Esophagus Cancer

General Illness Information

Medical Term:
ESOPHAGUS CANCER

Common Name: None Specified

Description:

Malignant growth in the esophagus (food pipe) ,in which cells multiply in an uncontrolled manner. Usually develops in people between the ages of 50 to 70 years of age.

The overall ratio of men to women is 3:1.

There are 2 types of cancer – squamous cell carcinoma and adenocarcinoma. In the United States, squamous cell carcinoma is much more common in blacks than whites. Chronic alcohol and tobacco use are strongly associated with an increased risk of squamous cell carcinoma. Adenocarcinoma is more common in whites ,and is increasing dramatically in incidence. The vast majority of adenocarcinomas develop as a complication of Barrett’s metaplasia ,which is a complication of chronic gastro esophageal reflux. Thus most adenocarcinomas arise in the lower third of the esophagus.

Esophagus cancer may develop in any part of the esophagus. Usual distribution is as follows: 20% in upper third, 30% in the middle third and 50% in the lower third.

Causes: Unknown. Most esophagus cancers arise from the esophagus, but some spread from other parts of the body.

Prevention:

  • Avoid excess alcohol, tobacco and corrosive chemicals.
  • Those people at high risk ( e.g. gastro esophageal reflux, and head and neck cancer) should have endoscopic examination ( examination of the esophagus with a special viewing tube).

Signs & Symptoms

  • Unfortunately, most patients with esophageal cancer present with advanced, incurable disease.
  • Swallowing difficulty or pain (dysphagia)- mainly for solids.
  • Rapid weight loss.
  • Enlarge supraclavicular lymph nodes.( nodes above the collar bone).
  • Esophageal obstruction.
  • Hiccups.
  • Cough.
  • Hoarseness.
  • Regurgitation of bloody mucus, especially at night.

Risk Factors

  • Smoking.
  • Excess alcohol consumption.
  • Previous head and neck tumors.
  • Celiac disease.
  • Hiatus hernia.
  • Strictures.
  • Chronic gastric reflux-may lead to Barrett’s metaplasia in 10 to 40% of patients with chronic gastric reflux.
  • Malnutrition.
  • Anemia (iron deficiency ) and esophageal web- Plummer-Vinson syndrome.

Diagnosis & Treatment

  • For diagnosis, biopsy (removal of a small amount of tissue or fluid for laboratory examination that aids in diagnosis) of the tumor;
  • X-ray of the upper-intestinal tract;
  • CT scan;
  • esophagoscopy.
  • Laboratory findings are nonspecific. Anemia is a common finding due to chronic blood loss.

General Measures:

  • The approach to and treatment of esophageal cancer depends on the stage of the disease. Treatment consists of surgery, radiation, chemotherapy or a combination of these. Very few patients are candidates for curative surgical resections. In the majority, the goal is local tumor control and palliation.
  • Surgical  treatment- in most cases , surgery is performed for palliative purpose, to improve patients ability to eat and to prevent local tumor complications.
  • Radiation therapy – for patients with unresectable disease and for those who are poor operative candidates . Radiation therapy may provide significant short-term relief of local symptoms ,such as swallowing difficulties and pain.
  • Radiation and chemotherapy – Combined therapy with radiation and chemotherapy appears to be superior to radiation therapy alone for localized tumor that has not metastatized. To date ,best results have been achieved with 2 agents – cisplastin and fluorouracil.

Medications:

  • Analgesics or narcotics to relieve pain can be prescribed.
  • Tranquilizers to reduce anxiety.
  • Anticancer drugs – cisplastin and fluorouracil.
  • Anticholinergics or calcium-channel blockers for esophageal spasms.

Activity:

Remain as active as possible.

Diet:

  • Soft to liquid. Avoid chocolates, alcohol and fats.
  • High calorie supplements.
  • Prior to surgery, special nutritional support may be required (feeding tube with formula diet).

Possible Complications :

  • If treatment doesn’t begin immediately, esophagus cancer spreads rapidly to the lungs and liver.
  • Aspiration into lungs from esophagus obstruction
  • Complications of surgical procedures.
  • Toxicities of chemotherapy- nausea, vomiting, hair loss, gastroenteritis and depression of the immune system.
  • Complications of radiotherapy- esophageal perforation, inflammation of the esophagus, pneumonitis (inflammation of the lung), and pulmonary fibrosis.

Prognosis

This condition is currently considered incurable. Early diagnosis and aggressive treatment offer the only chance of survival. Overall 5 year survival is 5%. In squamous cell carcinoma with uninvolved nodes 5 year survival is 15 to 20%. In any case, symptoms can be relieved or controlled.

Other

Medical literature cites a few instances of unexplained recovery. Scientific research into causes and treatment continues, so there is hope for increasingly effective treatment and cure.

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