Esofageal Cancer - Treatments, Symptoms, Causes
What is esophageal cancer? What are the causes and risk factors?
What is esophageal cancer? What are the causes and risk factors?
The esophagus acts as part of the digestive system. "esophagus" in American English; In British English it is spelled "oesophagus".
It is a hollow tube-shaped organ that carries the food taken from the mouth to the stomach. The esophagus (esophagus), located inside the rib cage, runs from the end of the oral cavity between the trachea and the spinal cord from top to bottom to the stomach. When the swallowing process takes place, the muscle layers in the esophagus are contracted and the food is transmitted to the stomach.
Esophageal cancer
Esophageal cancer starts in the inner layer (mucosa) and develops outward (towards the submucosa and muscle layer). There are 2 types of cells in the esophagus. For this reason, 2 types of esophageal cancer develop. Now let's examine these two types of cancer that develops in the esophagus together.
Squamous (squamous) cell carcinoma
The esophagus is normally lined with squamous cells. Cancer starts mostly in these cells and is usually seen in the upper part of the esophagus and a little in the middle. These cells are resistant to hot drinks and hard foods and can heal quickly when damaged. But the more damaged it is, the more new cells it will produce. This increases the chance of new cells being produced to turn into cancer.
Adenocarcinoma
Cancers that start in gland cells are called adenocarcinomas. These gland cells are located in the lower mucosa of the esophagus and secrete mucus. In recent years, more than half of esophageal (esophageal) cancers are diagnosed as adenocarcinoma.
Adenocarcinoma begins in the area where the esophagus meets the stomach and tends to develop like cancer. Another reason is the formation of tumor cells due to the change of cells lining the esophagus as a result of long-term reflux. The frequent occurrence of reflux increases the rate of adenocarcinoma. In addition, it has been observed that "Barrett's esophagus" has an effect on the development of this cancer type.
What are the risk factors for esophageal (esophageal) cancer?
Anything that changes the chance of getting the disease is a risk factor for us. For this reason, it is possible to reduce the risk factors that have an effect on cancer by paying attention to our lifestyle, habits, and all the environmental factors we are exposed to.
Some risk factors, such as smoking and using alcohol, are habits we acquire in life and can be changed. There are also some risk factors, such as a person's age and family history, that cannot be changed. On the other hand, just because you are at risk does not mean you will get cancer. Or it can be said that it is possible to have cancer without any risk factors.
For this reason, it is important to know the causative risk factors in esophageal (esophageal) cancer. In this way, you can reduce the risk by making small changes in your life. If you have some risk factors for this type of cancer, you should not neglect your routine check-ups at frequent intervals. Thus, you can have the opportunity of early diagnosis and effective treatment in cancer.
What are the symptoms of esophageal – esophageal cancer?
Esophageal cancer is usually diagnosed based on the symptoms seen.
The most common symptom is difficulty swallowing.
In addition, pain during swallowing,
- weight loss,
- hoarseness,
- persistent cough,
vomiting,
Some symptoms, such as the return of swallowed food, are frequently encountered in esophageal (esophageal) cancer.
However, it is not correct to directly associate these symptoms with esophageal (esophageal) cancer. Other non-serious health problems can also cause such symptoms. In this case, your duty is to consult a specialist doctor without wasting time. In this way, it will be possible to quickly find a solution to the health problem detected early.
Is early diagnosis and screening possible in esophageal cancer? How is it diagnosed?
There is no routine cancer screening test for esophageal cancer and it is usually diagnosed based on the symptoms seen.
Imaging tests
Imaging tests use X-rays, magnetic fields, sound waves, or radioactive material. Imaging tests are tests applied to understand whether the suspicious area is cancer, to detect the spread of cancer, to determine the effectiveness of treatment and to examine the tendency of cancer to recur.
Barium passage graph
A substance containing barium is given to coat the esophageal wall. By providing the image of the esophagus with its outlines, images are taken from the places deemed necessary. This test can show abnormalities in the normally soft surface of the inner lining of the esophagus.
Endoscopy
The endoscope is a flexible, thin device with a high image capacity with a camera at the end. Endoscopy, which is frequently used for imaging the digestive system, is a test that can help diagnose esophageal cancer and determine its spread.
Upper endoscopy
Upper endoscopy is a test that plays an important role in the diagnosis of esophageal cancer. During this test, the endoscope is inserted down the throat to view the esophagus and stomach. The camera at the end of the endoscope gives the images to the monitor. Thus, abnormal areas are detected in the esophageal wall. This procedure will provide information about the size and spread of the tumor and will determine the likelihood of surgery.
How is esophageal cancer treated?
The main treatment for esophageal cancer is surgery. With this method, it is possible to completely destroy the cancer and achieve success in the treatment. However, in order for surgery to be performed, the cancer must be detected at an early stage.
If the cancer has spread to all layers of the esophagus, lymph nodes and distant organs (metastatic stage = 4th stage), the chance of surgery is eliminated. However, if the cancer has not spread to distant organs, it is limited to the esophagus and has progressed to the surrounding lymph nodes, surgery is a treatment option.
However, chemotherapy and radiotherapy treatments should be applied to make the cancer suitable for surgery. In addition, targeted and endoscopic therapies are among the treatment methods used in esophageal cancer depending on the course of the disease.
Esophageal cancer surgery
Surgery is used as the main treatment for early-stage esophageal cancer. With this method, it is aimed to completely destroy the cancer and to achieve success in the treatment. Again, if the cancer has not spread to distant organs, is limited to the esophagus and has progressed to the surrounding lymph nodes, surgery may be an option. However, in such cases, chemotherapy and radiotherapy treatments are used to make the cancer suitable for surgery. Surgery can also be used from time to time to alleviate or prevent cancer-related problems instead of treatment.
Chemotherapy and targeted therapy in esophageal cancer
Chemotherapy is drug therapy to kill cancer cells. Chemotherapy treatment includes cancer drugs that are used orally or injected through a vein. These drugs are effective in the treatment of all cancer that has spread throughout the body, beyond the head and neck region of the cancer, by circulating the whole body through the bloodstream. Chemotherapy alone is not effective in the treatment of esophageal cancer. For this reason, it is often given simultaneously with radiotherapy (chemoradiotherapy).
Targeted therapy – smart drugs
As more is learned about the cancer-causing changes within the cell, new drugs targeting these changes continue to be developed. These targeted drugs work differently from standard chemotherapy drugs. In cases where chemotherapy drugs are not effective in treatment, targeted drugs may be preferred.
Treatment with radiotherapy in esophageal cancer
Radiotherapy aims to kill cancer cells or slow their growth using high-energy X-rays or particles. Radiotherapy can be applied concurrently with chemotherapy and/or surgery to increase the effect of treatment in esophageal cancer. This method, called chemoradiotherapy treatment, is mostly used in patients who cannot undergo surgery or whose health condition is not suitable.
Immunotherapy in esophageal – esophageal cancer
Many immunotherapy methods are being tried in esophageal cancer, but there is no drug approved for use yet. Immunotherapy methods tried in this field can be examined under 5 headings: immune checkpoint inhibitors/regulators, adoptive cell transfer, monoclonal antibodies, therapeutic vaccines, and cytokines.