Esophageal Cancer Symptoms and Treatment

Esophageal cancer is a condition that affects the esophagus, the long, muscular tube that carries food from the throat to the stomach. Symptoms are often not noticeable until the cancer has spread, making early detection challenging. The most common types are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma typically develops in the upper part of the esophagus, while adenocarcinoma usually occurs in the lower part. Symptoms may include difficulty swallowing, pain, weight loss, indigestion, and esophageal blockage. Risk factors include chronic reflux disease, obesity, and certain dietary habits. With early diagnosis, doctors can successfully intervene with surgery and other treatments

What Is Esophageal Cancer?

This type of cancer is increasingly common today and begins in the tissues of the esophagus, the muscular tube that helps move swallowed food from the throat to the stomach for digestion. Esophageal cancer can develop anywhere along the esophagus, and tumors caused by it might not show clear symptoms until the cancer has spread. In early-stage esophageal cancer, doctors may use surgery to remove tumors or relieve symptoms. For more advanced stages, treatment options include chemotherapy, radiation therapy, and immunotherapy.

Causes of Esophageal Cancer

Esophageal cancer occurs due to abnormalities in the DNA of cells within the esophageal tissues. These abnormal changes cause cells to multiply more than usual. The accumulation of these mutated cells creates a tumor in the esophagus. Although the exact cause is still unknown, several risk factors increase the likelihood of developing esophageal cancer. Some of these risk factors include:

• Barrett’s Esophagus: This condition occurs when cells at the lower end of the esophagus undergo changes due to chronic, untreated acid reflux. Chronic reflux disease can alter the tissue in the esophagus, increasing cancer risk.
• Obesity: Being overweight or obese can cause inflammation in the esophagus, which may lead to cancer. Obesity raises inflammation levels in the body, which can contribute to cancer development.
• Other Health Conditions: Esophageal cancer may be associated with certain rare hereditary conditions. One such condition is achalasia, a rare disorder that affects the swallowing reflex. Another is tylosis, a rare inherited condition that causes thickened skin on the palms and soles.
• Dietary Habits: Poor diet, such as low fruit and vegetable intake and excessive consumption of high-fat or processed foods, can also increase the risk of esophageal cancer.
• Genetic Factors: Those with a family history of esophageal cancer may have a genetic predisposition. Certain gene mutations can raise the risk of developing this cancer.
• Exposure to Certain Chemicals: Long-term exposure to some occupational chemicals, such as dry-cleaning solvents, can increase the risk of developing esophageal cancer.

What are the Symptoms of Esophageal Cancer?

In the early stages of esophageal cancer, noticeable symptoms may not appear. However, difficulty swallowing can be among the first symptoms that people may detect. Other symptoms include:

• Pain in the throat or back, behind the breastbone, or between the shoulder blades
• Vomiting or coughing up blood
• A painful burning sensation in the chest
• Hoarseness or chronic cough
• Unintended weight loss

Stages of Esophageal Cancer

After an esophageal cancer diagnosis, doctors attempt to determine whether the cancer has spread and, if so, how far. This assessment process is called staging. The earliest stage of esophageal cancer is called stage 0, and stages range from I to IV. Generally, a lower stage number indicates less spread of the cancer. Cancer staging is usually done as follows:

• Stage 0: Cancer is only in the upper layer of cells lining the esophagus (epithelium) and has not begun to grow into deeper layers or spread to other tissues. This stage typically indicates superficial cancer cells, with a high chance of successful treatment.
• Stage I: Cancer has progressed from the inner layer of the esophagus to its outer layers but has not spread to lymph nodes or other organs.
• Stage II: Cancer may have advanced to the outer layer of the esophagus or nearby tissues but has not spread to the lymph nodes.
• Stage III: Cancer has begun growing into the thick muscle layer (muscularis propria). It may have spread to lymph nodes or surrounding tissues but not to distant organs.
• Stage IV: Cancer has typically spread outside the esophagus and may have metastasized to distant organs. This stage usually signifies advanced cancer, with limited treatment options.

How is Esophageal Cancer Diagnosed?

In diagnosing esophageal cancer, a doctor will first take the patient's medical history, reviewing symptoms and past health. Additionally, doctors may request the following tests for diagnosis:

• Barium X-ray: A barium test allows doctors to see the structure of the esophagus on an X-ray. This diagnostic method involves drinking a barium suspension orally, followed by taking images with an X-ray machine. Barium coats the inside of the esophagus, revealing any tissue changes in the X-ray.
• Endoscopy and Biopsy: Endoscopy uses a flexible tube (endoscope) to examine the inside of the esophagus. This method allows doctors to observe abnormalities on the esophageal surface and take a biopsy. Doctors may remove a small tissue sample for microscopic examination to check for cancer cells and determine the cancer type.
• Endoscopic Ultrasound (EUS): EUS is used during endoscopy to examine lymph nodes and nearby tissues in greater detail. This method helps determine the extent of cancer spread and informs treatment options.
• Computed Tomography (CT) Scan: CT scans can help assess the presence and spread of esophageal cancer. This test helps identify whether tumors have spread to the chest and abdominal areas.
• Magnetic Resonance Imaging (MRI): MRI helps in a more detailed examination of esophageal cancer, particularly in assessing spread to lymph nodes or nearby tissues.
• Positron Emission Tomography (PET) Scan: PET scans are used to evaluate whether the cancer has metastasized to other areas of the body. This scan helps identify cancer presence in other parts of the body.

How is Esophageal Cancer Treated?

The treatment of esophageal cancer is planned by specialists based on the stage and grade of the cancer. Some of the treatment options include:

• Surgery: Esophagectomy is the most commonly preferred treatment method by doctors for early-stage esophageal cancer. It involves removing a portion or most of the esophagus and surrounding tissues. Surgeons may create a new esophagus by pulling part of the stomach up into the chest. Surgery also includes removing lymph nodes where cancer has spread if it has reached other tissues.
• Radiation Therapy: Radiation therapy aims to kill cancer cells by applying a beam of radiation to the tumor. It can be used before surgery to shrink tumor tissues or after surgery to eliminate any remaining cancer cells.
• Chemotherapy: Chemotherapy is a treatment method that involves the use of drugs to kill or stop the growth of cancer cells. It can also be given along with radiation therapy.
• Targeted Therapy: Some esophageal cancer cells carry an unusually high amount of HER2 protein, which can affect cancer cell growth. In targeted therapy, doctors try to treat esophageal cancer with drugs that target HER2 proteins.
• Immunotherapy: This treatment includes immune checkpoint inhibitors. These drugs can be used to encourage specific immune cells to attack cancer cells or to strengthen the immune system against cancer.

Frequently Asked Questions

Does Tongue Cancer Recur?

Tongue cancer can recur. In some treated cases, cancer cells can return, or new cancers may appear after treatment. Therefore, regular follow-up and monitoring are essential.

Which Doctor Treats Esophageal Cancer?

The diagnosis and treatment of esophageal cancer are usually carried out with the cooperation of several different medical fields. Gastroenterologists, general surgeons, or oncologists generally play significant roles in diagnosing and treating esophageal cancer.

Esophageal cancer is a condition that can arise from many factors and is often treated with surgical intervention in its early stages. People with symptoms of esophageal cancer can begin treatment by making an appointment at the gastroenterology department of hospitals.