Causative & risk factors
Suffering from gastroesophageal reflux disease (GERD) or Barrett’s esophagus are associated with a high risk of developing esophageal cancer. Using tobacco, smoking and excessive alcohol intake are also major risk factors for cancer of the esophagus. Esophageal cancer is seen to occur more commonly in males, people of advanced age and certain races like African-Americans.
Clinical presentation
In the initial stages of esophageal cancer, there are usually no symptoms. As the cancer goes on advancing, symptoms start becoming apparent. The patient invariably finds it difficult to swallow i.e. dysphagia. Dysphagia is the cardinal symptom of esophageal cancer. He may show symptoms of indigestion and start losing weight. Hoarseness, coughing or chest pain may be present.
Investigations
Barium swallow is performed in which a liquid containing radioactive material is consumed by the patient and X-rays are taken.
An ultrasound or CT scan of the esophagus is performed to visualize the tumor. Esophageal endoscopy is performed to visualize the cancerous cells and biopsy samples are taken. Endoscopic procedures such as bronchoscopy, thoracoscopy and laryngoscopy may be carried out to determine the extent of spread of the tumor. Other investigations include X-ray of the chest and laparoscopy are performed if necessary.
Esophageal cancer is staged as follows:
Stage 0 and 1 – Cancer cells are found only in the layer of cells that line the esophagus.
Stage II – Cancer cells are found in the outer muscle layer of the esophagus. Stage III – Cancer cells have spread into the inner muscle layer of the esophagus. Regional lymph nodes and surrounding organs may also be involved.
Stage IV – Cancer has metastasized to other body organs and faraway lymph nodes.
Treatment
Treatment for esophageal cancer will depend upon its stage and the age and health status of the patient. Treatment usually involves a combination of surgery, radiation and chemotherapy.
Other treatment measures include the use of lasers, electrocoagulation and radiofrequency ablation.
In inoperable cases, a conservative procedure is performed to dilate the esophagus; it is known as esophageal stenting.
Recent updates
A recent study unearthed that people with Barrett’s esophagus who also have diabetes, have a doubled risk of developing esophageal cancer.
