Do You Know What Esophageal Cancer Is?

Esophageal cancer, originating in the tube from throat to stomach, is a serious yet less-discussed cancer type. Understanding its risks, symptoms, and treatments is crucial, as it’s aggressive and hard to diagnose early.

Understanding Esophageal Cancer

The esophagus is a hollow muscular tube that helps to move food and liquids from the throat to the stomach. Esophageal cancer typically starts in the cells lining the inside of the esophagus and can occur anywhere along its length. There are two main types of esophageal cancer, categorized based on the type of cells that are involved:

1. Adenocarcinoma: This type usually begins in the cells of mucus-secreting glands in the esophagus. It most commonly affects the lower part of the esophagus and is the most prevalent type in the Western world, closely linked to Barrett’s esophagus, a condition often caused by chronic acid reflux.
2. Squamous Cell Carcinoma: This type originates in the flat, thin cells that line the surface of the esophagus. This variant is more commonly seen in the upper and middle parts of the esophagus and is the most prevalent form worldwide.

Risk Factors

Several factors may increase the risk of developing esophageal cancer:

• Chronic gastroesophageal reflux disease (GERD): Long-standing acid reflux can lead to changes in the lining of the esophagus, which can increase cancer risk.
• Smoking and Alcohol Consumption: Both are significant risk factors, especially when combined.
• Obesity: Excess body weight can increase the risk of adenocarcinoma of the esophagus.
• Diet: A diet lacking fruits and vegetables can increase the risk of esophageal cancer.
• Age: Esophageal cancer is more commonly diagnosed in people aged 55 and older.

Risk Factors for Esophageal Cancer

Early Signs of Esophageal Cancer

1. Difficulty Swallowing (Dysphagia)
   • One of the earliest signs of esophageal cancer is a feeling of difficulty swallowing or the sensation that food is sticking in your throat or chest. Initially, it might occur only with solid foods, but as the tumor grows, even liquids can become hard to swallow.
2. Changes in Appetite
   • Some people may experience a decrease in appetite or a change in their eating habits without a known cause.
3. Mild Chest Pain or Discomfort
   • Discomfort or pain in the chest, not necessarily severe, which can be mistaken for heartburn or indigestion.
4. Weight Loss
   • Unintentional weight loss without changes in diet or exercise habits can be an early indicator, often because swallowing difficulties lead to eating less.
5. Heartburn or Indigestion
   • Increases in episodes of heartburn or indigestion can be early symptoms, especially if they become progressively worse or are resistant to over-the-counter treatments.
6. Persistent Cough or Hoarseness
   • A cough that doesn’t go away or a hoarse voice might suggest compression or irritation of the esophagus by a tumor, or that the tumor is affecting the laryngeal nerves.

Symptoms of Esophageal Cancer

1. Dysphagia (Difficulty Swallowing):
   • One of the most common symptoms, dysphagia, occurs when the tumor grows large enough to obstruct the passage of food through the esophagus. This may initially manifest as difficulty swallowing solid foods and progress to difficulties with softer foods and liquids.
2. Weight Loss:
   • Unintended weight loss is a common symptom and can be a direct result of dysphagia, as individuals eat less due to difficulty swallowing. It may also result from a decreased appetite or the body’s increased energy expenditure from fighting the cancer.
3. Chest Pain or Discomfort:
   • Pain in the chest, back, or throat that is not related to eating can be a symptom of esophageal cancer. The pain might be persistent or intermittent.
4. Persistent Cough or Hoarseness:
   • A tumor in the esophagus can irritate the esophagus or compress surrounding tissues and organs, leading to a chronic cough or changes in voice, including hoarseness.
5. Regurgitation of Food and Saliva:
   • As the tumor obstructs the esophagus, it can cause food and saliva to back up into the throat, leading to regurgitation. This can sometimes be mistaken for severe heartburn or gastroesophageal reflux disease (GERD).

Symptoms of Esophageal Cancer

When to See a Doctor

If you experience any of these symptoms persistently, especially if you have risk factors such as long-standing acid reflux, smoking, heavy alcohol use, or a family history of gastrointestinal cancers, it’s important to consult a healthcare provider. They might recommend an endoscopy or other diagnostic tests to investigate the cause of your symptoms.

Early detection of esophageal cancer is crucial for effective treatment and can significantly improve the prognosis. If diagnosed early, treatment options like surgery, radiation, and chemotherapy can be more effective in managing the disease.

Diagnosis and Treatment

Diagnosis typically involves a combination of endoscopy, where a thin tube with a camera is inserted down the throat to look at the esophagus, and a biopsy, where a sample of tissue is taken for lab testing.

1. Surgery:
   • Esophagectomy: The most direct treatment for localized esophageal cancer, where all or part of the esophagus is removed, often including nearby lymph nodes. Depending on the location and extent of the tumor, part of the stomach may also be used to reconstruct the esophagus.
   • Endoscopic Mucosal Resection (EMR): Used for very early-stage cancers, this procedure involves removing the tumor and a margin of healthy tissue through an endoscope.
2. Radiation Therapy:
   • Often used in combination with chemotherapy (chemoradiotherapy), radiation therapy involves targeting the affected area with high-energy beams to destroy cancer cells. It’s commonly applied before surgery to shrink tumors or afterward to eliminate any remaining cancer cells. It can also be a standalone treatment for patients who are not candidates for surgery.
3. Chemotherapy:
   • Chemotherapy uses drugs to kill cancer cells and is typically given systemically to affect cancer cells throughout the body. It may be administered before surgery to shrink tumors (neoadjuvant chemotherapy) or after to kill any lingering cancer cells (adjuvant chemotherapy). For advanced cancer, chemotherapy might be used to relieve symptoms and extend life.
4. Targeted Therapy:
   • This treatment involves drugs or other substances that specifically target cancer cells without harming normal cells. Targeted therapies can be used in people whose tumors have specific genetic mutations. For example, the drug trastuzumab is used for tumors that overexpress the HER2 protein.
5. Immunotherapy:
   • Immunotherapy helps to boost or restore the immune system’s ability to fight cancer. Drugs like pembrolizumab are used for advanced esophageal cancer that has progressed during or after chemotherapy. These treatments are often reserved for cases where the cancer has specific characteristics that make it likely to respond to this type of therapy.

Prevention and Outlook

While not all cases of esophageal cancer can be prevented, reducing risk is possible by managing acid reflux, quitting smoking, reducing alcohol consumption, maintaining a healthy weight, and eating a balanced diet rich in fruits and vegetables.

The prognosis for esophageal cancer depends on the cancer’s stage at diagnosis. Early detection is key, which is why recognizing symptoms and managing risk factors is crucial.

Conclusion

Esophageal cancer is a challenging and serious disease, but awareness and understanding can improve early detection and outcomes. If you or someone you know is experiencing any of the symptoms mentioned above, consult a healthcare provider. Regular check-ups and managing risk factors are the best defenses against this formidable cancer.

References for Further Reading

1. www.cancer.org/cancer/esophageal-cancer
2. www.mayoclinic.org/diseases-conditions/esophageal-cancer
3. www.ncbi.nlm.nih.gov/pmc/articles/PMC5554451