HEALTH - ESOPHAGEAL CANCER (ESOPHAGUS) SYMPTOMS & TREATMENT
What is Esophageal Cancer?
Esophageal cancer is the eighth most common type of cancer and causes 12,000 deaths per year in the U.S. (2% of all cancer deaths). One type of esophageal cancer, adenocarcinoma, accounts for 50% of esophageal cancers and occurs primarily in Caucasian men. The incidence of adenocarcinoma and deaths from esophageal cancer have been increasing steadily in the U.S. and western Europe.
The esophagus is a 10-inch long, hollow, muscular tube that connects the throat to the stomach. When a person swallows, the walls of the esophagus contract to push food down into the stomach. Esophageal cancer (also called esophagus cancer) begins when cells in the lining of the esophagus grow uncontrollably and eventually form a tumor.
Cancer of the esophagus begins in the inner layer of the esophageal wall and grows outward. If it spreads through the esophageal wall, it can invade lymph nodes, blood vessels in the chest, and other nearby organs. If the cancer spreads outside the esophagus, it often goes to the lymph nodes first. (Lymph nodes are small, bean-shaped structures that are part of the body's immune system.) Esophageal cancer can also spread to the lungs, liver, brain, stomach, and other parts of the body.
There are two major types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma arises in squamous cells that line the esophagus. This type of cancer usually develops in the upper and middle part of the esophagus. Adenocarcinoma begins in the glandular tissue in the lower part of the esophagus at the junction between the esophagus and the stomach. Treatment is similar for both of these types.
Health: Risk Factors of Esophageal Cancer (Esophagus)
The exact causes of cancer of the esophagus are not known. However, studies show that any of the following factors can increase the risk of developing esophageal cancer:
Age. People between the ages of 45 and 70 are at greatest risk.
Gender. Men are three to four times more likely than women to develop esophageal cancer.
Race. Black people are twice as likely as white people to develop esophageal cancer.
Tobacco. Using any form of tobacco, including cigarettes, cigars, pipes, chewing tobacco and snuff, raises the risk of esophageal cancer.
Alcohol. Heavy drinking over the long term increases the health risk of squamous cell carcinoma of the esophagus, especially when combined with tobacco use.
Barrett's esophagus. This health condition can develop in some people who have chronic gastroesophageal reflux disease (GERD) or esophagitis (inflammation of the esophagus), even when a person does not experience symptoms of chronic heartburn. Damage to the lining of the esophagus causes abnormal changes in cells. People with Barrett's esophagus are more likely to develop adenocarcinoma of the esophagus.
Diet/Nutrition. A diet that is low in fruits and vegetables and certain vitamins and minerals can increase a person's risk of developing esophageal cancer.
Obesity. Being severely overweight and having excess body fat can increase a person's risk of developing esophageal adenocarcinoma.
Lye ingestion. Lye ingestion by children is associated with an increase in squamous cell carcinoma. Lye can be found in some cleansing products, such as drain cleaners.
Achalasia. Achalasia, a health condition when the lower muscular ring of the esophagus fails to relax during swallowing of food, increases the risk of squamous cell carcinoma.
Having any of these risk factors increases the likelihood that a person will develop esophageal cancer. Still, most people with one or even several of these factors do not get the disease. And most people who do get esophageal cancer have none of the known risk factors.
Identifying factors that increase a person's chances of developing esophageal cancer is the first step toward preventing the disease. We already know that the best ways to prevent this type of cancer are to quit (or never start) smoking cigarettes or using smokeless tobacco and to drink alcohol only in moderation. Researchers continue to study the causes of esophageal cancer and to search for other ways to prevent it. For example, they are exploring the possibility that increasing one's intake of fruits and vegetables, especially raw ones, may reduce the risk of this disease.
Researchers are also studying ways to reduce the risk of esophageal cancer for people with Barrett's esophagus.
Health: Symptoms of Esophageal Cancer (Esophagus)
People with esophageal cancer may experience the following symptoms. Sometimes, people with esophageal cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about symptoms on this list, please talk with your doctor or health care provider.
- Difficulty and pain with swallowing, particularly when eating meat,
bread, or raw vegetables (As the tumor grows, it can block the pathway
to the stomach. Even liquid may be painful to swallow.)
- Pressure or burning in the chest
- Indigestion or heartburn
- Vomiting
- Frequent choking on food
- Unexplained weight loss
- Coughing or hoarseness
- Pain behind the breastbone or in the throat
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Health: Diagnosis of Esophageal Cancer (Esophagus)
Routine screening tests to detect early esophageal cancer are not used in the United States. People with Barrett's esophagus may be advised to have endoscopic examinations (looking inside the esophagus through a flexible, lighted tube) and biopsies (removal of a small amount of tissue for examination under a microscope) on a regular basis to help detect cancer early.
In addition to a physical examination, the following tests may be used to diagnose esophageal cancer:
Barium swallow (also called an esophagram). The patient swallows a liquid containing barium and then a series of x-rays (pictures of the inside of the body) are taken. Barium coats the surface of the esophagus, making tumors or other abnormalities easier to see on the x-ray. If there is an abnormality, doctors may order an upper endoscopy and biopsy to determine if cancer is present.
Upper endoscopy (also called esophagus-gastric-duodenoscopy, or EGD). This test allows the doctor to see the lining of the esophagus. A thin, flexible tube with a light and video camera on the end, called an endoscope, is passed down the throat and into the esophagus. If an abnormality is found, a biopsy will be performed to determine if it is noncancerous or cancerous. An endoscopy can also help expand the blocked area, so that food can temporarily pass through until treatment can begin.
Endoscopic ultrasound. This procedure is often done at the same time as the upper endoscopy. During an ultrasound, sound waves provide a picture of structures inside the body. During an endoscopic ultrasound, a transducer (the machine that produces the sound waves) is inserted into the esophagus through the mouth. The ultrasound can identify if the tumor invades the wall of the esophagus, how deep the tumor is, and whether lymph nodes are involved.
Bronchoscopy. Similar to an upper endoscopy, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the windpipe, and into the breathing passages of the lungs. A bronchoscopy may be performed if a patient’s tumor is located in the upper two-thirds of the esophagus to determine if the tumor is invading the person’s airway, including the trachea (windpipe) and bronchial tree (area where the windpipe branches out into the lungs).
Biopsy. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The tissue sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better details health wise.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.
Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images.
Health: Staging of Esophageal Cancer (Esophagus)
If the diagnosis is esophageal cancer, the doctor needs to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. Knowing the stage of the disease helps the doctor plan treatment. Listed below are descriptions of the four stages of esophageal cancer.
- Stage I. The cancer is found only in the top layers of cells lining the esophagus.
- Stage II. The cancer involves deeper layers of the lining of the esophagus, or it has spread to nearby lymph nodes. The cancer has not spread to other parts of the body.
- Stage III. The cancer has invaded more deeply into the wall of the esophagus or has spread to tissues or lymph nodes near the esophagus. It has not spread to other parts of the body.
- Stage IV. The cancer has spread to other parts of the body. Esophageal cancer can spread almost anywhere in the body, including the liver, lungs, brain, and bones.
Some tests used to determine whether the cancer has spread include:
- Cat (CT) scan (computed tomography). A computer linked to an x-ray machine creates a series of detailed pictures of areas inside the body.
- Bone scan. This technique, which creates images of bones on a computer screen or on film, can show whether cancer has spread to the bones. A small amount of radioactive substance is injected into a vein; it travels through the bloodstream, and collects in the bones, especially in areas of abnormal bone growth. An instrument called a scanner measures the radioactivity levels in these areas.
- Bronchoscopy. The doctor puts a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the windpipe to look into the breathing passages.
Natural Alternative Treatment: NATURAL CANCER TREATMENT
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Health: Conventional Treatment for Esophageal Cancer (Esophagus)
Treatment for esophageal cancer depends on a number of factors, including the size, location, and extent of the tumor, and the general health of the patient. Patients are often treated by a team of specialists, which may include a gastroenterologist (a doctor who specializes in diagnosing and treating disorders of the digestive system), surgeon (a doctor who specializes in removing or repairing parts of the body), medical oncologist (a doctor who specializes in treating cancer), and radiation oncologist (a doctor who specializes in using radiation to treat cancer). Because cancer treatment may make the mouth sensitive and at risk for infection, doctors often advise patients with esophageal cancer to see a dentist for a dental exam and treatment before cancer treatment begins.
Many different treatments and combinations of treatments may be used to control the cancer and/or to improve the patient's quality of life by reducing symptoms.
Surgery
Surgery has traditionally been the most common treatment for esophageal cancer. A doctor may remove the esophagus in an operation called an esophagectomy and then connect the remaining healthy part of the esophagus to the stomach, so the patient can swallow normally. The stomach or part of the intestine may sometimes be used to make the connection. The doctor also removes lymph nodes around the esophagus.
If the surgeon cannot remove the entire tumor, a combination of chemotherapy (see below) and radiation therapy (see below) may be used before surgery to shrink the tumor. For people who cannot undergo surgery, the best treatment option is often a combination of chemotherapy and radiation therapy.
To help patients eat and relieve symptoms caused by the cancer, surgeons can also:
- Put in a percutaneous gastrostomy or jejunostomy (also called a
feeding tube), so a person can receive nutrition directly into the
stomach or intestine. This may be done before chemotherapy and
radiation therapy is given to ensure that the patient can eat enough
food to maintain his or her weight and strength during treatment.
- Dilate (expand) the esophagus (this procedure may have to be repeated if the tumor grows)
- Put an esophageal stent into the esophagus. An esophageal stent is
a metal, mesh device that is expanded to keep the esophagus open.
- Use photodynamic therapy (lasers or light therapy; see below) to destroy cancerous tissue and relieve blockages
- Create a bypass, or new pathway, to the stomach (if a tumor blocks the esophagus but cannot be removed); this procedure is rarely used.
People who have had trouble eating and drinking may need intravenous (IV) feedings and fluids for several days before and after the operation, as well as antibiotics to prevent or treat infection. Patients learn special coughing and breathing exercises to keep their lungs clear.
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation treatment is given directly inside the body, it is called internal radiation therapy or brachytherapy. For esophageal cancer, this involves temporarily inserting a radioactive wire into the esophagus using an endoscope.
Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.
Photodynamic therapy
Photodynamic therapy is used to make swallowing easier, especially for people who cannot, or choose not, to have surgery, radiation therapy, or chemotherapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor and stays longer in cancer cells than in normal cells. A laser is directed at the tumor, destroying the cancer cells. Although photodynamic therapy may relieve swallowing problems for a brief period, it does not cure esophageal cancer.
Laser therapy
Laser therapy is the use of high-intensity light to destroy tumor cells. Laser therapy affects the cells only in the treated area. The doctor may use laser therapy to destroy cancerous tissue and relieve a blockage in the esophagus when the cancer cannot be removed by surgery. The relief of a blockage can help to reduce symptoms, especially swallowing problems.
Advanced and recurrent esophageal cancer
Cancer of the esophagus is most successfully treated when it is found in the earliest stages, before it has spread. However, since early esophageal cancer causes few symptoms, it is usually advanced at the time of the diagnosis. In advanced or recurrent esophageal cancer, the goal of treatment is usually to prolong life, while relieving symptoms such as pain and problems with eating.
Treatment for advanced esophageal cancer usually involves chemotherapy. Radiation therapy can help relieve pain or discomfort. An esophageal stent, laser therapy, or photodynamic therapy may help keep the esophagus open.
Health: Prevention of Esophageal Cancer (Esophagus)
Although it's not possible to prevent all cases of esophageal cancer, the following lifestyle changes can greatly reduce your health risk:
- Quit smoking. This may be the single most important thing you can do to prevent esophageal cancer and improve your overall health. Cigarette smoke contains carcinogens that can damage the DNA that regulates cell growth and is a leading cause of gastroesophageal reflux. Talk to your doctor about the best ways to quit, or contact the American Cancer Society for more information.
- Limit alcohol consumption. Many esophageal squamous cell carcinomas and adenocarcinomas result from heavy alcohol consumption over a period of years. Abstaining from alcohol or drinking in moderation — no more than one drink daily for women or two drinks daily for men — can greatly reduce your health risk of this type of esophageal cancer.
- Get help for heartburn. Don't ignore severe or frequent heartburn. Your doctor can recommend medications and lifestyle changes that can help prevent gastric reflux. Sometimes drugs that inhibit acid formation may provide the relief you need. You may also be helped by waiting at least two to three hours after eating before lying down or exercising, and by elevating the head of your bed.
- Eat a healthy diet. Eating more fruits and vegetables may help protect against esophageal cancer. Aim for at least five fruits and vegetables daily. Choose whole-grain foods over processed or refined grain products. Limit the amount of red meat and processed meats that you consume.
- Maintain a healthy weight. Being significantly overweight (obese) increases your risk of esophageal cancer as well as your risk of other serious health problems, such as diabetes, cardiovascular disease and stroke. Slow and steady weight loss of 1 or 2 pounds a week is considered the safest way to lose weight and keep it off. In many cases, you can lose weight by committing to eating a healthier diet, exercising and changing unhealthy behaviors.
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Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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