Esophageal cancer: Trends and Risks
Cancer is a condition that develops when cells in the body begin to grow uncontrollably and can develop in any part of the body. The esophagus is a 10-13 inch long muscular tube that connects the throat to the stomach. Food that is consumed, passes through the esophagus to reach the stomach. The esophagus is made up of various layers, the inner layer of the esophagus is called the mucosa and the outer layer of the esophagus is called adventitia. Cancer of the esophagus generally starts from the inside and then grows outwards.
There are different types of esophageal cancers that can occur depending on the type of cells involved. Rare types of esophageal cancer include sarcoma, lymphoma, melanoma and choriocarcinoma. However, the two main types of cancers caused in the esophagus are:
Adenocarcinoma: Adenocarcinoma starts in the lower part of the esophagus and happens when cells in the glands grow uncontrollably. This type of cancer is becoming more common than in the past. In fact, it is now more common than squamous cell carcinoma. History of consistent GERD is a risk factor for this type of cancer. It is not fully understood why this is so, but there is probably an association with increasing incidence of GERD, obesity and related diseases in the population.
Squamous cell carcinoma: Most of esophagus is lined by squamous cells. Cancer that arises from these cells is called squamous cell cancers. This typically occurs in upper or middle part of esophagus. It is likely that there is an association between this cancer and smoking, consumption of alcohol or a combination of the two. There could also be a genetic or racial predisposition. The symptoms of esophageal cancer include heartburn, weight loss without even trying, hoarseness of voice, indigestion, dysphagia or difficulty in swallowing and persistent cough. 85%- 95% of esophageal cancer patients suffer dysphagia. However, symptoms tend to occur only when the disease has advanced to a certain stage. There may be no symptoms early in the course of the disease. This is what makes an early diagnosis of esophageal cancer challenging. Nevertheless, it is possible to detect the disease early by screening select populations.
People suffering from Gastroesophageal reflux disease (GERD) and Barrett’s esophagus are at a higher risk of developing cancer of the esophagus, and such patients are one example of a population that should undergo periodic screening. GERD is a condition in which the stomach acids or contents surge back up into the esophagus causing a burning sensation. In some patients with long-standing GERD, the tissue that lines the esophagus is replaced by cells similar to that in the intestine; this is called Barrett’s esophagus, and this is a risk factor for adenocarcinoma of esophagus.
Acid reflux is common and almost everybody experiences acid reflux at some point in their life. However, people often believe that acid reflux is a harmless yet annoying problem. Many patients do not seek medical attention for the same. However, patients need to be aware of alarm symptoms that could indicate serious underlying problems. Patients need to know that if any of alarm symptoms are noticed, medical consultation should not be delayed.
The book titled ‘Descriptive Epidemiology of Gastrointestinal Malignancies’ states that esophageal cancer is the 5th most common cause of cancer related deaths in men, 8th most common among women and the 7th most common cancer globally. The condition often gets disregarded because symptoms do not manifest until the condition has reached an extreme state. Dysphagia or difficulty in swallowing is the most common symptom to which people respond by chewing carefully and eating slowly. The condition gradually worsens, causing the tumor to grow and obstruct the esophagus. It is necessary to be aware of the causes and symptoms of esophageal cancer in order to be aware of the changes in one’s body. It is mandatory to consult a specialist on observing any unusual symptoms as it is best if diagnosed early because there is no known preventive measure for esophageal cancer.
Treatment options for esophageal cancer depend on the stage it is diagnosed in. The various stages of esophageal cancer are;
Stage 0: is pre-cancer when the esophageal lining contains abnormal cells called high grade dysplasia.
Stage I: is when the cancer would have spread to the first lining of the esophagus but not reached the lymph nodes or any other organs. People with stage 1 cancer can be treated with radiation therapy, chemotherapy or ablation.
Stage II: is when the cancer has affected the deeper layers or the main muscles of the esophagus and affected one or two lymph nodes. In stage II and III, surgery is recommended for those who do not have any underlying conditions, depending on the type of cancer.
Stage III: is when the cancerous cells have penetrated to the deepest layer of the esophagus and also affected a few organs including the nearby lymph nodes.
Stage IV: is when the cancer has spread to various other parts of the body. At this stage it is difficult to eradicate the cancer completely. Treatment methods are undertaken to control the condition and relive any symptoms.
Surgery, endoscopic procedures, radiation therapy and chemotherapy are the possible treatment options for esophageal cancer, depending on the type and stage of cancer. Surgical methods are used to remove very small tumors, a part of the esophagus or even a part of the esophagus and stomach.
Dr. Amal Premchandra Upadhyay
Aster Hospital Mankhool
To know more about Dr. Amal – http://asterhospital.com/doctor/dr-amal-premchandra-upadhyay/
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