What is esophageal cancer?

The oesophagus is a hollow, muscular tube that connects the throat to the stomach and is 10 inches long. It is a portion of a person’s digestive system, often known as the gastrointestinal tract. The walls of the esophagus pull together when a person swallows, pushing food down into the stomach.

Cancer is caused by healthy cells that mutate and expand out of control, resulting in a tumour. Tumors can be malignant or noncancerous. A malignant tumour is one that has the potential to grow and spread to other regions of the body. The term “benign tumour” refers to a tumour that can develop but not spread. Esophageal cancer, commonly known as esophageal cancer, is a type of cancer that starts in the cells that line the oesophagus.

Esophageal cancer, in particular, starts in the inner layer of the esophageal wall and spreads outward. It can spread through the esophageal wall to lymph nodes, which are small bean-shaped organs that help fight infection, as well as blood arteries in the chest and other surrounding organs, if it goes through the esophageal wall. Esophageal cancer has the potential to spread to the lungs, liver, stomach, and other organs.

Esophageal cancer is a type of cancer that develops in the oesophagus, which is a long, hollow tube that connects the throat to the stomach. Your oesophagus is a tube that connects the back of your throat to your stomach, where it is processed.

Esophageal cancer normally starts in the cells that lining the esophagus’s interior. Esophageal cancer can develop at any point in the oesophagus. Esophageal cancer affects more men than women.

Esophageal carcinoma is the sixth leading cause of mortality from cancer worldwide. The rates of infection change depending on where you live. Tobacco and alcohol use, as well as certain food habits and obesity, may be linked to greater risks of esophageal cancer in specific areas.

What causes esophageal cancer?

Factors that can increase your risk of esophageal cancer include:

• Smoking
• Heavy alcohol consumption
• Chronic heartburn or acid reflux
• Gastroesophageal reflux disease (GERD)
• Barrett’s esophagus, a condition that sometimes develops in people with GERD
• Achalasia, a rare disorder of muscles in the lower esophagus

Symptoms of esophageal cancer

Signs and symptoms of esophageal cancer include:

• Difficulty swallowing (dysphagia)
• Weight loss without trying
• Chest pain, pressure or burning
• Worsening indigestion or heartburn
• Coughing or hoarseness

Early esophageal cancer typically causes no signs or symptoms.

Please speak with your health care provider if you are worried about any changes you are experiencing. In addition to other questions, your doctor will inquire about how long and how frequently you’ve been experiencing the symptom(s). This is to assist in determining the cause of the condition, which is referred to as a diagnosis.

If cancer is discovered, symptom relief is a critical element of cancer care and treatment. This is known as palliative or supportive care. It is frequently initiated soon after a diagnosis and continued throughout the course of treatment. Make an appointment with your health care provider to discuss your symptoms, including any new or changing symptoms.

Types of esophageal cancer

There are 2 main types of esophageal cancer:

Squamous cell carcinoma: This type of esophageal cancer starts in squamous cells that line the esophagus. It usually develops in the upper and middle part of the esophagus.

Adenocarcinoma: This type begins in the glandular tissue in the lower part of the esophagus where the esophagus and the stomach come together.

Treatment is similar for both of these types of esophageal cancer. There are other types of very rare tumors of the esophagus. These include small cell neuroendocrine cancers, lymphomas, and sarcoma and make up less than 1% of esophageal cancers.

Diagnosis of esophageal cancer

Tests and procedures used to diagnose esophageal cancer include:

• Barium swallow study. During this study, you swallow a liquid that includes barium and then undergo X-rays. The barium coats the inside of your esophagus, which then shows any changes to the tissue on the X-ray.
• Using a scope to examine your esophagus (endoscopy). During endoscopy, your doctor passes a flexible tube equipped with a video lens (videoendoscope) down your throat and into your esophagus. Using the endoscope, your doctor examines your esophagus, looking for cancer or areas of irritation.
• Collecting a sample of tissue for testing (biopsy). Your doctor may use a special scope passed down your throat into your esophagus (endoscope) to collect a sample of suspicious tissue (biopsy). The tissue sample is sent to a laboratory to look for cancer cells.

Determining the extent of the cancer

Once a diagnosis of esophageal cancer is confirmed, your doctor may recommend additional tests to determine whether your cancer has spread to your lymph nodes or to other areas of your body.

Tests may include:

• Bronchoscopy
• Endoscopic ultrasound (EUS)
• Computerized tomography (CT)
• Positron emission tomography (PET)

Your doctor will assign a stage to your cancer based on the results of these procedures. The stages of esophageal cancer are denoted by Roman numerals ranging from 0 to IV, with the lowest stages signifying that the cancer is tiny and only affects the esophagus’s surface layers. By stage IV, the cancer has spread to other parts of the body and is termed progressed.

As doctors improve cancer detection and therapy, the cancer staging system continues to evolve and become more complex. Your doctor will choose the treatments that are best for you based on your cancer stage.

Treatment of esophageal cancer

Different types of specialists frequently collaborate in cancer care to develop a patient’s overall treatment plan, which may include a variety of treatments. A multidisciplinary team is what this is referred to as. Physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counsellors, nutritionists, and other health care professionals are all part of cancer treatment teams.

The most frequent types of esophageal cancer therapies are listed below. Treatment for symptoms and side effects, which is an important element of cancer therapy, may be included in your treatment plan.

The type and stage of cancer, potential side effects, as well as the patient’s preferences and overall health, all influence treatment options and recommendations. Take the time to learn about all of your treatment options, and don’t be afraid to ask questions if you have any concerns. Discuss the aims of each treatment with your doctor, as well as what to expect during treatment. “Shared decision-making” is the term for these types of discussions. When you and your doctors work together to identify treatments that match your care objectives, this is known as shared decision-making. Because there are several treatment choices for esophageal cancer, shared decision-making is very vital. Find out more about selecting treatment choices.

Doctors frequently propose combining multiple types of treatment for a tumour that has not moved beyond the oesophagus and lymph nodes, such as radiation therapy, chemotherapy, and surgery. Chemotherapy and radiation therapy are sometimes combined in a procedure known as “chemoradiotherapy.” The order in which therapies are given varies depending on a number of circumstances, including the type of esophageal cancer.

ASCO recommends a treatment approach that incorporates multiple types of therapy for locally advanced esophageal cancer.

Chemoradiotherapy is frequently suggested as the first treatment for squamous cell carcinoma. Depending on how well the chemoradiotherapy worked, surgery may be used. According to recent studies, chemoradiotherapy before surgery is superior to surgery alone. All persons with locally advanced esophageal squamous cell cancer should get chemoradiotherapy before surgery, according to the American Society of Clinical Oncology (ASCO). This treatment may cause the cancer to go into remission in some people, and surgery may not be required right away. If tumour cells are still identified in the tissue removed during surgery after chemoradiotherapy and surgery, immunotherapy (see below) may be advised. Radiation therapy may not be an option for some persons. Before surgery, some individuals can get chemotherapy alone.

Chemoradiotherapy is the most prevalent treatment for adenocarcinoma in the United States, followed by surgery. Unless there are conditions that increase the risks of surgery, such as a patient’s overall health, surgery is almost always indicated after chemoradiotherapy. ASCO advises chemoradiotherapy before surgery or chemotherapy before and after surgery for locally advanced esophageal cancer. If tumour cells are discovered in the tissue removed during surgery after chemoradiotherapy and surgery, immunotherapy (see below) may be advised. Surgery is not an option for some people. In that circumstance, chemoradiotherapy is the only treatment option. When chemotherapy and radiation therapy are used together, the adverse effects can be more severe. However, in other cases, this treatment combination may be more successful. It’s critical to discuss which treatment options are best for you with your doctor.

Surgery to remove the cancer can be used alone or in combination with other treatments.

Operations used to treat esophageal cancer include:

• Surgery to remove very small tumors. If your cancer is very small, confined to the superficial layers of your esophagus and hasn’t spread, your surgeon may recommend removing the cancer and margin of healthy tissue that surrounds it. Surgery can be done using an endoscope passed down your throat and into your esophagus.
• Surgery to remove a portion of the esophagus (esophagectomy). During esophagectomy, the surgeon removes the portion of your esophagus that contains the cancer, along with a portion of the upper part of your stomach, and nearby lymph nodes. The remaining esophagus is reconnected to your stomach. Usually this is done by pulling the stomach up to meet the remaining esophagus.
• Surgery to remove part of your esophagus and the upper portion of your stomach (esophagogastrectomy). During esophagogastrectomy, the surgeon removes part of your esophagus, nearby lymph nodes and a larger part of your stomach. The remainder of your stomach is then pulled up and reattached to your esophagus. If necessary, part of your colon is used to help join the two.

Infection, haemorrhage, and leakage from the place where the surviving oesophagus is reattached to the stomach are all risks associated with esophageal cancer surgery.

The removal of your oesophagus can be done as an open procedure with huge incisions or through a series of small cuts in your skin with specific surgical equipment (laparoscopically). The manner in which your operation is carried out is determined by your unique circumstance and the method taken by your surgeon in dealing with it.