Causes and risk factors
The cells undergo an abnormal and uncontrolled proliferation and eventually these clusters of cells lead to formation of tumor or mass in the lining of the esophagus or its lumen. What causes this abnormal growth is still a mystery. However, tedious research and study of various cases have laid down certain risk factors which can predispose a person to cancer. Genetic factors head the list. Many cancers are caused due to certain abnormality or mutation in the genes, which stimulate the cells to undergo an abnormal proliferation. Certain inherited conditions like tylosis; Plummer-Vinson syndrome increases the risk for esophageal cancer. History of achalasia has been reported while those suffering from gastroesophageal reflux are more vulnerable especially to adenocarcinoma. Dysplasia commonly seen in Barrett’s esophagus is considered as a precancerous condition. Use of cigars, tobacco, and tobacco products along with some dietary factors like excessive intake of processed meat and a habit of drinking very hot liquid along with alcohol intake are considered as major risk factors for the development of cancer. People with weak immune system and those who are obese may add up to the risk factors.
Clinical presentation:
Indolent growths of abnormal cells in its initial stage do not pose any noticeable signs and symptom in the body hence the patient remains asymptomatic for a long period. Over a period of time though, the patient can come up with other health issues. On most of the occasions, the patient usually comes up with vague symptoms like bodyache, fatigue, and tenderness all over the body. A noticeable change in weight is complained by the patient or is brought into notice by the loved ones. Difficulty in swallowing is the foremost symptom seen. The patient feels as if the food is choking or stuck. Increased salivation is seen. Sensation of burning or pressure in the chest is seen. Vomiting, hoarseness of voice, hiccups, and chronic cough are the other associated symptoms. Esophageal bleeding can also occur, which can either be coughed up or passed to the digestive system resulting in bloody stools. Metastasis can lead to various other symptoms pertaining to that system or organ.
Investigations:
Taking into consideration the complaints mentioned by the patient, a physical examination of the patient is carried out. Accordingly, certain set of investigations are advised. Barium x-ray, upper endoscopy, bronchoscopy, or CT scan of abdomen are done. If any abnormal growth or mass is detected, a biopsy is done which will help to differentiate between the benign and neoplastic cells. If the cancerous growth is confirmed, certain other set of investigations like routine blood test and blood markers for cancer are diagnostic. A complete scan (PET scan) is the most essential investigation tool mandatorily advised in all cancerous conditions.
Treatment:
Staging of cancer, (i.e., advancement and spread of pathology) is the essential tool for formulating the treatment plan. If any abnormal mass is detected, surgical excision of the tumor along with removal of the cancerous part of esophagus (esophagectomy) is done. In patients who have difficulty in swallowing, esophageal stent is inserted. Radiation treatment along with administration of chemotherapeutic agents is done as a palliative treatment method.
