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What is Esophageal Cancer?
Esophageal cancer is when malignant (cancer) cells
grow in the esophagus. There are two common forms of esophageal cancer and they
are named for the cells that become malignant (cancerous).
- Squamous
Cell Carcinoma: This is cancer that forms in the squamous cells. These
cells are thin and flat; found in tissues that form the surface of the skin, hollow organs
of the body and the passages of the respiratory and digestive tracts. SCC is generally found
in the upper and middle portions of the esophagus but can occur anywhere. It arises in mutations
of the traditional lining cells of the esophagus.
- Adenocarcinoma:
This is cancer that forms in the glandular cells. Glandular cells produce and release fluids
such as mucous. Adenocarcinoma is generally found in the lower portion of the esophagus near
the stomach, and most commonly arises from mutations resulting from chronic acid reflux disease,
i.e. Barrett’s esophagus.
While the exact cause of esophageal cancer is not known, there are several risk factors
that may increase your chances of developing cancer. These factors include:
- GERD: Gastroesophageal
reflux disease, sometimes called "heartburn," dyspepsia
or indigestion.
- Barrett’s esophagus: This pre-cancerous condition of the esophagus results
from continual erosion of the esophagus by stomach acid and bile.
- Tobacco Use: Cigarette smoking,
even smokeless tobacco, is a major risk factor in the development of esophageal cancer.
- Alcohol
Use: Chronic or heavy drinking of alcohol increases your risks of developing esophageal
cancer. Heavy/chronic drinking in combination with tobacco use greatly increases your risk.
- Age:
Esophageal cancer most commonly develops in patients who are over 60.
What symptoms will I experience if I have Esophageal
Cancer?
It is possible to have early stage Esophageal Cancer and have no symptoms.
However, common symptoms for esophageal cancer may include:
- Painful or difficult swallowing
- Weight loss
- Pain in the throat, behind the breastbone or in between your shoulder blades
- Disappearance
of heartburn/GERD symptoms
- Hoarseness
- Chronic cough
- Vomiting
- Coughing up blood
How is it diagnosed?
There are several
diagnostic tests that your physician may order to determine the presence of esophageal cancer.
There are four tests that your doctor may order—barium swallow,
upper endoscopy or esophagoscopy, endoscopic ultrasound and a CT/PET scan. For a barium swallow,
the patient drinks a liquid that contains barium, which coats the esophagus. A series of
x-rays are then taken and structural changes that may have occurred in the esophagus are
noted. Next, your physician may request an esophagoscopy or upper endoscopy. This is when
a thin, flexible tube with a camera is introduced to your esophagus orally. Your physician
is able to see the lining of your esophagus and biopsies may be taken of abnormal cells in
order to perform further evaluation of those cells. An endoscopic ultrasound is similar to
endoscopy, only this time the doctor uses a special probe at the end of the endoscope which
emits sound waves through the wall of the esophagus to evaluate the esophagus and surrounding
lymph nodes. This way, the doctor is able to precisely determine the extent of tumor depth
into the esophagus.
CT and/or PET scans are done to image the soft tissues in the
esophagus. A PET scan is a special type of imaging test that is done after an injection of
glucose is given. The glucose is utilized by all the cells in the body, however, cancer cells
use more glucose, so those areas are expected to glow very brightly in the images. This test
allows doctors to determine if any cancer cells have left the esophagus and traveled to other
parts of the body.
What is the treatment process for Esophageal Cancer?
The treatment process for Esophageal Cancer varies greatly depending on the size, type
and location of your tumor. It is important, if you have been diagnosed with esophageal cancer,
that you speak with a number of different kinds of physicians about your case before deciding
how to proceed with treatment. Consultation with a surgeon and oncologist are imperative.
A multidisciplinary center that can provide a team of physicians is often the best way to
ensure that your case has been thoroughly reviewed and that you are, indeed, proceeding in
the manner best suited to your health, lifestyle and your particular cancer.
The following are the most common treatments used in treating esophageal cancer. Your
physician may recommend any combination of these treatments, as well as others not discussed
here.
- Surgery: The most common surgery used in treating esophageal cancer is called an
esophagectomy. This requires the removal of the tumor, a portion or even the entire esophagus,
as well as any lymph
nodes near by. The remaining portion of the esophagus is then connected
to the stomach so that patients can continue to swallow. Surgery may be performed as a first
line of treatment or after other treatment methods have been performed.
- Radiation Therapy(Radiotherapy): Radiation therapy involves the use of high-energy rays to kill cancer cells.
Only cells in the treated area are affected. Radiation therapy can be delivered by a machine
located outside of the body or by placing radioactive materials in or near the tumor inside
your body. Radiation therapy is commonly used in an effort to reduce the size of a tumor
prior to surgery. Radiation therapy is also used in the case of a tumor that may be hard
to access. Radiation therapy is sometimes used to relieve pain and ease swallowing, even
when a tumor cannot be removed surgically or destroyed entirely by radiation therapy.
- Chemotherapy:
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy drugs travel throughout
your entire body and are not limited to the tumor cells. Chemotherapy to treat esophageal
cancer may be given intravenously and/or orally. Chemotherapy may be used alone
or in conjunction with radiation therapy to shrink a tumor prior to surgery.
Where can I learn more about Diffuse Esophageal Spasm?
Where can I find a support group?
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