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Esophageal Cancer

Esophageal Cancer

What is the Esophagus?

The esophagus is a hollow organ responsible for transporting food to the stomach. The esophagus, the medical name of the esophagus, is located in the rib cage. And starting from the lower part of the oral cavity, it extends from the spinal cord and trachea to the stomach. Its length varies between 25 and 30 cm. Cancers that occur in the esophagus are also called esophageal cancer or esophageal cancer. Esophageal cancer is less common than other types of cancer. This type of cancer usually starts in cells in the esophagus. Cancer can occur in any part of the esophagus. Men are more likely to get this cancer than women. Esophageal cancer is more common in some regions than eating and drinking habits.

Who Gets Esophageal Cancer?

This type of cancer is seen in almost 5 thousand patients per year. It is seen more in some regions according to eating and drinking habits. For example, squamous esophageal cancer is more common in provinces such as Erzurum, Ağrı and Kars in the eastern Anatolian region of Turkey. The reason for this is that in the eastern region, it is common to eat meat rather than vegetables. In addition, frequent consumption of beverages such as very hot tea are important factors for cancer. Excessive consumption of hot drinks in colder countries increases the incidence of esophageal cancer. Another factor is the use of alcohol and cigarettes, and people who use them have a risk of developing esophageal cancer. Esophageal cancer is more common in older people over the age of 60. It is rare in young people.

Types of Esophageal Cancer

Esophageal cancer is classified according to the region and cell type. Squamous squamous cell esophageal cancer and adenocarcinoma are divided into 2 as esophageal cancer. Squamous cell (squamous) esophageal cancer is a cancer that originates from thin tissue formed by cells inside the esophagus. This type of cancer is more common in Turkey. If adenocarcinoma is cancer of the esophagus, the mucosa under the esophagus is exposed to bile and stomach acid, and the mucosa changes shape and begins to resemble glands. This is why this type of cancer occurs. It is more common than squamous cell esophageal cancer in western countries. These two types of cancer are more common. But there are other types of cancers that originate from muscle tissue, which are sometimes very rare. Esophageal cancer may originate from cells, or it can be divided according to the section in which it is located. For example, esophageal cancer can be seen in 3 different regions: in the thoracic esophagus, neck and stomach entrance. Squamous esophageal cancer occurs mostly in the upper or middle region of the esophagus. Adenocarcinoma esophageal cancer is usually seen at the entrance of the stomach and below the esophagus.

Causes of Esophageal Cancer

The factors that cause squamous cell esophageal cancer are generally consuming large amounts of hot drinks, alcohol and smoking, and consuming burned or smoked food can cause squamous esophageal cancer. Adenocarcinoma, another type of esophageal cancer, is mostly caused by a reflux problem. Reflux can be encountered in approximately 20% of people. But not every person with reflux gets esophageal cancer. Only when long-lasting reflux disease and excessive use of alcohol and cigarettes cause Barrett’s esophagus. Barrett’s esophagus is a very important risk factor for esophageal cancers. The causes of esophageal cancer can sometimes be prevented. Apart from these preventable causes, some diseases and genetic predisposition pose little risk for cancer. Not consuming vegetables, instead eating meat-based diets and consuming burnt foods made from barbecue pose a significant risk for esophageal cancer.

What are the Symptoms of Esophageal Cancer?

Esophageal cancer has important and understandable symptoms. Difficulty in swallowing is the most common and most important symptom. In addition, in esophageal cancers, symptoms of a feeling of stuckness or pain when swallowing can also be seen. Symptoms are very rare in esophageal cancer unless the tumor covers most of the esophagus. Since the symptoms show itself very late, the tumor may show itself in later stages. The first symptoms are usually things like drooling at night and pain when swallowing. Symptoms may also differ depending on which region of the esophagus the tumor occurs. However, swallowing is a valid symptom for a tumor that occurs in any region. The most important symptom of esophageal cancer in the neck is hoarseness. Cough is a symptom of cancer in the middle of the chest. If cancer has occurred in an area close to the stomach, its symptom is severe reflux. Bleeding is rare in esophageal cancers. Bleeding occurs in the intestines. Symptoms vary according to the stages of esophageal cancer. The symptoms of cancer in the 1st stage are usually absent. In the 2nd stage cancer, the symptom manifests itself with difficulty in swallowing. At this stage, a feeling of obsession in the throat and bleeding in the intestines can also be seen rarely. In the 3rd stage, difficulty in swallowing manifests itself seriously. And the patient has a lot of trouble eating solid foods. In addition, salivation may occur. However, this drooling is generally seen in the elderly and not in young patients. In the 4th stage, severe weight loss manifests itself as a symptom. Sometimes there may also be a cough and bone pain.

Esophageal Cancer Stages

Esophageal cancer occurs in 4 stages. It increases in stages as the cancer progresses. For example, the new onset of cancer can be said to be stage 1.

  • Stage 1 in esophageal cancer: In this type of cancer, no symptoms are seen at this stage because the symptoms appear very late. That’s why it’s very difficult to diagnose a stage 1 cancer. Cancer occurs only in the inner lining of the esophagus. Cancer cells have not yet reached the muscle structure. In patients at this stage, the treatment is generally not done by removing the entire esophagus, but only by removing the cancerous membrane by entering through the mouth with the help of an endoscope.
  • Stage 2 in esophageal cancer: At this stage, cancer cells have reached the muscle structures.
  • Stage 3 in esophageal cancer: The disease has spread to the surrounding lymph nodes after the esophagus. In patients at this stage, it is aimed to reduce the tumors by applying chemotherapy and radiotherapy. In case of decrease, the tumor is removed by surgical procedures.
  • Stage 4 in esophageal cancer: At this stage, the tumor has spread well around it. It usually spreads to the liver, stomach, lung and bone lymph nodes. Since the tumor has spread widely and it is the last stage of the disease, surgery is usually not performed for patients at this stage. Only chemotherapy can be applied.

Risk Factors in Esophageal Cancer

Factors that cause irritation to cells in the esophagus and some factors that increase the risk of esophageal cancer are as follows;

  • Obesity,
  • Drinking hot drinks too often
  • Excessive alcohol consumption,
  • Having gastroesophageal reflux disease
  • To smoke,
  • Barrett Esophagus,
  • Having the problem of bile reflux,
  • Constantly feeding on meat,
  • Not consuming vegetables and fruits
  • Factors such as radiation therapy of the chest or abdomen pose a risk for esophageal cancer.

Diagnostic Methods for Esophageal Cancer

With endoscopy, the diagnosis of esophageal cancer can be made. The damaged or cancerous area can be determined by inserting it through the mouth and descending into the esophagus. Another diagnostic method is biopsy. Again, with the endoscope tool that goes down from the throat to the esophagus, a tissue that is suspected of being cancerous is removed with this tool. And with a biopsy of the tissue sample, it is understood whether it is cancerous or not.

Esophageal Cancer Treatments

The type of cancer-causing cells, the general health status of the patient and the stage of the cancer determine the treatment option in esophageal cancer. Surgical interventions and treatment methods are also divided into classes within themselves. One of them is surgery to remove very small tumors. If the tumor does not spread around it and its size is small, surgery can be performed through an endoscope. Another is the surgical procedure to remove only part of the esophagus. With this procedure called esophagectomy, only the tumor part of the esophagus is removed. The last surgical procedure is esophagogastrectomy, if the tumor has spread to the stomach, a part of the esophagus and a part of the stomach where the tumor has spread are removed. These operations are performed with the help of special surgical instruments. However, there may be great risks such as bleeding and leakage in these surgical procedures. The treatment method other than surgical interventions is the esophageal stent. This form of treatment is performed by keeping the esophagus open by placing a stent when cancer narrows the esophagus. Apart from these treatments, chemotherapy, radiochemotherapy and radiation treatments are also used for esophageal cancer. These treatments are only used to reduce the size of tumors in the esophagus. It is also used in conjunction with other forms of treatment.