Statistics:

In 2020, Esophageal Cancer caused more than 0.6 million new cases and 0.54 million deaths globally.

Esophageal carcinoma is the eleventh most frequent cancer globally. It is the seventh most frequent cancer in males, and the sixteenth most common cancer in women.

What is the Esophagus and its functions?

The esophagus is the hollow, muscular tube that passes food and liquid from your throat to your stomach.

The major function of the esophagus is to transport food and drink from the mouth to the stomach. When you swallow, food and drink go from the oral cavity to your throat (pharynx). The epiglottis is a tiny muscle flap that shuts to prevent food and drink from entering your windpipe (trachea). The uvula is another tiny flap that prevents fluids from traveling vertically into the nasal passages.

What is Esophageal Cancer?

Esophageal cancer is the development of cells that begin in the esophagus. Esophageal cancer typically develops in the cells that line the inside of the esophagus.

Esophageal cancer can develop anywhere in the esophagus.

The esophagus, often referred to as the food pipe, transfers food and liquids from the mouth to the stomach as part of the digestive system.

It does this by a mechanism known as peristalsis, in which muscle contractions drive the food bolus down the tube.

The esophagus is engaged in the swallowing reflex, which consists of synchronized muscular responses that ensure food enters the esophagus rather than the airway.

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 cancer starts in the squamous cells that line the esophagus. Squamous cell esophageal cancer often affects the upper and middle portions of the esophagus.

Adenocarcinoma

Adenocarcinoma is a cancer that originates in the glands that line your organs. These glands produce mucus and digestive juice. Tumors can arise when your glandular epithelial cells begin to alter or grow uncontrollably.

Adenocarcinoma is the most prevalent kind of cancer that affects your organs. It can have a wide range of effects on your body.

Squamous Cell Carcinoma

Squamous cell carcinoma, also known as cutaneous squamous cell carcinoma (CSCC), is the second most frequent kind of skin cancer. It begins with squamous cells in your skin's surface layer, the epidermis. Squamous cell carcinomas often develop on parts of the skin that receive the most sun exposure, such as the head, arms, and legs. Cancer may also develop in parts of your body with mucus membranes, which are the inside linings of organs and body cavities such as your mouth, lungs, and anus.

It primarily affects males in the esophagus as a result of exposure to substances such as cigarettes and arsenic.

Symptoms of Esophageal Cancer

Esophageal cancer may not present symptoms right away. Esophageal cancer symptoms often appear as the illness progresses.

Symptoms of esophageal cancer include:

• Cough or hoarseness.
• Swallowing is difficult.
• Increasing indigestion or heartburn.
• Chest discomfort, pressure, or burning.
• You can lose weight without trying.

Causes

Medical doctors don't know exactly what causes esophageal cancer.

However, several risk factors have been found. These include:

• Human papillomavirus (HPV) is a common virus that can cause tissue changes in the voice cords and mouth, as well as on the hands, feet, and genitals.
• Obesity: Being overweight or obese 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.
• People with a history of cancer in the neck or head are more likely to develop esophageal cancer.
• Other disorders: Esophageal cancer has been connected to several uncommon and/or genetic diseases. One is 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.

Diagnosis

Esophageal cancer 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.

• A biopsy is a technique that involves removing a sample of tissue for laboratory examination. To get the tissue sample, a healthcare expert inserts specific cutting instruments through an endoscope. The instruments are used by the healthcare expert to remove a little piece of tissue from the esophagus. The tissue sample is submitted to a lab to be tested for cancer cells.
• Upper endoscopy
• Upper endoscopy is a test that examines the upper digestive tract. An endoscope is a long, flexible tube with a camera at the end that is used to view inside the body. 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).
• Esophageal endoscopic ultrasound
• Sound waves generate pictures of the inside of your esophagus. The procedure may be performed as part of an EGD.
• Computed tomography (CT) scan
• This diagnostic procedure assists healthcare practitioners evaluate whether cancers have migrated to your chest and abdominal area.
• Barium swallow study
• A barium swallow 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 consume a white liquid known as barium. The barium covers the esophagus, making it easier to spot on X-rays. If anything concerning is discovered during the barium swallow 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. These tests help your healthcare team 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.

Stages of Esophageal Cancer

• In Stage 0, 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 tumor(T), lymph-node involvement(N), and metastasis(M).

Complications

• As esophageal cancer progresses, difficulties might arise. Complications could include:
• An esophageal obstruction. Cancer can make it harder to move food and drink via the esophagus.
• Esophageal cancer might result in bleeding. Though bleeding is normally slow, it can occur unexpectedly and severely at times.
• Advanced esophageal cancer may be painful.

Treatment

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

• 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.

• Chemotherapy:

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.

• Radiation Therapy:

1. External Beam Radiation: This technique uses radiation beams to target the tumor.
2. Intraoperative Radiation Therapy (IORT): Radiation is administered during surgery to target the tumor bed.

• Targeted Therapies:

Tyrosine Kinase Inhibitors (TKIs) are drugs that target proteins implicated in cancer progression.

• Immunotherapy:
• Checkpoint Inhibitors: Drugs that aid the immune system in combating cancer cells.
• Endoscopic Treatments:

1. Endoscopic Mucosal Resection (EMR) is the removal of tumors from the mucous lining that covers the esophagus.
2. Endoscopic Submucosal Dissection (ESD): Removal of the lesion out of the muscularis mucosa.

FAQs

Q. What is esophageal cancer?

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. What are some symptoms of esophageal cancer?

Symptoms of esophageal cancer may include trouble swallowing, chest discomfort, hoarseness or persistent cough, and weight loss. Other possible symptoms include a sense of food caught in the chest, choking on food, and persistent heartburn or indigestion.

Q. Can esophageal cancer be cured?

Esophageal cancer 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. How is esophageal cancer treated?

Treatment for esophageal cancer is extremely customized and is determined by the disease's stage, the patient's general health, and other variables. Surgery, chemotherapy, radiotherapy, and targeted treatments are all common treatment choices. In certain circumstances, a combination of these treatments may be employed.

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.