The esophagus is a hollow, muscular tube that connects the mouth and throat to the stomach. Esophageal cancer is when a malignant tumor develops in the esophagus. FITBOOK reveals what you should know regarding the disease.
The esophagus is regarding 25 centimeters long and transports the chyme into the stomach via wave-like movements. It lies behind the trachea, runs through the diaphragm in its lower part, then opens into the stomach and is lined with a mucous membrane. When cells change in the lining of the esophagus, tumors develop that can spread to the deeper tissues of the esophagus. Symptoms of esophageal cancer usually only become apparent when the disease is very advanced.
What symptoms can indicate esophageal cancer?
In the early stages of the disease, esophageal cancer usually does not manifest itself at all or with hardly noticeable symptoms. In later stages, when the cancer has continued to grow, there may be signs such as:1,2
- unwanted weight loss
- indigestion
- heartburn
- Pain or difficulty swallowing
- frequent choking while eating
- Vomit
- Food coming back up the esophagus
- hiccup
- chest pain
- fatigue
- chronic cough
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What causes esophageal cancer?
As with many types of cancer, the exact causes of the disease have not yet been clearly clarified. Basically, cancer is caused by DNA changes. When certain cells multiply uncontrollably due to altered DNA, tumors form. Oncogenes are genes that help cells divide and stay alive. Tumor suppressor genes, in turn, ensure that cell division is kept under control and that it dies off at the right time. In cancer, there may be mutations in the DNA that activate oncogenes and turn off tumor suppressor genes. In esophageal cancer cells, the DNA shows changes in many different genes, although it is not clear to what extent there are specific gene changes found in most or all esophageal cancers.3
What are the risk factors for the disease?
To date, several factors have been identified that are associated with an increased risk of developing esophageal cancer. The most important factor in the cancer is the persistent reflux of stomach acid into the lower part of the esophagus. The constant irritation caused by the acid can lead to changes in the mucous membrane, which is considered a precursor to esophageal cancer Barrett’s esophagus. Risk factors for developing esophageal cancer also include:
- chronic heartburn
- Smoking
- high alcohol consumption
- overweight
- Consumption of very hot drinksi.e. hotter than 65 degrees
- partial closure to the entrance of the stomach
- Radiation in the neck and chest area
- Tumors in the mouth and throat
- Acid or lung burns of the esophagus
- Injuries to the esophagus
Although the risk factors potentially increase the likelihood of developing the disease, even very healthy people can develop the disease due to a genetic error.4,5
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How is esophageal cancer diagnosed?
As soon as you are struggling with these symptoms of esophageal cancer, you should see a doctor. He then asks regarding possible complaints, lifestyle and his own and, if necessary, family health history. In addition, a physical examination is carried out, during which, among other things, the lymph nodes are palpated. As a rule, if a disease in the digestive tract is suspected, the family doctor then sends it to a gastroenterologist.
Imaging procedures are then used during the examination by the gastroenterologist. An esophagoscopy, i.e. an esophageal endoscopy, in which a small camera is inserted through the mouth into the esophagus with a tube, is an option. The attending doctor can see on a screen what the esophagus looks like and whether or where it is narrowed. Tissue samples are then taken from conspicuous areas along the esophagus, which are then examined. With the help of an endosonography, in which an ultrasound probe is inserted into the esophagus, one can determine how far and whether the cancer has penetrated into other tissue layers and which areas are exactly affected. Computed tomography (CT) or magnetic resonance imaging (MRI) may also be performed to determine the spread of the cancer.6,7
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How is esophageal cancer treated?
Depending on how far the cancer has progressed, where exactly it has spread and how big it is, there are different therapeutic approaches that can also be combined. Surgery, radiation, or chemotherapy are usually options. If the cancer is discovered in time, the tumor tissue can be completely removed by surgery. The extent of the operation depends on the location and size of the tumor. It is often necessary to remove part of the esophagus so that the tumor can be completely removed.
Radiation therapy aims to destroy cancer cells. The therapeutic approach is often combined with chemotherapy. If the esophageal cancer has progressed so far that treatment no longer promises to cure or regress the tumor, palliative care is used to try to control the tumor-related symptoms. Even if there are problems with swallowing, eating and drinking, palliative care in the form of a feeding tube and/or an infusion system for feeding can help the patient. In any case, the therapy must be individually tailored to the patient.8,9
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frequency and forecasts
Esophageal cancer is a relatively rare cancer. In 2018, regarding 1,800 women and 5,700 men developed the cancer. Due to the often late diagnosis, the chances of survival are unfavorable. Females have a relative 5-year survival rate of 24 percent, males 26 percent. The 10-year survival rate is 21 percent for both men and women. 43 percent of the diseases are squamous cell carcinomas, that is, tumors occurring in the upper and middle part. And at 47 percent around Adenocarcinomathe cell changes occurring in the lower third in the transition to the stomach.10
What regarding prevention?
Although there are certain risk factors associated with developing esophageal cancer, the disease occurs in healthy people who have not had any symptoms until they are diagnosed. There is not necessarily a rule for the prevention of oesophageal cancer.
Basically, it is recommended to maintain a healthy lifestyle. Smoking, drinking excessively, and eating an unhealthy diet not only increase your risk of esophageal cancer, but also your chances of developing a variety of other diseases and cancers. Anyone who has persistent symptoms that might indicate a disease of the stomach or esophagus should consult a doctor.
