Esophageal Cancer

What is the esophagus?

The esophagus is a muscular tube in the chest. It’s about 10 inches (25 centimeters) long.

This organ is part of the digestive tract. Food moves from the mouth through the esophagus to the stomach and is called Food Pipe.

 

Esophagus

Cancer Cells

 

Normal cells in the esophagus and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Esophageal cancer cells can spread by breaking away from an esophageal tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.

Types of Esophageal Cancer

 

The two most common types are named for how the cancer cells look under a microscope:

  1. Adenocarcinoma : Usually, Adenocarcinoma tumors are found in the lower part of the esophagus, near the stomach. AC of the esophagus may be related to having acid reflux (the backward flow of stomach acid), having a disease of the lower esophagus known as Barrett esophagus, or being obese.

 

  1. Squamous Cell Carcinoma : Usually, Squamous Cell Carcinoma are found in the upper part of the esophagus. SquamousCell Carcinoma of the esophagus may be related to being a heavy drinker ofalcoholsmoking or tobacco.

Diagnosis

  1. Radiological Investigations
  2. CECT Chest and abdomen
  3. PET-CT Scan
  4. Biopsy

 

Treatment

People with cancer of the esophagus have many treatment options. Treatment options include:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Targeted therapy

The treatment that’s right for you depends mainly on the type and stage of esophageal cancer.

Surgery

Surgery is an option for people with early-stage cancer of the esophagus. Usually, the surgeon removes the section of the esophagus with the cancer, a small amount of normal tissue around the cancer, and nearby lymph nodes alongwith part or all of the stomach is also removed.

If only a very small part of the stomach is removed, the surgeon usually reshapes the remaining part of the stomach into a tube and joins the stomach tube to the remaining part of the esophagus in the neck or chest. Or, a piece of large intestine or small intestine may be used to connect the stomach to the remaining part of the esophagus.

If the entire stomach needs to be removed, the surgeon will use a piece of intestine to join the remaining part of the esophagus to the small intestine.

The same surgery for the Esophagus (food pipe) can be done by Minimal Invasive Technique (Key whole surgery). Thoracoscopically the Esophagus is mobilized and is replaced with a stomach tube and is joined in the neck with upper part of the food pipe. This has revolutionized treatment of esophageal cancer and does not need large incisions and patients are discharged early with morbidity and almost zero mortality.

Radiation Therapy

Radiation therapy is an option for people with any stage of esophageal cancer. The treatment affects cells only in the area being treated, such as the throat and chest area.

Radiation therapy may be given before, after, or instead of surgery. Chemotherapy is usually given along with radiation therapy.

Doctors use two types of radiation therapy to treat esophageal cancer. Some people receive both types:

  • Machine outside the body: The radiation comes from a large machine. This is called external radiation therapy. The machine aims radiation at your body to kill cancer cells. It doesn’t hurt. You’ll go to a hospital or clinic, and you’ll lie down on a treatment table. Each treatment session usually lasts less than 20 minutes. Treatments are usually given 5 days a week for several weeks.
  • Radioactive material inside the body (brachytherapy)

 

The side effects of radiation therapy depend mainly on the type of radiation therapy, how much radiation is given, and the part of your body that is treated.

External radiation therapy aimed at the chest may cause a sore throatcough, orshortness of breath. These problems usually go away when treatment ends.

External radiation therapy can harm the skin. It’s common for the skin in the chest area to become red and dry and to get darker. Sometimes the skin may feel tender or itchy. After treatment is over, the skin will heal.

You’re likely to become tired during external radiation therapy, especially in the later weeks of treatment. Although getting enough rest is important, most people say they feel better when they exercise every day. Try to go for a short walk, do gentle stretches, or do yoga.

Chemotherapy

Most people with esophageal cancer get chemotherapy. It may be used alone or with radiation therapy.

The side effects depend mainly on the drugs given and amount of chemotherapy that you get. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you’re more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. They may also give you medicines that help your body to make new blood cells.
  • Cells in hair roots: Chemotherapy may causehair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive tract: Chemotherapy can cause a poor appetite,nausea and vomiting,diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.

 

Other possible side effects include a skin rashjoint pain, tingling or numbness in your hands and feethearing problems.

Targeted Therapy

People with esophageal cancer that has spread may receive a type of treatment called targeted therapy. This treatment can block the growth and spread of esophageal cancer cells.

Targeted therapy for cancer of the esophagus is usually given intravenously.

During treatment, your health care team will watch you for side effects. You may get diarrheabelly pain, heartburn, joint pain, tingling arms and legs, or heart problems. Most side effects usually go away after treatment ends.

 

Nutrition

It’s important for you to be well nourished before, during, and after cancer treatment. Being well nourished may help you feel better, have more energy, and get the most benefit from your treatment.

However, esophageal cancer and its treatment can make it hard to be well nourished, and it may be hard for you to not lose weight. For many reasons, you may not feel like eating. For example, you may have nausea or trouble swallowing, and the foods you used to like to eat could now cause discomfort.

If you’re unable to eat, special treatments or other ways of getting nutrition may be needed. If the cancer in your esophagus makes it very hard to swallow food, your health care team may suggest that you have radiation therapy to shrink the tumor. Or, they may suggest that a plastic or metal mesh tube (stent) be put in your esophagus to keep it open. Another option is for you to receive nutrition through a feeding tube. Sometimes, intravenous nutrition is needed.

Nutrition After Surgery

If your stomach is removed during surgery for esophageal cancer, you may develop dumping syndrome. After meals, people with dumping syndrome may have cramps, nausea, bloatingdiarrhea, and dizziness.

If you have dumping syndrome, a registered dietitian can help you learn how to be well nourished without making your symptoms worse. Here are some tips for preventing or controlling the symptoms of dumping syndrome:

  • Try to eat at least 6 small meals each day.
  • Sit up during meals and for at least 30 minutes afterward.
  • Chew food very well.
  • Eat mostly solid meals, and drink liquids between meals.
  • Avoid very sweet foods anddrinks.
  • After surgery, ask your health care team whether you need a dietary supplement, such as calcium or vitamin B12.

Follow-up Care

You’ll need regular checkups (such as every 3 to 6 months) after treatment for cancer of the esophagus. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, contact your doctor.

Checkups may include a physical exam, blood tests, chest x-rays, CT scans, endoscopy, or other tests.

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