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What is Esophageal Cancer?

Esophageal cancer is the cancer of the food pipe or esophagus or gullet.

The esophagus is a part of the digestive system. It is a tube like structure which carries food from mouth to the stomach. Cancer can develop in any part of the esophagus. In the upper and middle part, these tend to be squamous cell carcinomas, i.e. they develop from the inner lining of the esophagus. Cancers in the lower part are usually adenocarcinomas, i.e. they arise from the glands.

The lowermost end of the esophagus joins the stomach. This area is known as the gastro-esophageal junction. Cancers arising from here are known as gastro-esophageal junction cancers.

How common is Esophageal Cancer?

In India, it constitutes 3.6% of all body cancers in the rich and 9.13% of those in the poor and the male to female ratio is 3:1.

What are the risk factors of Esophageal Cancer?

Smoking and alcohol consumption are high risk factors and so are some particular dietary habits. In India, a very high incidence is associated with tobacco chewing and smoking. About 5% of esophageal cancers arise in the pre-existing lesions, such as benign strictures, hiatus hernia, achalasia cardia, diverticula, Plummer-Vinson syndrome, etc.

Diet deficiencies (Vit. A, C, riboflavin)5% common
Mycotoxin – A toxic metabolite produced by several fungiCommon after 45 years
Alcohol and tobaccoCommon in men
Human papilloma virus (HPV 16,18)In India, common in Karnataka and Orissa
Achalasia Cardia – A disorder characterized by difficulty in swallowing30%
Esophageal webs – formation of thin membranes of esophageal tissue that can partially/completely obstruct the esophagus.25%
Barrett’s esophagus – Barrett’s esophagus is a condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus.15%

 

What are the symptoms of Esophageal cancer? 

  • Dysphagia (difficulty in swallowing): This is the commonest feature. For dysphagia to develop, more than 2/3rd of the food pipe opening should be blocked.
  • Loss of appetite and subsequent dramatic loss of weight.
  • Pain – just below the ribs or in the abdomen.
  • Ascites – Abnormal accumulation of fluid in the abdomen.
  • Bronchopneumonia
  • Hoarseness of voice may be present.
  • Hiccup

How is Esophageal cancer diagnosed?

Barium swallow – A barium swallow is an X-ray imaging test that allows the doctor to see the lining of esophagus. To do this, the patient swallows a chemical called barium while the images are being obtained.

  • Endoscopy: Esophagoscopy is a procedure in which a fibre optic tube is passed through the mouth into the food pipe to visualize the level and degree of obstruction. Simultaneously a biopsy can also be obtained.
  • Biopsy: Done to obtain a tissue from the affected area to be observed under a microscope
  • Chest x-ray: To study in detail
  • CT scan: It is used for staging of the cancer
  • Ultrasound of abdomen: To study in detail
  • PET Scan: Done for cancer screening
  • Laparoscopy: A surgical procedure in which a fibre-optic instrument is inserted through the abdominal wall to view the spread of the cancer to other organs in the abdomen.
  • Routine Blood tests such as Haemogram, complete blood count, etc.

How is Esophageal cancer treated?

  • Radiotherapy: Surgery of the upper one-third of esophagus is difficult due to great vessels and involvement of mediastinal nodes. In such cases, radiotherapy is the treatment of choice.
  • Surgery: It is the treatment of choice for cancer of middle and lower one-third. The affected segment, with a wide margin of esophagus and the beginning of the stomach, can be removed with reconstruction of the food channel.
  • Palliative Care: In advanced lesions, only palliative therapy is possible. Also chemotherapy can be advised along with radiotherapy. Temporarily the esophageal block can be stented so that the patient can swallow food without difficulty. If this is not possible, a tube is inserted into the stomach or small intestine, surgically, to allow intake of food (It is called Feeding Gastrostomy or Feeding Jejunostomy).

How can Esophageal cancer be prevented?

Although there’s no sure way to prevent esophageal cancer, there are a few steps one can take to lower the risk:

  • Avoiding cigarettes and chewing tobacco
  • Limiting the consumption of alcohol is also thought to lower the risk
  • Eating a diet with lots of fruits and vegetables and maintaining a healthy weight may also be effective ways to avoid esophageal cancer

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