Esophageal cancer: symptoms, diagnosis, treatment and cause

Esophageal cancer is a tumor in the tissue of the esophagus. This form of cancer is very dangerous, because the disease usually has no symptoms in the early stages. The patient often only notices symptoms when the cancer has already spread. Early detection is important to adequately treat the disease.

Symptoms

  • Food does not sink properly into the esophagus
  • Less appetite
  • Decrease in weight
  • Pain near the breastbone
  • Dizziness/nausea (due to anemia)
  • Tarry/jet black poop
  • Vomiting blood
  • Constantly having hiccups

Diagnosis

If esophageal cancer is suspected, various tests can be done.

Endoscopy and blood tests

This usually starts with an endoscopy. The esophagus is then examined through a tube with a camera. Pieces of tissue can also be removed. These are viewed under a microscope to see whether there are tumor cells. Blood tests are used to determine whether the patient has anemia. If the endoscopy examination shows that there is esophageal cancer, additional tests are performed.

Ultrasound and puncture

Ultrasound is performed to see whether there are metastases in the lymph nodes in the neck and/or the liver. At the same time, a puncture can also be performed if the ultrasound identifies abnormal glands. Tissue is then removed with a hollow needle through the skin, which is then examined in the laboratory. Ultrasound is also performed in combination with an endoscopy.

CT scan and PET scan

CT scans are made to see how far the cancer has spread in the body. A PET scan identifies cancer cells by injecting radioactive sugar into the blood. Cancer cells use more sugar than normal cells. During a bronchoscopy, a tube with a camera goes into the lungs. This makes it possible to see whether there are also cancer cells there. Finally, keyhole surgery is performed if, after all examinations, it is not yet clear how far the tumor has spread into the esophagus. During keyhole surgery, the upper abdomen is mapped.

Therapy

Endoscopy and surgery

If the esophageal cancer is in the early stages, the malignant tissue can be removed via endoscopy. In most cases, surgical intervention is necessary. That can be done in different ways. The most common operation is the gastric tube surgery. The entire esophagus and the transition from the esophagus to the stomach are removed. The surgeon then turns the stomach into a tube that replaces the esophagus.

Chemoradiation and radiation

Chemoradiation is used in patients with the prospect of recovery. This is a combination of chemotherapy and radiation. Chemoradiation can cause the tumor to shrink significantly. Chemoradiation is also occasionally used in palliative patients. In esophageal patients with metastases, radiation is applied in the palliative phase. The growth of the tumor can be slowed down in this way.

Stent

If a patient has difficulty eating, a stent is placed. This is a tube that ensures that food can pass through the esophagus. This happens when the cancer prevents food from passing through the esophagus.

Prognosis

The prognosis for esophageal patients depends on the stage of the disease. One in four patients who have undergone surgery for a cure are still alive after five years. About half of people with esophageal cancer are eligible for treatment that aims for a cure, usually involving surgery and chemoradiation. In people who do not undergo surgery because the tumor has already spread far, life expectancy is not high, often less than a year.

Cause

The exact cause of esophageal cancer is unknown. There are known risk factors. These are smoking, frequent alcohol use, unhealthy eating (particularly consuming little fruit and vegetables), being too fat and heartburn. With heartburn, the acidic stomach contents flow back towards the esophagus. This can destroy the tissue in the esophagus.

Increased risk of developing esophageal cancer

Stomach acid in the esophagus often leads to esophagitis. As a result, the esophageal tissue can change, which is then referred to as Barrett’s esophagus. People with Barrett’s esophagus have an increased risk of developing esophageal cancer. This also applies to patients with achalasia. People between the ages of 60 and 70 are more likely to develop esophageal cancer than younger people. The disease is rare under the age of 50. Esophageal cancer is fairly common in countries such as China and Iran and less common in Western countries. This may be due to poisoned food.