Esophageal cancer starts in the cells of the esophagus. The esophagus is a muscular tube that leads from the back of the mouth (pharynx) to the stomach. It sits between the spine and the lungs. The muscles of the esophagus move in rhythmic waves to push food and drink to the stomach. The point where the esophagus joins the stomach is called the gastro esophageal junction. The muscles at the junction prevent the contents of the stomach from flowing back up into the esophagus.
Cancer of the esophagus may develop anywhere along the length of the esophagus.
There are 2 main types: Squamous cell carcinoma, which starts in the squamous cells that line the esophagus and. Adenocarcinoma, which starts in the glandular cells of the lower third of the esophagus or in cells that have been damaged by acid backing up from the stomach.
Causes & Risk Factors of Esophageal Cancer
Age - Esophageal cancer is more likely to occur as people get older, over age 60.
Sex - Cancer of the esophagus is more common in men than in women.
Tobcco / Alcohol Use - Chronic and/or heavy use of alcohol is another major risk factor.
Barrett's Esophagus - Long-term irritation can increase the risk of esophageal cancer. Tissues at the bottom of the esophagus can become irritated if stomach acid frequently "backs up" into the esophagus -- a problem called gastric reflux. Over time, cells in the irritated part of the esophagus may change and begin to resemble the cells that line the stomach. This condition, known as Barrett's esophagus, is a premalignant condition that may develop into adenocarcinoma of the esophagus.
Medical History - Patients with family history of cancer.
Signs and Symptoms of Esophageal Cancer
Early esophageal cancer usually does not cause symptoms. However, as the cancer grows, symptoms may include: difficult or painful swallowing, severe weight loss, pain in the throat or back, behind the breastbone or between the shoulder blades, chronic cough, Vomiting and / or Coughing up blood.
DIAGNOSIS OF ESOPHAGEAL CANCER
Barium Swallow or Upper Gastrointestinal (GI) X-rays : -
Esophageal cancers grow from the wall of the esophagus into the opening of the esophagus, creating a tumor or bump inside the esophagus. Barium in liquid form is used to coat the esophagus wall before the x-ray is taken, allowing the x-ray to show the esophagus clearly.
Upper Endoscopy for Esophageal Cancer : -
Upper endoscopy is a procedure involving use of an endoscope, which is a flexible, very narrow tube with a video camera and light on the end. The patient is sedated to allow for this tube to pass through into the esophagus and stomach. The camera is connected to a television and doctor to sees abnormalities in the wall of the esophagus clearly. Endoscopy is important test for diagnosing esophageal cancer.
Endoscopic Ultrasound for Esophageal Cancer : -
An endoscope with a small ultrasound probe attached to its end is used. The probe sends very sensitive sound waves that penetrate deep into tissues. The sound waves bounce off the normal tissues and the cancer are picked up by the probe and determine how deeply the tumor has invaded into the esophagus.
Bronchoscopy for Esophageal Cancer : -
This procedure is similar to an upper endoscopy except in this instance the doctor looks into the trachea (windpipe) and bronchi (tubes leading from the trachea to the lung). The patient is sedated the procedure.
Positron Emission Tomography for Esophageal Cancer : -
In this test, radioactive glucose (sugar) is injected into your vein. Because cancers use sugar much faster than normal tissues, the cancerous tissue takes up the radioactive material. A scanner can spot the radioactive deposits. It may be a useful test for staging the cancer.
Thoracoscopy and Laparoscopy for Esophageal Cancer : -
These procedures allow the doctor to see lymph nodes and other organs near the esophagus inside the chest (by thoracoscopy) or the abdomen (by laparoscopy) through a hollow lighted tube. The surgeon can operate instruments through the tube and remove lymph node samples and biopsy organs to see whether they contain cancer cells. It is often important to decide whether a person is likely to benefit from surgery.
Biopsy for Esophageal Cancer : -
During an endoscopy or other procedure, the doctor will remove a small piece of tissue. This tissue is then examined by a pathologist who examines the tissue to determine whether cancer cells are present and if so, their type. It usually takes a couple of days to get the results of a biopsy.
Other diagnostic procedures include a CT Scan and an MRI : -
Treatment Of Esophageal Cancer in India
Surgery to remove the cancer in India : -
Two types of surgery are commonly performed for esophageal cancer. In one type of surgery, parts of the esophagus and nearby lymph nodes are removed, and the remaining portion of the esophagus is reconnected to the stomach. In the other surgery, part of the esophagus, nearby lymph nodes, and the top of the stomach are removed. The remaining portion of the esophagus is reconnected to the stomach.
Laser treatment and stents to relieve symptoms : -
Even if your esophageal cancer cannot be cured and if your cancer is blocking your oesophagus and making it difficult to swallow, Laser treatment may be used to clear any blockages. Or a tube called a stent is put in to allow food and drink to pass through.
Chemotherapy for Esophageal Cancer in India
Radiotherapy for Esophageal Cancer in India: -
Combined chemotherapy and radiotherapy for Esophageal Cancer in India
If your cancer hasn't spread, but is difficult to remove, your doctor may suggest you have combined chemotherapy and radiotherapy.This treatment is designed to try to get rid of your cancer fully. Your doctor may also suggest this approach if you cannot have surgery for some reason, but your cancer could potentially be removed. It is quite an intensive treatment and there are side effects. It has proved to be particularly successful for squamous cell cancers that are nearer to the top of the oesophagus. Read More .
Photodynamic Therapy (PDT) : -
This treatment involves the use of low powered lasers combined with a light sensitive drug to destroy cancer cells. PDT is a relatively new treatment. There are two situations where your doctor may suggest it.1)As a treatment to try to prevent high grade Barrett's oesophagus developing into cancer 2) To destroy part of a tumour and improve swallowing when advanced oesophageal cancer is making this difficult.
The list of of world class Cancer hospitals in India is as follows : -
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