Oesophageal Cancer- Overview, Causes, Symptoms, Diagnosis, Treatment

Dr Rudra Acharya is a highly qualified and experienced cancer specialist to treat esophageal cancer. Below is all needed to know about its causes, symptoms, diagnosis and treatment.

Esophageal Cancer

Your oesophagus refers to a hollow muscular tube that moves food to your stomach from your throat. Esophageal cancer may happen when esophageal lining develops a malignant (noncancerous) tumour anywhere along the length. While growing, it may turn cancerous, harming the esophageal muscles and deep tissues.

Below are the 2 usual types of esophageal cancer:

• Squamous cell carcinoma
  It happens when the thin, flat cells of your esophageal lining develop cancer. It generally occurs in the middle or top of your oesophagus or sometimes, anywhere else.
• Adenocarcinoma
  It happens when the esophageal glandular cells which produce fluids like mucus develop cancer. It mostly occurs in your lower oesophagus.

Esophageal Cancer Causes

The precise esophageal cancer causes are unknown, like many other cancers. It’s assumed to be associated with DNA mutations of your esophageal cells. This signals cellular multiplication faster than usual. It also impairs the signal for the timely death of these cells. This leads to their accumulation and formation of tumours.

Despite uncertain esophageal cancer causes, there are the following definite risk factors:

• Being overweight
• Possessing a reflux issue like GERD (gastroesophageal reflux disorder)
• Smoking
• Consuming alcohol
• Not having adequate fruits and veggies
• Possessing Barrett’s oesophagus (marked by a diseased esophageal lining because of GERD)
• Possessing achalasia (where the muscle at your esophageal bottom cannot relax enough)

Individuals at pronounced risk of this cancer are:

• Men who are thrice more probable to have esophageal cancer than women
• Those older than 45 as the risks of this cancer heightens with age

Esophageal Cancer Symptoms

In the initial stages of this cancer, you might not develop any signs. However, with the progression of the condition, you may have the following esophageal cancer symptoms:

• Hiccups
• Chronic cough
• Fatigue
• Chest pain
• Food returning up your oesophagus
• Vomiting
• Often choking while eating
• Trouble or pain when swallowing
• Heartburn
• Indigestion
• Sudden weight loss
• Esophageal bleeding in extreme cases

Esophageal Cancer Stages

Esophageal cancer stages are numbered in the increasing order according to the cancer progression as follows:

• Stage 0
  Here, abnormal malignant cells are found only in the cells of the esophageal lining.
• Stage I
  Here, cancerous cells are discovered only in the cells of the esophageal lining.
• Stage II
  Here, cancer has advanced to the external wall or muscle layer of your oesophagus. Moreover, cancer might have advanced to 1-2 adjacent lymph nodes.
• Stage III
  Here, cancer has progressed deeper into your connective tissue wall or your internal muscle layer. It might have progressed beyond your oesophagus to the nearby organs or other nearby lymph nodes.
• Stage IV
  It involves the most advanced stage. Here, your cancer has metastasised to other parts of your body or other lymph nodes distant from your oesophagus.

Many tests are there for ascertaining your esophageal cancer stage. These are:

• Chest X-ray
• Bronchoscopy where the doctor employs a bronchoscope to check your airways and trachea. The lighted, thin tube is put through your mouth or nose. This process can determine cancer presence in your airways or trachea.
• CT scan which takes precise images of the interior of your body.
• Endosonography or endoscopic ultrasound performed during endoscopy. Here, sound waves are reflected off your body parts for producing images called sonograms. This method can give better information regarding the extent and size of your tumour.
• Thoracoscopy where an endoscope is inserted into your chest via a cut for analysing the chest’s interior to check for chest organs and surrounding lymph nodes where your cancer might have metastasised. Biopsies can accompany this method.
• Laparoscopy in which a lighted laparoscope is put via an incision in your abdomen for checking your abdominal organs and obtaining tissue samples to detect cancer metastasis.

Diagnosis

Various test procedures are available to diagnose esophageal cancer depending on your esophageal cancer symptoms and stage. The tests are as follows:

• Endoscopy
  It refers to the employment of a tool having a camera linked with a tube which passes down the throat and lets the doctor observe your esophageal lining for checking for any irritation or irregularities.
• Barium swallow
  It involves an X-ray imaging test which permits the doctor to view your esophageal lining. For doing this, you have to swallow barium while the doctor will procure the images.
• Biopsy
  It involves a method where the doctor takes out a sample of your suspicious tissue using an endoscope and sends it to the laboratory to be tested.
• Imaging tests
  An MRI, PET scan or CT scan may be performed to determine if your cancer has metastasised to other organs of your body.

Treatment

Based on your esophageal cancer symptoms, the doctor will recommend the most appropriate treatment option suitable for your specific case. He might suggest surgery if your cancer has not yet metastasised to your other body parts. Otherwise, the doctor may suggest radiation therapy or chemotherapy as the optimal course of action. These procedures are also carried out, at times, for shrinking tumours in your oesophagus in order that they can be surgically eliminated more conveniently.

Esophageal Cancer Surgery

If your cancer is small and has not metastasised, the doctor can rid you of your tumour with the help of a minimally invasive method, via multiple tiny incisions and an endoscope.

In the usual approach, the surgeon makes a larger incision for eliminating a part of your oesophagus and at times, the surrounding lymph nodes. The surgeon will rebuild your oesophagus obtaining tissue from your large intestine or stomach.

In potential cases, a section of the top of your stomach will also be taken away.

There can be certain surgical risks or complications like:

• Leakages, bleeding and/or pain in the region where the reconstructed oesophagus is connected to your stomach
• Infection
• Heartburn
• Nausea
• Swallowing issues
• Lung complications

Chemotherapy

It refers to the employment of medications for attacking cancer cells. It might be performed preceding or following the surgery. At times, it is coupled with radiation therapy.

Chemotherapy has several possible side effects. Most of them happen as chemotherapy medications also destroy healthy cells. The side effects will vary with the drugs recommended by your doctor. Such adverse effects are:

• Neuropathy
• Pain
• Fatigue
• Vomiting
• Nausea
• Hair loss

Radiation Therapy

This process employs radiation beams for destroying cancer cells. The doctor may administer it externally using a machine or internally using an apparatus put close to your tumour (during brachytherapy).

Radiation is usually done together with chemotherapy. The side effects are commonly more serious when combination therapy is performed. The adverse effects of radiation can be:

• Painful ulcers in your esophageal lining
• Fatigue
• Trouble or pain when swallowing
• Skin which appears sunburnt

You may probably undergo specific side effects of the approach long after treatment is over. These might be esophageal stricture in which your esophageal tissue loses flexibility and results in the narrowing of your oesophagus, causing pain or difficulty in swallowing.

Targeted Therapy

They can target particular proteins on your cancer cells in a manner of threatening your cancer. A small part of cancer can be cured with Trastuzumab which targets HER2 protein on your cancer cell surface. Besides, cancers can advance by producing new blood vessels. Ramucirumab, a form of targeted procedure which joins monoclonal antibodies with VGEF protein that aids in new blood vessel creation.

Other Treatments

If the oesophagus is blocked due to cancer, the doctor might implant one stent into the organ for keeping it open.

Photodynamic therapy may also be done where your tumour is injected with a photosensitive medication for attacking the tumour with light exposure.

Immunotherapy is another treatment option. It stimulates your immune system for attacking cancer cells.

Electrocoagulation, another alternative, employs electric current for destroying cancer cells.

Cryotherapy may also be performed for freezing cancer cells to aid in tumour shrinkage.

Stage-wise esophageal cancer treatment includes:

• For stage 0
  – Surgery
  – Endoscopic mucosal resection
  – Radiofrequency ablation
  – Photodynamic therapy
• For stages I, II, III
  – Chemotherapy
  – Radiation therapy
  – Surgery
• For stage IV
  – Radiation therapy
  – Chemotherapy
  – Immunotherapy
  – Targeted therapy
  – Palliative therapy (for relieving the associated pain and swallowing trouble)

FAQ

How curable is the cancer of the oesophagus?

Usually, esophageal cancer can be treated. However, unfortunately, the issue is rarely curable. The generic survival rate on a 5-year basis manageable with specific treatment is around 5-30%. Rarely, a patient with a very early stage possesses a higher probability of survival.

What is the main cause of esophageal cancer?

The primary cause of esophageal cancer is GERD (gastroesophageal reflux disorder) and also smoking. GERD refers to a chronic digestive issue where your bile or stomach acid can irritate your esophageal lining by flowing into the tube. It is generally indicated by heartburn and acid reflux more than twice every week. Smoking can trigger squamous cell esophageal cancer. Besides, Barrett’s oesophagus is also a serious cause associated with adenocarcinoma.

How aggressive is esophageal cancer?

The aggressiveness of esophageal cancer has reached the extent that it can deteriorate your quality of life and is usually fatal also. The liquids and foods that you consume will fail to pass through the oesophagus as it will be blocked by cancer. In potential stages, if untreated, you will experience esophageal bleeding as a critical esophageal cancer symptom.

What were your first symptoms of esophageal cancer?

The initial esophageal cancer symptoms might include:

• Hoarseness or coughing
• Heartburn
• Worsening indigestion
• Chest pain
• Unexplained weight loss
• Difficulty swallowing

These early esophageal cancer symptoms will be experienced only in the preliminary stages of the disorder.