reduce symptoms associated with swallowing problems.

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