Esophageal Cancer

Cancer that begins in the esophagus is divided into two major types: squamous cell carcinomas, tumors that develop in the tissue lining the hollow organs of the body, and adenocarcinoma, depending on the type of cells that are malignant.  Squamous cell carcinomas arise in the squamous cells that line the esophagus.  These cancers usually occur in the upper and middle part of the esophagus.  Adenocarcinomas usually develop in the glandular tissue in the lower part of the esophagus.

Incidence; Causes and Development; Contributing Risk Factors

Approximately 11,000 - 13,000 new cases of esophageal cancer are diagnosed each year in the United States.

The exact causes of cancer of the esophagus are not known.

It is more common in men than women, and is more likely to occur at you get older; most people who develop esophageal cancer are over age 60.

Smoking cigarettes or using smokeless tobacco is one of the major risk factors for esophageal cancer.  Chronic and/or heavy use of alcohol is another major risk factor for esophageal cancer.  People who use both alcohol and tobacco have an especially high risk of esophageal cancer.  Scientists believe that these substances increase each other's harmful effects.  Studies have shown these other factors to increase your risk of developing cancer of the esophagus:

• Barrett's Esophagus. Long-term irritation can increase your 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 (GERD).  Over time, cells in the irritated part of the esophagus may change and begin to resemble the columnar cells that line the stomach.  This condition, known as Barrett's esophagus, is a pre-malignant condition that may develop into adenocarcinoma of the esophagus.
• Other types of irritation. Other causes of significant irritation or damage to the lining of the esophagus, such as swallowing lye or other caustic substances, can increase the risk of developing esophageal cancer.
• History of head/neck cancers. People who have had other head and neck cancers have an increased chance of developing a second cancer in the head and neck area, including esophageal cancer.

Other risk factors include achalasia and a history of gastroesophageal reflux (GERD).  It is important to bear in mind that most people with one or even several of these factors do not get the disease, and that most people who do get esophageal cancer have none of the known risk factors.

Signs and Symptoms

Esophageal cancer symptoms become progressively worse as tumor size increases.  Initially, a patient may not notice esophageal cancer symptoms at all, as the tumors are too small to cause problems.  As tumors grow, esophageal cancer symptoms appear, beginning with difficulty swallowing.  This may come and go, generally growing worse each time it returns.

The signs and symptoms may include, but are not limited to, the following:

• Difficulty swallowing
• Feelings of fullness, pressure, and burning as food travels down the esophagus
• The sensation of having a piece of food stuck behind the breastbone
• Weight loss, caused by a change in eating habits, which is in turn due to the discomfort from other esophageal cancer symptoms such as heartburn, indigestion, and vomiting
• Regurgitation of food
• Coughing and hoarseness
• Blood found in vomit or in stool.

Many of the various symptoms mimic symptoms of other disorders, so it is important to have the disease properly diagnosed.  Esophageal cancer symptoms are generally investigated by a gastroenterologist.  Diagnosis of esophageal cancer symptoms is usually conducted through an X-ray method known as the barium swallow, and may also include endoscopy along with a biopsy, and a CT scan of the chest and abdomen.  Analysis of esophageal cancer symptoms may also be accomplished using a thin, lighted tube known as an esophagoscope.  Properly diagnosing esophageal cancer symptoms is critical to ensuring patients' chances for survival.

Treatment and Prevention

Treatment methods vary depending upon a patient's condition, but is similar for both types of esophageal cancer.  The most common surgical treatment for esophageal cancer is laparoscopic esophagectomy.

The best ways to prevent this type of cancer are to quit (or never start) smoking cigarettes or using smokeless tobacco and to drink alcohol only in moderation.

Complementary and alternative esophageal cancer treatment options include:

• Nutritional Therapy
  According to the National Cancer Institute, about one-third of all cancer deaths are related to malnutrition.  For cancer patients, optimal nutrition is important.  Cancer can deplete your body's nutrients and cause weight loss.  Cancer and cancer treatment can also have a negative effect on your appetite, and your body's ability to digest foods.  These factors may leave you in a vulnerable condition - high nutrient need, and low nutrient intake.
  
  Vitamin and mineral supplements help provide nutrients that diet alone may not, and offer a boost where illness may have depleted your body.  A supplementation plan should include nutrients that help support your immune system and reduce toxic side-effects, including:
  • Beta carotene
  • Selenium
  • Vitamin C
  • Eicosapentaenoic acid (EPA)
  • Vitamin E
• Pain Management
  Most patients with advanced cancer experience pain during the course of their disease.  Cancer pain may be acute or chronic.  Acute pain generally results from tissue damage and is of limited duration.  Once the cause of pain has been identified, it can be successfully managed.  Chronic pain, on the other hand, is persistent – usually greater than three months in duration.  Because the cause of chronic pain often cannot be altered, your nervous system will adapt, which may cause depression, anxiety and/or insomnia.
  
  The severity and prevalence of pain you may experience depend on many factors, including the site and stage of your disease and the location of metastases.  Cancer-related pain can result from both the disease process and treatment.  Pain affects each person differently, depending upon factors such as age, personality, perception, pain threshold and past experiences with pain.  Psychological factors such as fear, worries or knowledge of impending death can also influence the effect of pain.  Insomnia, fatigue and anxiety may lower the pain threshold, while rest, sleep and diversion can raise it.
  
  The goal of pain management is not only relief from pain, but also the maintenance of your normal quality of life.  All methods of pain management attempt to either control the cause of the pain or alter your perception of it.  Although pain management techniques are many and varied, therapeutic approaches can be classified as either pharmacological or non-pharmacological.  Pharmacological pain control involves the use of analgesics, as well as other medications that intensify the analgesics' effects or modify your mood or pain perception.  Non-pharmacological approaches include:
  • Behavioral techniques
  • Radiation
  • Surgery
  • Neurological and neurosurgical interventions
  • Traditional nursing and psychosocial interventions
  Because of the complex nature of cancer-related pain, successful management usually involves a combination of techniques.

Complications

If the cancer spreads outside the esophagus, it often goes to the lymph nodes first.  Esophageal cancer can also spread to almost any other part of the body, including the liver, lungs, brain, and bones.