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Cancer of the esophagus Causes and Treatment

The esophageal cancer affects muscle tube (2 cm to 3 cm in diameter and 25 cm to 30 cm in length) connecting the larynx (throat) to the stomach. Once swallowed, the food enters the esophagus and descends to the stomach, driven by gravity and pushed by the contraction of the muscles of its wall. The entrance and exit of the esophagus are closed by muscular rings that open and close to handle the passage of food. These are the oesophageal sphincters . If the sphincter at the entrance to the stomach does not function well, gastroesophageal reflux may occur. As the liquid rising in the esophagus is acidic, it irritates its wall. This chronic irritation of the esophagus is a well-known factor in esophageal clearance, although there are other risk factors.

The esophageal cancer is a malignant tumor in the tissue of the wall of the esophagus. There are two main types.

Types of esophageal cancer

  • The squamous cell carcinoma relates to the cells lining the inner wall of the esophagus (squamous cells). It usually reaches the upper part of the esophagus.
  • The adenocarcinoma appears more often in the lower part of the esophagus. It concerns the glandular cells that make and secrete mucus and other liquids that contribute to digestion.

The esophageal cancer is a rare cancer in Canada: it represents less than 1% of all cancer cases. But, it can be serious because it is often diagnosed at an advanced stage. Early detection measures for people at risk can make a big difference. According to the Cancer League, esophageal cancer affects around 5,000 French people every year.

At the beginning of the disease, esophageal cancer rarely causes specific and obvious symptoms. It is therefore not easy to diagnose the disease at an early stage. However, cancer of the esophagus can trigger the following symptoms:

  • Painful swallowing, difficulty swallowing solid foods, feeling food is stuck to the sternum.
  • Unexplained weight loss .
  • Loss of appetite .
  • Pain in the chest .
  • Recurrent heartburn .
  • Persistent hoarseness of voice (more than 2 weeks),
  • Chronic cough.
  • Nausea , vomiting.
  • Vomiting of blood.
  • Bronchopulmonary infection,
  • Difficulty breathing (if the tumor is on the trachea)
These symptoms do not necessarily indicate the presence of a cancerous tumor. They may be signs of other more common problems. If such symptoms occur, it is important to consult a doctor for proper examination and determine the cause.

The diagnosis is made by an esophageal fibroscopy, passage of a flexible tube in the esophagus and allowing small samples of tissues in case of abnormal area.

 People at risk

  • Men are at greater risk than women
  • People with chronic gastroesophageal reflux (= heartburn). Repetitive gastric juices from the stomach cause irritation of the lining of the esophagus. In response to this irritation, cells lining the esophagus can turn into glandular cells (cells similar to those in the stomach). The medical term that describes this condition is ” Barrett’s esophagus syndrome  “. These transformed cells are more likely to become adenocarcinoma-like cancer cells.
  • People over 50 years old .
  • Those who have had previous esophageal burn injury (eg ingestion of toxic products).
  • Obese people,
  • Person suffering from both smoking and alcohol addiction
  • People who have been irradiated 10 years or more before (breast cancer before 1980, lymphoma, thymoma, etc.) The risk of cancer of the esophagus is multiplied by 10 and these people must therefore be followed very closely.
  • People with diffuse keratodermiapalmoplantaire,
  • People with Plummer-Vinson syndrome.

Risk factors

  • Obesity.
  • Smoking, including the consumption of chewing tobacco.
  • Excessive consumption of alcohol.
  • Have undergone  radiotherapy  of the chest area for cancer or Hodgkin’s disease.
  • Regular irritation of the esophagus due to frequent absorption of too hot liquids  .
  • Gastroesophageal reflux.
  • The consumption of mate (South America) if more than one liter consumed per day.
  • Consumption of betel quid (South Asia).

 Prevention

Basic preventive measures
  • Consuming fiber , fruits and vegetables regularly can help prevent the appearance of cancer cells in the esophagus.
  • Do not smoke or quit.
  • Do not consume alcohol excessively.
  • Keep a healthy weight without being overweight or obese.
  • Seek treatment in case of gastroesophageal reflux. Do not neglect it.
  • Be followed regularly in case of esophagitis.
Screening measures
  • Ten percent of people with chronic gastroesophageal reflux develop Barrett’s syndrome. In about 0.5% of people, this syndrome causes the formation of an adenocarcinoma . The early detection of adenocarcinoma dramatically increases the success of treatment.

 Medical treatments of esophageal cancer

The treatment of esophageal cancer is treated by surgery, or by combining several therapies. Therapeutic options vary depending on the location of the tumor and the stage of the cancer.

Surgery for esophageal cancer

The surgeon can perform partial or complete esophagectomy .

If the tumor is superficial , it is sometimes possible (but rarely) to remove the affected area by introducing a tube with a goal (endoscope) through the mouth to access diseased tissue and destroy.

Otherwise, the surgeon proceeds to remove a portion of the esophagus or all of it, depending on where the tumor is located. It also removes neighboring lymph nodes. Sometimes a part of the stomach must also be removed, if the tumor is located at the bottom of the esophagus.

The surgeon then connects the stomach to the preserved esophagus area. Sometimes the surgeon replaces the esophagus operated by part of the intestine.

The convalescence can be relatively long. The operated person can spend several days in the intensive care unit. She must then learn to swallow and be fed intravenously or by tube until it is again possible to swallow. Being informed of all this before surgery helps to actively go through the recovery stages.

Some tumors can block the esophagus, preventing the passage of food. In this case, the surgeon can insert a tube (stent) into the esophagus to keep it open. Such an intervention is not enough to cure the disease, but it reduces the symptoms (pain, bleeding) and discomfort.

chemoradiotherapy

In some cases, radiation and chemotherapy are given before surgery to reduce the size of the tumor. Radiation therapy can also be used after surgery to complete its action and to remove remaining cancer cells.

The radiation therapy is to irradiate the affected area that is to say to send rays on a specific spot to destroy cancer cells. Since high-energy rays also reach healthy cells, this therapy causes a number of more or less uncomfortable side effects. Fatigue, inflammation of the skin becoming red and sensitive, chest pain, or difficulty swallowing.

The chemotherapy is a drug treatment based on peuvant be administered intravenously or orally. Chemotherapeutic drugs destroy cancer cells, but they also reach certain healthy cells, which can have serious side effects.

The combination of therapies makes the treatment more effective, but it also increases the intensity of the side effects. These usually fade when healthy cells have had time to regenerate.

 Complementary approaches

Notice . Check out our Cancer fact sheet for all of the complementary approaches that have been studied in people with cancer, such as acupuncture, visualization, massage therapy and yoga. These approaches may be appropriate when used in addition to, but not substituting for, medical treatments.

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