What is
Esophageal Cancer?
The esophagus, part of the digestive tract, is a tube that connects the
throat with the stomach. It lies between the trachea (windpipe) and the spine. In an
adult, the esophagus is about 10 inches long. When a person swallows, the muscular walls
of the esophagus contract to push food down into the stomach. Glands in the lining of the
esophagus produce mucus, which keeps the passageway moist and makes swallowing easier.
There are two main types of
esophageal cancer. One type is called squamous cell carcinoma. This name comes from the
type of cell that becomes cancerous. This type of esophagus cancer was by far the more
common of the two cancers in the past, and was responsible for almost 90% of all
esophageal cancers. However, more recent medical studies show that squamous cell cancers
today account for only about half of esophageal cancers. Since the entire esophagus is
normally lined with squamous cells, squamous cell carcinoma can occur anywhere along the
length of the esophagus.
The other common type of esophageal cancer is
called adenocarcinoma. This type of cancer starts in glandular tissue which normally does
not cover the esophagus.
Cancer of the esophagus is also called esophageal
cancer. It can develop in any part of the esophagus. If the cancer spreads outside the
esophagus, it usually shows up in nearby lymph nodes (sometimes called lymph glands). In
many cases, the cancer also spreads to the windpipe, the large blood vessels in the chest,
and other nearby organs. Esophageal cancer can also spread to the lungs, liver, stomach,
and other parts of the body. |
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Causes and Prevention
Cancer of the esophagus is
fairly common in some parts of the world. But in the United States, this disease accounts
for only about 1 percent of all cancers. The exact causes of cancer of the esophagus are
not known. Researchers are trying to solve this problem. The more they can find out about
what causes this disease, the better the chance of finding ways to prevent it.
Studies in the United States
show that esophageal cancer is found mainly in people over age 55. It affects men about
twice as often as women, and it is more common in black people than in white people. But
doctors still cannot explain why one person gets esophageal cancer and another doesn't.
So far, doctors know for sure
that no one can "catch" esophageal cancer from another person. Cancer is not
contagious. Also, doctors know that certain risk factors increase a person's chance of
getting esophageal cancer. In the United States, smoking and excessive use of alcohol are
the major risk factors for this disease. Heavy users of both alcohol and tobacco are much
more likely to get esophageal cancer than are people who do not drink or smoke.
Cutting down on the use of
alcohol reduces the chance of getting esophageal cancer, as well as cancers of the mouth,
throat, and larynx. By not smoking, people can lower their risk of cancers of the
esophagus, lung, mouth, throat, larynx, bladder, and pancreas. Also, it's very important
to know that people who develop cancer due to smoking are at risk of getting a second
cancer.
Most doctors urge esophageal
cancer patients to stop smoking to cut down the risk of a new cancer and to reduce other
problems, such as coughing. The risk of cancer of the esophagus is also increased by
long-term irritation of esophageal tissues. Tissue at the bottom of the esophagus can
become irritated if the contents of the stomach frequently "back up" into the
esophagus, a problem known as reflux. When cells in the irritated part of the esophagus
change and begin to resemble the cells that line the stomach, doctors call this condition
Barrett's esophagus. In some cases, Barrett's esophagus leads to esophageal cancer.
Other kinds of irritation or
damage to the lining of the esophagus can also increase the risk of cancer. For example,
people who have swallowed lye or other caustic substances have a higher-than-average risk
because these substances damage esophageal tissue. Poor nutrition is another factor that
may increase a person's risk of esophageal cancer. Scientists are not sure exactly how
diet changes the risk of developing this disease, but they think that it's important to
have a well-balanced diet that includes generous amount of fruits and vegetables.
Often, patients with
esophageal cancer have no clear risk factors. In most cases, the disease is probably the
result of several factors (known or unknown) acting together. People who think they might
be at increased risk for cancer of the esophagus should discuss this concern with their
doctor. The doctor may be able to suggest ways to reduce the risk and can suggest an
appropriate schedule of checkups.
Symptoms
Very small tumors in the
esophagus usually do not cause symptoms. As the tumor grows, the most common symptom is
difficulty in swallowing. The person may have a feeling of fullness, pressure, or burning
as food goes down the esophagus. Also, it may feel as if food gets stuck behind the
breastbone. Problems with swallowing may come and go. At first, they may be noticed mainly
when the person eats meat, bread, or coarse foods, such as raw vegetables. As the tumor
grows larger and the pathway to the stomach becomes narrower, other foods—even
liquids--may be hard to swallow, and swallowing may be painful. Cancer of the esophagus
can also cause indigestion, heartburn, vomiting, and frequent choking on food. Because of
these problems, weight loss is common.
Sometimes a tumor in the
esophagus causes coughing or hoarseness. It can also cause pain behind the breastbone or
in the throat. Any of these symptoms may be caused by cancer or by other, less serious
health problems. Only a doctor can tell for sure. People with symptoms like these often
see a gastroenterologist, a doctor who specializes in diseases of the digestive tract.
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Treatment of Esophageal
Cancer
Here are some important questions to
ask the doctor:
What are my treatment choices?
Would a clinical trial be appropriate for me?
What are the expected benefits of treatment?
What are the risks and possible side effects of
treatment?
What can be done about side effects?
If I have pain, how will you help me?
Can I keep working during or after treatment?
Treatment Methods
Cancer of the esophagus
usually cannot be cured unless it is found in the earliest stages, before it has begun to
spread. Unfortunately, early esophageal cancer causes few symptoms, and the disease is
usually advanced when the diagnosis is made. However, advanced esophageal cancer can be
treated and symptoms can be relieved.
Esophageal cancer is usually treated with
surgery, radiation therapy (also called radiotherapy), or chemotherapy. The doctor may use
just one treatment method or combine them, depending on the patient's needs.
Surgery is often part of the treatment plan. Many
patients with esophageal cancer have an operation called esophagectomy. Generally, the
surgeon removes the tumor along with a portion of the esophagus, nearby lymph nodes, and
other tissue in the area. Usually, it is possible to connect the stomach to the remaining
part of the esophagus. In a few cases, the surgeon forms a new passageway from the throat
to the stomach, using tissue from another part of the digestive tract (such as the colon)
to replace the esophagus.
If a tumor blocks the esophagus but cannot be
removed, the surgeon may be able to create a bypass, a new pathway to the stomach. In some
cases, the surgeon can dilate (widen) the esophagus. This procedure may have to be
repeated as the tumor grows. Sometimes, the doctor puts a tube into the esophagus to keep
it open. Recently, some surgeons have used a laser to destroy cancerous tissue and relieve
blockages.
Radiation therapy is the use of high-energy rays
to damage cancer cells and stop them from growing. Like surgery, radiation therapy is
local therapy; it affects cells only in the treated area. Radiation therapy can be used to
shrink a tumor before surgery or to destroy cancer cells that may remain in the area after
surgery. Radiation may also be used instead of surgery, especially if the size or location
of the tumor would make an operation difficult. In some cases, radiation therapy is
recommended for patients who cannot have surgery for other health reasons. Even if the
tumor cannot be removed by surgery or destroyed entirely by radiation therapy, radiation
therapy can still help relieve pain and make swallowing easier.
In radiation therapy for esophageal cancer, the
energy usually comes from a machine outside the body (external radiation). Some patients
also need treatment with radioactive materials placed in the tumor (implant radiation).
Usually, patients receive external radiation therapy 5 days a week for several weeks. Most
patients can stay at home and go to the hospital or clinic each day for this treatment.
For implant radiation, patients must stay in the hospital for a short time.
Chemotherapy is the use of drugs to kill cancer
cells. The doctor may suggest one drug or a combination of drugs. Chemotherapy may be used
alone or combined with radiation therapy to shrink a tumor before surgery or to destroy
cancer cells that remain in the body after surgery. Chemotherapy may also be used if
surgery is not possible and for patients whose cancer returns after surgery or radiation
therapy.
A new method used to treat esophageal cancer is photodynamic
therapy, the use of laser light and drugs that make the cancer cells sensitive to
light so the laser can destroy them. |
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General Questions
The esophagus is a hollow tube that
carries food and liquids from the throat to the stomach. When a person swallows the
muscular walls of the esophagus contract to push food down into the stomach. Glands in the
lining produce mucus which keeps the passageway moist and makes swallowing easier. The
esophagus is behind the trachea which is often called the windpipe. The esophagus is about
10 inches long.
Cancer affects cells, the body's
basic unit of life. Normally cells grow, divide, and produce more cells when needed.
Sometimes, however, cells keep dividing when new cells are not needed. The mass of extra
cells forms a growth or tumor. Tumors can be benign or malignant.
BENIGN TUMORS are not cancer. They
usually can be removed and, in most cases, they do not come back. Cells in benign tumors
do not spread to other parts of the body. Most important, benign tumors are rarely a
threat to life.
MALIGNANT TUMORS are cancer. Cells
in malignant tumors are abnormal and divide without control or order. These cancer cells
can invade and destroy the tissue around them. Cancer cells can also break away and enter
the bloodstream or lymphatic system. This process is called metastasis and is how cancer
spreads from the primary site to other parts of the body.
1.What are the types of
esophageal cancer?
Squamous cell carcinomas
arise in squamous cells that line the esophagus. These cancers usually occur in the upper
and middle part of the esophagus.
Adenocarcinomas usually
develop in the glandular tissue in the lower part of the esophagus.
Both are treated similar. If the
cancer spreads outside the esophagus, it often goes to the lymph nodes first which are the
small bean-shaped structures that are part of the body's immune system. Esophageal cancer
can also spread to almost any other part of the body, including the liver, lungs, brain,
and bones.
2. What are the risk factors for
esophageal cancer?
The exact causes of cancer of the
esophagus are not known. However, studies show that any of the following factors can
increase the risk of developing esophageal cancer:
Age: Esophageal cancer is
more likely to occur as people get older; most people who develop esophageal cancer are
over age 60.
Sex: Cancer of the esophagus
is more common in men then in women.
Tobacco Use: Smoking
cigarettes or using smokeless tobacco is one of the major risk factors for esophageal
cancer.
Alcohol Use: Chronic and or
heavy use of alcohol is a major risk factor. People who use both alcohol and tobacco have
an especially high risk of esophageal cancer. Scientists believe that these substances
increase each other's harmful effects.
Barrett's Esophagus: Long
term irritation can increase the risk of esophageal cancer. Tissues at the bottom of the
esophagus can become irritated if stomach acid frequently "backs up" into the
esophagus which is called gastric reflux. Over time cells in the irritated part of the
esophagus may change and begin to resemble the cells that line the stomach. This condition
is known as Barrett's esophagus and is a premalignant condition that may develop into
adenocarcinoma of the esophagus.
Other Irritation: Other
causes of significant irritation or damage to the lining of the esophagus such as
swallowing lye or other caustic substances can increase the risk of developing esophageal
cancer.
Medical History: Patients who
have had other head and neck cancers have an increased chance of developing a second
cancer in the head and neck area, including esophageal cancer. Having any of these risk
factors increases the likelihood that a person will develop esophageal cancer. Still, most
people with one or even several of these factors do not get the disease. Most people who
do get esophageal cancer have none of the known risk factors
3. What are symptoms of
esophageal cancer?
Early esophageal cancer does not
cause symptoms. When the cancer grows symptoms may include:
Difficult or painful swallowing
Severe weight loss
Pain in the throat or back, behind
the breastbone or between the shoulder blades
Hoarseness or chronic cough
Vomiting
Coughing up blood
4. How is esophageal cancer
diagnosed?
The doctor will take a person's
medical history and perform a physical exam. The doctor usually orders a chest x-ray and
other diagnostic tests. The tests may include the following:
Barium Swallow is a series of
x-rays of the esophagus. The patient drinks a liquid containing barium which coats the
inside of the esophagus. The barium makes any changes in the shape of the esophagus show
up on the x-rays.
Esophagoscopy, also called
endoscopy, is an examination of the inside of the esopohagus using a thin lighted tube
called an endoscope. An anesthetic which numbs the area is done during this procedure. If
an abnormal area is found, the doctor can collect cells and tissue through the endoscope
for examination under a microscope. This is called a biopsy. A biopsy can show cancer,
tissue changes that may lead to cancer or other conditions.
5. How is staging done?
Staging is a careful attempt to find
out whether the cancer has spread and to what parts of the body. Knowing the stage of the
disease helps the doctor plan treatment. There are four stages of esophageal cancer.
STAGE I: The cancer is found
only in the top layers of cells lining the esophagus.
STAGE II: The cancer involves
deeper layers of the lining of the esophagus, or it has spread to nearby lymph nodes. The
cancer has not spread to other parts of the body.
STAGE III: The cancer has
invaded more deeply into the wall of the esophagus or has spread to tissues or lymph nodes
near the esophagus. It has not spread to other parts of the body.
STAGE IV: The cancer has
spread to other parts of the body. Esophageal cancer can spread almost anywhere in the
body, including the liver, lungs, brain, and bone.
6. What tests are used to
determine if cancer has spread?
CAT Scan: A computer linked
to an x-ray machine creates a series of detailed pictures of areas inside the body.
Bone Scan: This technique,
which creates images of bones on a computer screen or on film, can show whether cancer has
spread to the bones. A small amount of radioactive substance is injected into a vein; it
travels through the bloodstream and collects in the bones, especially in areas of abnormal
bone growth. An instrument called a scanner measures the radioactivity levels in these
areas.
Bronchoscopy: The doctor puts
a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the wind
pipe to look into the breathing passages.
7. What is the treatment for
esophageal cancer?
Treatment for esophageal cancer
depends on a number of factors, including the size, location, and extent of the tumor, and
the general health of the patient. Patients are often treated by a team of specialists,
which may include a gastroenterologist (a doctor who specializes in diagnosing and
treating disorders of the digestive system), surgeon (a doctor who specializes in removing
or repairing parts of the body), medical oncologist (a doctor who specializes in treating
cancer), and radiation oncologist (a doctor who specializes in using radiation to treat
cancer). Because cancer treatment may make the mouth sensitive and at risk for infection,
doctors often advise patients with esophageal cancer to see a dentist for a dental exam
and treatment before cancer treatment begins.
Surgery is the most common
treatment for esophageal cancer. Usually, the surgeon removes the tumor along with all or
a portion of the esophagus, nearby lymph nodes, and other tissue in the area. An operation
to remove the esophagus is called an esophagectomy. The surgeon connects the remaining
healthy part of the esophagus to the stomach so the patient is still able to swallow.
Sometimes, a plastic tube or part of the intestine is used to make the connection. The
surgeon may also widen the opening between the stomach and the small intestine to allow
stomach contents to pass more easily into the small intestine. Sometimes surgery is done
after other treatment is finished.
Radiation therapy uses high
energy rays to kill cancer cells. Radiation therapy affect cells in the treated area only.
The radiation may come from a machine outside the body or from radioactive materials
placed in or near the tumor into the esophagus to keep it open during the radiation
therapy. This procedure is call intraluminal intubation and dilation. Radiation therapy
may be used alone or combined with chemotherapy as primary treatment instead of surgery,
especially if the size or location of the tumor would make and operation difficult.
Doctors may also combine radiation therapy with chemotherapy to shrink the tumor before
surgery. Even if the tumor cannot be removed by surgery or destroyed entirely by radiation
therapy, radiation therapy can often help relieve pain and make swallowing easier.
Chemotherapy is the use of
anticancer drugs to kill cancer cells. The anticancer drugs used to treat esophageal
cancer travel throughout the body. Anticancer drugs used to treat esophageal cancer are
usually given by injection into a vein. Chemotherapy may be combined with radiation
therapy as primary treatment or to shrink the tumor before surgery.
Laser therapy is the use of
high intensity light to destroy tumor cells. Laser therapy affects the cells only in the
treated area. The doctor may use laser therapy to destroy cancerous tissue and relieve a
blockage in the esophagus when the cancer cannot be removed by surgery. The relief of a
blockage can help to reduce symptoms, especially swallowing problems.
Photodynamic therapy (PDT) a
type of laser therapy, involves the use of drugs that are absorbed by cancer cells; when
exposed to a special light, the drug become active and destroy the cancer cells. The
doctor may use PDT to relieve symptoms of esophageal cancer such as difficulty swallowing.
Clinical trials are research
studies to evaluate new ways to treat cancer. In some studies, all patients receive the
new treatment. In others, doctors compare different therapies by giving the new treatment
to one group and the usual (standard) therapy to another group. Through research, doctors
learn new, more effective ways to treat cancer.
8. What are the side effects of
treatment?
The side effects of cancer treatment
depend on the type of treatment and may be different for each person.
Surgery for esophageal cancer
may cause short-term pain and tenderness in the area of the operation, but this discomfort
can be controlled with medicine. Patients are taught special breathing and coughing
exercises to keep their lungs clear.
Radiation therapy affects
normal as well as cancerous cells. Side effects of radiation therapy depend mainly on the
dose and the part of the body that is treated. Common side effects of radiation therapy to
the esophagus are a dry, sore mouth and throat; difficulty swallowing; swelling of the
mouth and gums; dental cavities; fatigue; skin changes at the site of treatment; and loss
of appetite.
Chemotherapy, like radiation
therapy, affects depend largely on the specific drugs and the dose. Common side effects of
chemotherapy include nausea and vomiting, poor appetite, hair loss, skin rash and itching,
mouth and lip sores, diarrhea, and fatigue. These side effects generally go away gradually
during the recovery periods between treatments or after treatment is over.
Laser therapy can cause short
term pain where the treatment was given, but this discomfort can be controlled with
medicine.
Photodynamic therapy makes
the skin and eyes highly sensitive to light for 6 weeks or more after treatment. Other
temporary side effects of PDT may include coughing, trouble swallowing, abdominal pain,
and painful breathing or shortness of breath.
9. Is nutrition important during
treatment?
Eating well during cancer treatment
means getting enough calories and protein to control weight loss and maintain strength.
Eating well often helps people with cancer feel better and have more energy. Many people
with esophageal cancer find it hard to eat well because they have difficulty swallowing.
Patients may not feel like eating if they are uncomfortable or tired. The side effects
such as poor appetite, nausea, vomiting, dry mouth, or mouth sores, can make eating
difficult. Foods also may taste different.
After surgery, patients may receive
nutrients directly into a vein. Some may need a feeding tube (a flexible plastic tube that
is passed through the nose to the stomach or through the mouth to the stomach) until they
are able to eat on their own.
Patients with esophageal cancer are
usually encouraged to have several small meals and snacks through out the day, rather than
three large meals. When swallowing is difficult, may patients can still manage soft, bland
foods moistened with sauces or gravy. puddings, ice cream. And soups are easy to swallow.
It may be helpful to use a blender to process solid foods. The doctor, dietitian,
nutritionist, or other health care provider can advise patients about these and other ways
to maintain a healthy diet.
10. Is follow up care important?
Follow up care after treatment for
esophageal cancer is important to ensure that any changes in health are found. If the
cancer returns or progresses or if a new cancer develops, it can be treated as soon as
possible. Checkups may include physical exams, x-rays, or lab tests. Between scheduled
appointments patients should report any health problems to their doctor as soon as they
appear.
11. How do you deal with
emotions?
Living with cancer is challenging.
Apart from having to cope with the physical and medical challenges, people with cancer
face many worries, feeling and concerns that can make life difficult. They may find they
need help coping with the emotional as well as the practical aspects of their disease. In
fact, attention to the emotional burden of having cancer is often apart of a patient's
treatment plan. The support of the health care team (doctors, nurses, social workers),
support groups, and patient-to-patient networks help people feel less isolated and improve
the quality of their lives. Cancer support groups provide a setting in which cancer
patients can talk about living with cancer with other who have similar experiences.
12. What questions do I ask the
doctor?
What types of treatment are available?
Are there any risks or side effects of
the treatment?
Will I have to change my normal
activities?
How often are checkups needed?
Will I have to bring someone to the
treatments with me?
Will my treatments be in the hospital or
an outpatient clinic?
Can I continue to work?
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