Esophageal Cancer

What Is Esophageal Cancer?

Esophageal cancer is the malignant new formation of the cells of the esophagus. A distinction is made between Barrett's carcinoma and squamous cell carcinoma.

Frequency, Causes, And Risk Factors:

In Western industrialized countries, esophageal cancer is responsible for 2% of all cancers and frequently occurs in the 6th-7th decade of life. Men are affected three times as much as women. In Africa, Asia, and the Caribbean, esophageal cancer is more common.

The causes are irritating substances, such as high-proof alcohol, hot drinks, food containing nitrite (salted meat), and smoking. Betel nuts, which are popular in Asia, contain harmful substances which, if consumed regularly, have a carcinogenic effect on the digestive tract.

Esophageal cancer can also occur as a result of permanent irritation by gastric juice (known as reflux or heartburn). The tissue of the esophagus adapts to the continuous irritation by rebuilding itself (metaplasia) and tends to degenerate into cancer. This clinical picture is called Barrett's esophagus. Only the treatment of the causing reflux can prevent a dangerous progression.

The consequences of achalasia, a permanently too tightly closed sphincter of the lower esophagus, can also lead to esophagitis and finally contribute to the development of cancer. In general, factors that lead to inflammatory processes in the esophagus favor the development of esophageal cancer.

Symptoms of Esophageal Cancer

Symptoms of esophageal cancer become noticeable, very late. Cancer can cause difficulty in swallowing, frequent eructation, and pain behind the breastbone. Like many cancers, esophageal cancer can be accompanied by weight loss (tumor cachexia). Especially when food intake is disturbed by the tumor, weight loss can be a life-threatening complication. If cancer applies pressure on surrounding areas (e.g., trachea, nerves), it can lead to hoarseness, irritable cough, and breathing difficulties. Coughing up blood is possible due to tissue damage.

Treatment And Surgical Methods for Esophageal Cancer

In early forms of esophageal cancer, removal with an endoscope can already lead to healing. If radical surgery can be carried out, it is called resection of the esophagus, which involves the removal of parts of the esophagus and the surrounding lymph nodes. When the esophagus is replaced, parts of the stomach are shaped into a tube and connected to the upper esophageal stump. Parts of the intestine can also be used to restore the passage of food.

Radiation therapy is used for healing as well as palliatively to improve food intake in case of swallowing difficulties. Radiation therapy has not been successful in the treatment of Barrett's cancer of the esophagus, cancer that has developed as a result of Barrett's syndrome.

Palliative treatments such as placing a self-deployable stent in the esophagus can counteract a narrowing of the digestive tract and ensure that food intake remains as normal as possible until death. Tumor ablation, in which constricting cancerous tissue is removed with laser or heat (usually argon plasma coagulation), has the same goal. If it is no longer possible to maintain the passage through the esophagus, a gastric tube (PEG probe) can be placed.

An initially inoperable cancer becomes smaller (down-sizing) with chemotherapy and possibly operable. At present, modern combination chemotherapy can improve the disease in 15-20% of cases.

Healing Prospects And Life Expectancy

The difficulty of esophageal cancer is that it usually shows symptoms at a late stage, which is why 90% of tumors are not discovered until they are advanced. The earlier an esophageal cancer is diagnosed, the better the prognosis. Esophageal cancer tends to metastasize mainly to the lymph nodes. It only spreads late via the bloodstream (hematogenous). Then it spreads primarily to the lungs, liver, and bones, but this is usually not experienced anymore by the affected person.

Therapy with a prospect of a cure is only possible as long as no metastases have been found in lymph nodes or other organs. The tumor must be limited, i.e., it must not grow into surrounding tissue and should not be located in the upper third of the esophagus, which usually makes it inoperable. Barrett's cancer of the esophagus is 95% located in the lower third of the esophagus, whereas squamous cell carcinoma can occur in all parts.

The average survival rate is less than one year without a surgery. About 40% of esophageal tumors are considered to be operable and are treated with the aim of healing. The 5-year survival rate for these patients is 10-20%. Surgery is associated with risks, and about 10% of patients do not survive. With palliative therapy, the 5-year survival rate is 4%.

Alternatively, for inoperable tumors or tumors in the upper third of the esophagus, chemoradiotherapy can lead to a 3-year survival rate of 30%.

Which Doctors And Clinics Are Specialists for Esophageal Cancer?

Those who need a doctor want the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively, and a respectable doctor would never claim to be the best one, we can only rely on the experience of a doctor.

We will help you to find an expert for your disease. All listed doctors and clinics have been checked by us for their outstanding specialization in esophageal cancer and are awaiting your inquiry or treatment request.

Sources:

• Herold -Innere Medizin 2016
• Heiner Greten – Innere Medizin 12.Auflage
• Duale Reihe – Innere Medizin 2009