What is esophageal cancer?
Esophageal cancer is a form of cancer of the esophagus. Usually, it is a adenocarcinoma or squamous carcinoma of the lining of the esophagus, but rarely small cell lung carcinomas. Most tumors of the esophagus are malignant; benign tumors are the leiomyoma and gastrointestinal stromal tumor (GIST). The incidence of esophageal cancer is, in particular, over the past 10 years, strongly increasing. Treatment is with surgery in limited cases, it is possible, or with combinations of chemotherapy and radiotherapy as the tumor progressed too far for surgical treatment. The prognosis is quite poor: after five years, 10-15% of patients alive.
Epidemiology
For every 100,000 people every year 10 cases of esophageal cancer. In some parts of the world, the incidence of esophageal cancer is much higher, particularly in Asia and South America. The exact cause is unclear, but it seems that certain life habits and foods play a role.
Esophageal cancer causes and risk factors
Increased risk
There are a number of risk factors for developing esophageal cancer:
- Age: most of the patients is older than 60;
- Gender: more frequent in men;
- Heredity: more frequent in individuals with cancer occurs in the immediate family;
- Alcohol and smoking are contributing to the risk of esophageal cancer, however, the risk is greater than the individual joint risk of both (synergy).
- Gastroesophageal reflux disease (which in some cases leads to the development of Barrett's esophagus) increases the risk by the chronic irritation of the mucous membrane. In the presence of a Barrett's esophagus is the development of adenocarcinoma is more likely, while all other risk factors in the development of a squamous cell carcinoma is facilitated.
- Human papillomavirus (HPV);
- Swallowing lye or other corrosive products;
- Certain nutrient components such as nitrosamine;
- The (fast) drinking hot liquids like tea, coffee or soup almost immediately after cooking. Estimated to be between 70 to 80 degrees Celsius.
- A medical history of other head and neck cancers increases the chance of the development of new cancers in this region, including esophageal cancer;
- Plummer-Vinson syndrome (anemia and web-shaped tissue growth in the esophagus);
- Tylosis and Howel-Evans syndrome (hereditary thickening skin on the palm and sole of the foot);
- Radiation therapy for other conditions in the mediastinum;
- Celiac disease predisposes to the development of a squamous cell carcinoma;
- Obesity increases the risk of developing an adenocarcinoma by a factor of four: the increased risk of reflux in obese subjects appears to explain the association.
Reduced risk
- The risk appears to be lower in patients using aspirin or related drugs (NSAIDs);
- The existence of an infection with Helicobacter pylori seems to have a protective effect on the development of esophageal cancer. The presence of these bacteria are, however, increases the risk of developing gastric cancer;
- Fruits and vegetables may also have a protective effect (broccoli, cabbage, cauliflower);
- Moderate use of coffee is associated with a reduced risk.
Esophageal cancer symptoms
Typical symptoms are dysphagia and pain. The dysphagia is distinctive because drinking presents few problems, while hard and dry food (bread and meat) is difficult to endure; then weight loss is also common. If food can not pass through the tumor, occurs regurgitation or vomiting. The characteristic of esophageal cancer is burning pain and radiating out from the stomach dimple to the throat, although this is not always the case.
Choking occurs regularly, especially if there is also of regurgitation. This can lead to pneumonia, as the food scraps and irritate the gastric mucosa and lung bacteria from the esophagus populate the respiratory tract. This form of pneumonia (aspiration pneumonia) can be serious.
Esophageal cancer diagnosis
A slik picture is often the first examination if a patient swallowing develops. This thickening of the wall of the esophagus can show. Gastroscopy is also often carried out, this is the only way to obtain a biopsy (tissue sample). This is microscopically examined; the type of cancer is determined and the degree of invasion in the deeper tissues of the esophagus.
If a biopsy indicates that someone has esophageal cancer, it is first of all carried out a CT-scan in order to determine whether the tumor has spread (metastasis or spread) to other organs (such as the lymph nodes, lungs, liver or elsewhere). In addition, conducted an internal ultrasound of the esophagus (EUS) which metastases in lymph nodes can be accurately determined. It can also be purchased from these lymph node tissue (cytology). Together with the biopsy result determines whether it is useful to carry out an operation. Other tests that may occur are bone scan (if bone metastases are suspected on the basis of pain) and laboratory tests.
Esophageal cancer staging
The staging of a tumor is the numerical expression of the degree of progression. The TNM system is commonly used for esophageal cancer. A T code indicates the degree of expansion of the tumor itself: T1 is only the epithelial layer, T2 is the lamina propria (the underlying connective tissue), etc. The N-code indicates whether local lymph nodes are affected. The M-code, finally, if there are no metastases M0, M1 as the metastases are locally (e.g., the mediastinum), and M2 if they are located at other places in the body radius (eg the liver).
Esophageal cancer treatment
Treatment of the tumor
The most commonly used treatments for esophageal cancer are:
- surgery (surgery)
- radiation (radiotherapy)
- chemotherapy (treatment with drugs inhibiting cell division)
It is common for patients with esophageal cancer get a combination of these treatment methods. The choice and the ranking of the different treatments is depending on the characteristics of the tumor, the stage of the disease and the age at which esophageal cancer is found.
Surgery is only an option if the tumor is not ingrown in surrounding tissue (e.g. in lungs, diaphragm or aorta) and if there is no remote metastases are present. Tumor spread to lymph nodes or elsewhere "radical" (complete) surgery impossible. In the operation, the entire esophagus (including tumor) and surrounding lymph nodes removed. Of the stomach is using a "Staples device" made a tube (tube stomach), which is laid on the place where the original esophagus has located.
If surgery is performed, is then often still "adjuvant" chemotherapy, radiotherapy or a combination of these to reduce the chance of recurrence. In some cases, prior to the surgery chemotherapy or radiotherapy to shrink the tumor and surgery easier. This is called "neoadjuvant" chemotherapy.
As surgery in advance is impossible, the radical treatment performed with radiotherapy, chemotherapy or a combination ("chemoradiation"). Frequently used chemotherapy agents for this purpose are epirubicin, cisplatin and fluorouracil (5-FU). Oxaliplatin and capecitabine are also used in experimental setup and the 5-FU is given through a continuous infusion.
Supportive treatments
If the tumor normal eating and drinking impossible, is often required a feeding tube to deliver sufficient energy. If the tumor closes off the esophagus, can be a "stent" are necessary, a tubular mat that pushes aside the tumor and normal allows swallowing. Laser is sometimes used to burn away large tumors.
Patients with esophageal cancer are at greater risk of choking and often need guidance in the form of speech.