Esophageal Cancer: Causes, Symptoms, Diagnosis and Treatment

The esophagus is muscular tube that runs between stomach and mouth. It is often known as the food pipe. It carries food you swallow to be digested in your stomach. To some people, unfortunately, malignant or cancer cells can form inside the esophagus starting from cells lining inside it. These cells can form tumors which can spread to other organs.

What Is the Esophagus?

The esophagus is a muscular tube, about 25 centimeters long in adults, through which food passes to the stomach. Its wall consists of mucosa, sub mucosa, and connective tissues. The esophagus runs behind the trachea and heart. It passes through the diaphragm before entering the uppermost region of the stomach. Through a process called peristalsis, the muscles of the esophagus contracts to move food into the stomach.

The Upper Esophageal sphincter (UES), which protects food and the secretions from going down the windpipe, is a bundle of muscles present at the top of the esophagus. The Lower Esophageal Sphincter (LES) prevents the acid and food from going back into the stomach. While the UES muscles are directly under voluntary control and are used when breathing, eating, or vomiting, the LES however cannot be controlled voluntarily. The disorders that the esophagus is prone to are sometimes complex. The disorders include Heartburn, Gastroesophageal reflux disease, Barrett’s esophagus, Achalasia, Esophageal ulcer, esophageal cancer, and many other complications.

What Is Esophageal Cancer?

Esophageal Cancer is a disease where cancer cells form in the esophagus. It is a disease that occurs more in men as compared to women. It is also more commonly found in Asia and Africa than the rest of the world. This condition is so dangerous that the long term survival rate remains below 30%. It occurs most often to the people of developing countries where possibilities of nutrition deficiency and HPV infection exist. There are two major types of esophageal cancer:

• Squamous cell carcinoma: Squamous cells, which make up the outer lining of the esophagus, can sometimes get affected by the development of cancer cells in the esophageal lining. This disease is much more likely to affect people treated with squamous cell cancer of the head or neck. It affects the middle portion of the esophagus.
• Adenocarcinoma: This type of esophageal cancer starts from the esophageal glands which secrete mucus. Occurring more often in the lower parts of the esophagus, adenocarcinoma occurs 7 to 10 times more frequently in men as compared to women. People experiencing GERD or reflux pose a higher threat of being affected with adenocarcinoma than others.

What Causes Esophageal Cancer?

The two major types of esophageal cancer involve different sets of risk factors associated with them. Esophageal squamous cell carcinoma is more likely to occur in people with alcohol and smoking addictions. Regular consumption of nitrosamines, caustic substances, and very hot drinks are also some risk factors associated with developing this disease. Poor oral cleanliness and nutritional deficiencies are also a cause. However, alcohol and smoking consumption are the major causes of Squamous cell carcinoma.

People having GERD are more prone to developing this disease than others as it can be an erosive long-term effect of the aforesaid. In Barrett’s esophagus, the acids from stomach harm the lining by entering into the esophagus. Hence, those who are more prone to get this type of esophageal cancer. About 1-5% of the Barrett’s esophagus patients develop esophageal cancer. Obesity and not including apt nutrition in the diet can lead to the development of this disease.  

What Are the Symptoms of Esophageal Cancer?

The very initial stages of the esophageal cancer might not display any clear signs and symptoms. However, as the cancer progresses, it is possible that an individual might experience:

• Unintended weight loss
• Vomiting and indigestion
• Heartburn
• Difficulties in swallowing food
• Long lasting cough or hoarseness
• Fatigue
• Painful swallowing and frequent choking while eating
• Coughing on eating and drinking
• Vomiting with blood
• Nausea
• Chest Pain 
• Back stools

Is Esophageal Cancer Curable?

Esophageal cancer is a life threatening disease. It so dangerous that the overall five-year survival rate of esophageal cancer patients is just 18%. However, for those who are diagnosed before the cancer spreads too much in the lymph nodes and other organs of the body, the survival rate goes up to 40%. An early medical consultation and discovery of the cancer at an early stage can be lifesaving. In most cases, surgeries alone are undertaken for the treatment of the disease but sometimes it is combined with the consumption of drugs. A Proper nutrition-filled diet must be managed and smoking and drinking must be avoided.  

In cases where the cancer has entered its later stages or has spread out, chemotherapies and surgeries are undertaken to lengthen survival or to improve symptoms.

How Esophageal Cancer Is Treated?

If the disease is diagnosed while it is still in its early stages, curing methodologies can be adopted to end the cancer. But as the cancer spreads out, surgeries become more life threatening.

• Esophagectomy – Esophagectomy is a type of surgery where the cancerous part of the esophagus is removed and the remaining portion is connected to the stomach.
• Esophagogastrectomy – Esophagogastrectomy involves removal of the esophagus with nearby lymph nodes and the upper part of stomach. Once the surgery is complete, the stomach is pulled up and reattached to the esophagus.
• Photodynamic therapy – Photodynamic therapy involves improving the swallowing of food for people who cannot undergo surgeries. It cannot cure esophageal cancer but can solve swallowing problems for a short while.
• Chemotherapy – Chemotherapy involves the usage of drugs to kill cancer cells. It can be coupled with radiation therapy for curing the patients. This combined treatment is called ‘chemoradiotherapy’. The side-effects can include hair loss, diarrhea, and fatigue.

When healthy cells grow uncontrollably and form masses called tumors, being cancerous, they can spread to other body parts. Similarly, the esophageal cancer which begins in the lining and glands of the esophagus and grows outwards poses life threats to the patient. It can spread to the wall of the esophagus, blood vessels, lymph nodes, and other organs including the stomach, lungs, and liver.