Esophageal cancer
Risk Factors
1. Tobacco Use:
Smoking: Cigarette smoking significantly increases the risk of esophageal squamous cell carcinoma. The risk is dose-dependent, meaning the more one smokes, the higher the risk.
- Smokeless Tobacco: Using chewing tobacco or snuff also raises the risk, though to a lesser extent compared to smoking.
2. Alcohol Consumption:
- Chronic heavy drinking is strongly linked to esophageal squamous cell carcinoma. The risk escalates with the quantity and duration of alcohol consumption.
3. Diet and Nutrition:
- Low Fruit and Vegetable Intake: Diets low in fruits and vegetables may increase the risk due to insufficient intake of essential nutrients and antioxidants.
- Processed Meat: High consumption of processed meats has been associated with a higher risk of esophageal cancer.
- Obesity: Excess body weight, especially central obesity, is a significant risk factor for esophageal adenocarcinoma. It contributes to gastroesophageal reflux disease (GERD), which can lead to Barrett’s esophagus, a precursor to cancer.
4. Gastroesophageal Reflux Disease (GERD):
- Chronic reflux of stomach acid into the esophagus can cause irritation and inflammation, leading to Barrett’s esophagus, where the lining of the esophagus changes to resemble the intestine, significantly increasing the risk of adenocarcinoma
5. Barrett’s Esophagus:
- This condition, resulting from chronic GERD, involves the replacement of the normal esophageal lining with tissue similar to the intestinal lining. People with Barrett’s esophagus have a higher risk of developing esophageal adenocarcinoma.
6. Achalasia:
- Achalasia is a disorder where the lower esophageal sphincter fails to relax properly, causing food to remain in the esophagus longer than normal. This increases the risk of squamous cell carcinoma.
7. Exposure to Certain Substances:
- Exposure to certain chemicals, such as those in dry cleaning solvents and some industrial chemicals, may increase the risk.
8. Radiation Therapy:
- Prior radiation treatment to the chest or upper abdomen can increase the risk.
Esophageal cancer symptoms
1. Dysphagia (Difficulty Swallowing):
Progressive Difficulty: Initially, there might be difficulty swallowing solid foods. Over time, even liquids can become hard to swallow.
2. Weight Loss:
- Unintentional: Significant, unexplained weight loss often occurs.
3. Chest Pain or Discomfort:
- Pain: Some people experience pain or a burning sensation behind the breastbone or in the middle of the chest.
- Discomfort: General chest discomfort, which might be mistaken for heartburn or indigestion.
4. Regurgitation:
- Food or Liquid: Food or liquids may come back up into the mouth, sometimes causing coughing or choking.
Other Symptoms..
1. Chronic Cough
- Persistent Coughing: A chronic cough that doesn’t go away can be a symptom, especially if accompanied by other signs.
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2. Hoarseness:
- Voice Changes: Hoarseness or changes in the voice may occur if the cancer affects the nerves controlling the vocal cords.
3. Hiccups:
- Frequent Hiccups: Persistent hiccups can be an indication, particularly if they occur with other symptoms.
4. Vomiting:
- Blood in Vomit: Vomiting blood or material that looks like coffee grounds is a sign of advanced disease.
5. Anemia:
- Pale Skin and Fatigue: Anemia can result from chronic blood loss from the esophagus, leading to symptoms like pale skin, fatigue, and shortness of breath.
6. Pain in the Throat or Back:
- Radiating Pain: Pain may radiate to the back, especially if the tumor is large or invasive.
- Persistent Throat Pain: Continuous pain in the throat, especially when swallowing.
Diagnosis
- Oesophago-GastroDuodenoacopy with Biopsy.
- CECT – Thorax and Abdomen, Pelvis.
- PET- CT scan.
- Barium Swallow.
Treatment
Esophageal cancer surgery is a primary treatment option for localized esophageal cancer. The specific type of surgery depends on the cancer’s stage, location, and the patient's overall health.
Here are the main surgical options:
1. Esophagectomy
Esophagectomy is the most common surgical procedure for esophageal cancer. It involves removing part or all of the esophagus. There are several types:
A. Transhiatal Esophagectomy (THE)
- Procedure: The surgeon removes the esophagus through incisions in the neck and abdomen without opening the chest.
- Advantages: Less invasive for the chest, potentially fewer pulmonary complications.
- Disadvantages: Limited visibility of the upper chest area, potentially higher risk of incomplete tumor removal.
B. Transthoracic Esophagectomy (TTE)
– Procedure: This involves opening the chest (thoracotomy) to remove the esophagus. It can be done via:
- Ivor Lewis Esophagectomy: Involves an abdominal incision followed by a right thoracotomy.
- Three-Field Esophagectomy: Involves incisions in the abdomen, chest, and neck.
- Advantages: Better access to the entire esophagus, potentially more thorough lymph node removal.
- Disadvantages: More invasive with a higher risk of pulmonary complications.
C. Minimally Invasive Esophagectomy (MIE)
- Procedure: Uses laparoscopic (abdominal) and thoracoscopic (chest) techniques to remove the esophagus with smaller incisions.
- Advantages: Reduced postoperative pain, shorter hospital stay, quicker recovery.
- Disadvantages: Technically challenging, requires specialized surgical expertise.
2. Esophagogastrectomy
- Procedure: This involves removing the esophagus and part of the stomach, typically for tumors located at the gastroesophageal junction.
- Advantages:Allows for removal of both the tumor and potentially affected gastric tissues.
- Disadvantages: Complex procedure with significant potential for complications, including nutritional issues post-surgery.
3. Lymph Node Removal
- Procedure: Often performed alongside esophagectomy to remove potentially cancerous lymph nodes in the chest and abdomen.
- Advantages: Helps in staging the cancer and reducing recurrence risk.
- Reconstruction: After esophagectomy, the stomach tube us created and it is pulled up and connected to the remaining esophagus to maintain digestive tract continuity.