ESOPHAGEAL CANCER

Statistics:

• In 2020, Esophageal Cancer caused more than 0.6 million new cases and 0.54 million deaths globally.
• The eleventh most frequent cancer globally is Esophageal carcinoma. It is the seventh most frequent cancer in males, and the sixteenth most common cancer in women.

What is the esophagus and how does it work?

The esophagus is a muscular tube that helps in transportation of food and liquids from the mouth to the stomach (as part of the digestive system) by the help of contractions called peristalsis. The epiglottis is a flap that prevents these foods and liquids from entering the wind pipe instead of the esophagus.

What is Esophageal Cancer?

It is the development of cells that begin in the esophagus (typically the ones in the lining inside the esophagus that begins in the esophagus). It can develop anywhere in the esophagus.

Types of Esophageal Cancer:

Adenocarcinoma and squamous cell carcinoma make up the most common forms of esophageal cancer.

• Adenocarcinoma is the most frequent kind of esophageal cancer in the United States. It occurs in the tissue that produces mucus, which aids in swallowing. It mainly affects the bottom portion of the esophagus.
• Squamous cell carcinoma is the most frequent kind of esophageal cancer in India. It starts in the squamous cells that lining the esophagus. It often affects the upper and middle portions of the esophagus.

Risk factors:

1. Most cases are reported in people over the age of 55.
2. Men are three times more likely than women to develop this form of cancer. (As per MD Anderson Cancer Center)
3. A steady habit of drinking very hot liquids. (As per Mayo Clinic)
4. Gastroesophageal reflex disease
5. Not eating enough fruits and vegetables
6. Obesity and radiation treatment to the chest and upper abdomen.

Adenocarcinoma -

It is a cancer that originates in the glands that line the organs. These glands produce mucus and digestive juice. Tumors can arise when glandular epithelial cells begin to alter or grow uncontrollably. It can have a wide range of effects on the body and organs.

Squamous Cell Carcinoma -

It is the second most frequent kind of skin cancer. It begins with squamous cells on the skin's surface layer, the epidermis. They often develop on parts of the skin that receive the most exposure of sun, for example, the head, arms, and legs. Cancerous cells may also develop in parts of the body with mucus membranes, which are the inside linings of organs and body cavities such as your mouth, lungs, and anus.

It primarily affects people in the esophagus as a result of exposure to substances such as cigarettes and arsenic. Its occurrence is more frequent is males.

Stages of Esophageal Cancer:

• In Stage 0, the cancer cells are restricted to the esophageal inner lining (high-grade dysplasia).
• In Stage I, the cancer has progressed to the inner lining of the esophagus wall but not to deeper layers or lymph nodes.
• In Stage II, cancer has progressed to the esophagus' outer layer and may have migrated to adjacent lymph nodes.
• In Stage III, cancer has gone beyond the esophagus and may have reached local lymph nodes, but not distant organs.
• In Stage IV, cancer has progressed to distant organs or lymph nodes, as well as surrounding tissues.

The TNM staging also needs to be taken into consideration, which considers the size of the tumour(T), lymph-node involvement(N), and metastasis(M).

Symptoms of Esophageal Cancer:

It may not present symptoms right away. Symptoms often appear as the illness progresses.

• Cough, that won't go away or hoarseness.
• Swallowing is difficult.
• Increasing indigestion or heartburn.
• Chest discomfort, pressure, or burning. (Chronic heartburn)
• You can lose weight without trying.
• Pain in your throat or behind your breastbone (As per Cancer Research UK).
• Food coming back up or coughing up blood.

Causes:

Medical professionals don't know exactly what causes esophageal cancer. However, several risk factors have been found. These include:

• Human papillomavirus (HPV), a common virus that can cause tissue changes in the voice cords and mouth, as well as on the hands, feet, and genitals.
• Obesity or being overweight may induce inflammation in the esophagus, which can lead to cancer.
• Tobacco usage encompasses both smoking and using smokeless tobacco.
• Alcohol use: Chronic and/or excessive alcohol consumption raises the risk of esophageal cancer.
• Barrett's esophagus is a change in the cells at the lower end of the esophagus caused by prolonged, untreated acid reflux.
• People who suffer from chronic heartburn, even if they do not have Barrett's esophagus, are more likely to develop esophageal cancer.
• Occupational exposure to particular chemicals: Long-term exposure to dry cleaning solvents increases the chance of getting esophageal cancer.
• History of cancer in the neck or head.
• Other disorders: Connected to a number of uncommon and/or genetic diseases. Achalasia, a rare illness that causes difficulty swallowing. Tylosis is a rare, genetic illness in which extra skin develops on the palms and soles of your feet.

Prevention:

Not all esophageal cancers can be prevented. But one can lower the risk of developing this disease by avoiding certain risk factors.

1. Maintaining a weight that is healthy for you.
2. Protect yourself against HPV infections (ask your medical professional about shots that defend the virus).
3. Use protective gears if your job includes long term exposure to solvents and other substances.
4. Avoid tobacco and alcohol.

Diagnosis:

It is frequently diagnosed with imaging examinations of the esophagus. To observe the esophagus, a thin, flexible tube with a camera can be inserted down the mouth. A sample of tissue may be collected for laboratory examination.

1. Biopsy

A technique that involves removing a sample of tissue for laboratory examination. A healthcare expert inserts specific cutting instruments through an endoscope ( a long, flexible tube with a camera at the end that is used to view inside the body) to get the tissue sample. A little piece of tissue from the esophagus are removed using the instruments. The tissue sample is then submitted to a lab to be tested for cancer cells.

1. Upper endoscopy

It is a test that examines the upper digestive tract. To view within the esophagus, a healthcare professional inserts an endoscope down the throat. The health expert is looking for symptoms of cancer. The procedure is sometimes called esophagogastroduodenoscopy (EGD).

1. Esophageal endoscopic ultrasound

Sound waves generate pictures of the inside of your esophagus. The procedure may be performed as part of an EGD.

1. Computed tomography (CT) scan

This diagnostic procedure assists healthcare practitioners to evaluate whether cancers have migrated to your chest and abdominal area.

1. Barium swallow study

This examination employs X-rays to examine the digestive system. It can reveal changes in the esophagus, such as a potentially malignant development. Before the test, you are required to consume a white liquid known as barium, which covers the esophagus, making it easier to spot on X-rays. If anything concerning is discovered during the exam, your healthcare provider may request an endoscopy to investigate.

Determining the extent of the cancer:

Following an esophageal cancer diagnosis, you may have further testing to determine whether the disease has spread or not. These tests help your healthcare team to determine the stage of your cancer.

• Cancer staging exams frequently include imaging testing. The tests may check for symptoms of cancer in your lymph nodes or other areas of your body.
• The findings of your cancer staging test are used by your healthcare team to build your treatment plan.

Bronchoscopy, endoscopic ultrasonography, CT, MRI, and PET scans are all examples of imaging examinations. Not all tests are appropriate for every individual. Consult your healthcare expert about which tests you will require.

Treatment:

Esophageal cancer treatment consists of a range of techniques that vary depending on the stage of the cancer.

1. Surgery:

• Esophagectomy is the removal of the malignant part of the esophagus and its surrounding lymph nodes, followed by rebuilding to allow food passage.
• Endoscopic treatments include Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD), which can be used to remove early-stage tumors or precancerous diseases.

1. Chemotherapy:
   • Either alone or in combination with chemoradiation, is used to destroy cancer cells and is commonly administered before to or following surgery.
   • Neoadjuvant Therapy: Using chemotherapy and radiation before surgery to reduce the tumor and avoid recurrence.
2. Radiation Therapy:
   • External Beam Radiation: This technique uses radiation beams to target the tumor.
   • Intraoperative Radiation Therapy (IORT): Radiation is administered during surgery to target the tumour bed.
3. Targeted Therapies:
   • Tyrosine Kinase Inhibitors (TKIs) are drugs that target particular proteins implicated in cancer progression.
4. Immunotherapy:
   • Checkpoint Inhibitors: Drugs that aid the immune system in combating cancer cells.
5. Endoscopic Treatments:
   • Endoscopic Mucosal Resection (EMR) is the removal of tumors from the mucous lining that covers the esophagus.
   • Endoscopic Submucosal Dissection (ESD): Removal of the lesion out of the muscularis mucosa.

FAQs

Q. What is esophageal cancer?

A: Esophageal cancer is a disease in which cancerous cells grow in the esophagus, the muscular tube that transports nutrients and fluids from the oral cavity to the gastrointestinal tract.

Q. What causes esophageal cancer?

Esophageal cancer is generally caused by chronic irritation and inflammation of the esophageal lining, which is frequently caused by disorders such as gastroesophageal reflux disease (GERD) and Barrett's esophagus. Other important indicators of risk include consumption of tobacco products (smoking and chewing tobacco), high alcohol intake, and certain hereditary diseases or genetic abnormalities.

Q. Can esophageal cancer be cured?

It is often treated, but not necessarily cured, especially when detected at a later stage. While some patients achieve full recovery or long-term survival following therapy, others may require continuous maintenance to keep the disease under control. Early identification and stage of cancer have a substantial influence on the chances of cure and total survival rate.

Q. Can esophageal cancer be prevented?

While there are no guarantees of a lifestyle that prevents esophageal cancer, certain steps can be taken to reduce risks.

• Avoid tobacco - Stop smoking and chewing tobacco.
• Limit alcohol consumption - Drink in moderation or not at all.
• Maintain a healthy weight; obesity raises risk.
• Eat a balanced diet rich in fruits, vegetables, and whole grains.
• Treat acid reflux - Control GERD to avoid Barrett's esophagus.
• Avoid really hot beverages and allow them to cool before ingesting.
• If you're at risk, be checked, especially if you have persistent reflux or Barrett's esophagus
• Maintaining proper dental hygiene may minimize your chances of developing cancer.
• Avoid processed meats, since they have been linked to an increased risk of cancer.
• Stay active - Regular physical exercise benefits your overall health.

Q. What are the side effects of surgery?

Pain after surgery, nausea, vomiting, heartburn, difficulty in swallowing food can be common side effects (as per moffit.org).

Q. What type of questions do I ask my doctor a before the surgery?

1. Will I be able to speak properly?
2. What to do if mg cancer comes back?
3. What type of follow up do I need?