Esophagus cancer: about, risks, symptoms, diagnosis, stages, treatments

Zellos Lambros
Zuletzt aktualisiert: Fr, 08/12/2017 - 23:52

M.D, M.P.H Thoracic Surgeon, Instructor in Surgery Harvard Medical School

General information about cancer of the esophagus  

Cancer of the esophagus is a disease in which malignant (cancer) cells form in the tissues of the esophagus.

The esophagus is the hollow, muscular tube that moves food and liquids from the throat to the stomach. The wall of the esophagus is composed of several layers of tissue, including mucosa, muscle and connective tissue. The cancer starts from the lining of the esophagus and spreads outward to the other layers as it grows.

The two most common forms of cancer of the esophagus are named from the type of cells that become malignant:
• Squamous cell carcinoma: Cancer that originates from the squamous cells of the esophagus. This cancer is most common in the upper and middle esophagus but can occur anywhere along the esophagus.
• Adenocarcinoma: Cancer that starts at glandular (secretory) cells of the lining of the esophagus and produce liquid and mucus. Adenocarcinomas are usually at the bottom of the esophagus near the stomach.

Risk factors include:
• Smoking.
• Heavy alcohol use.
• Barrett’s esophagus: A situation in which the cells lining the bottom of the esophagus have changed or have been replaced with abnormal cells that could lead to esophageal cancer. Gastric reflux can irritate the esophagus and, over time, cause Barrett’s esophagus.
• Increasing age.
• Male gender
• Afro-American race


Symptoms:
The most common symptoms of esophageal cancer are painful or difficult swallowing and weight loss. These and other symptoms may be caused by esophageal cancer or other conditions. You should consult a doctor if any of the following problems occur:
• Painful or difficulty swallowing.
• Weight loss.
• Pain behind the breastbone.
• hoarseness and cough.
• Indigestion and heartburn.

Tests and procedures to detect, diagnose, and stage
The procedure used to determine if cancer cells have spread within or outside the esophagus called staging. It is important to know the stage in order to plan treatment. Certain factors affect prognosis and treatment options such as:
• The stage of cancer (if it affects part of the esophagus, involves the whole esophagus, or has spread to other parts of the body).
• The size of the tumor.
• the general health of the patient.
When cancer of the esophagus is too early, there is a better chance of recovery.
The appropriateness of each test depending on the clinical scenario and the physical condition of the patient.

The following tests and procedures may be used:

History and Physical examination.

Chest radiograph.

Barium swallow: A series of radiographs of the esophagus and stomach. The patient drinks a liquid containing barium (a silver-white metallic compound) and X-rays are taken.

EGD: A procedure to look inside the esophagus to check for abnormal areas. A esophagoscope (a thin, lighted tube) is inserted through the mouth and throat into the esophagus. Tissue samples can be taken for biopsy.

Endoscopic ultrasound (EUS): A procedure in which a special endoscope is used to bounce high-energy sound waves (ultrasound) on the wall of the esophagus. This process helps in determining the local spread of the tumor.

Computed tomography (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body taken from different angles. The images made by a computer linked to an X-ray device, a dye may be injected into a vein or swallowed to help the organs or tissues show more clearly. This is also called computed tomography, computerized tomography, or CT scan.

PET scan (positron emission tomography scan): A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is used in the body. Malignant tumor cells appear brighter in the picture because they are more active and take up more glucose than normal cells.

Biopsy: The removal of cells or tissues to be examined under a microscope for cancer cells. The biopsy is usually done during a esophagoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but may lead to cancer.

Thoracoscopy: The surgical procedure to examine the organs inside the chest to check for abnormal areas. An incision is made between the two sides and thoracoscope (a thin, lighted tube) is inserted into the chest. Samples of tissue and lymph nodes can be removed for biopsy.

Laparoscopy: A surgical procedure to examine the organs inside the abdomen to look for signs of disease. A laparoscope (a thin, lighted tube) is inserted into one of the incisions made in the abdominal wall and tissue samples and lymph nodes can be removed for biopsy.

Stages of cancer of the esophagus:

Stage 0 (carcinoma in situ)
In stage 0, abnormal cells found in the innermost layer of tissue lining the esophagus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I
In stage I, cancer has formed and spread beyond the inner layers of tissue to the next layer in the wall of the esophagus.

Stage II
• Stage IIA: Cancer has spread to the muscle layer of the esophagus or on the outside wall of the esophagus.
• Stage IIB: Cancer may have spread to any of the first three layers of the esophagus and nearby lymph nodes.

Stage III
In stage III, cancer has spread to the outer wall of the esophagus and may have spread to tissues or lymph nodes near the esophagus.

Stage IV
• Stage IV A.: Cancer has spread to nearby or distant lymph nodes.
• Stage IVB: Cancer has spread to distant organs or lymph nodes of other organs.

Cancer relapse
The cancer may come back into the esophagus or other body parts.

Treatment, Selection& Review by Stage
There are several types of treatment for patients with esophageal cancer.
Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, nad medical team.

Surgery
Surgery is the most common treatment for esophageal cancer. Part of the esophagus can be removed in an operation called esophagectomy. The surgeon will connect the remaining healthy part of the esophagus to the stomach so the patient can still swallow. Lymph nodes near the esophagus may also be removed and examined under a microscope for cancer.

Radiotherapy
Radiotherapy is a cancer treatment that uses high energy X-rays or other radiation to kill cancer cells. There are two types of radiotherapy. External radiation therapy uses a machine outside the body to send radiation to cancer. Internal radiation therapy uses a radioactive substance in needles, seeds, wires, or catheters placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of cancer treatment. If the esophagus is blocked in part by the tumor, an expanded metal stent (tube) may be placed inside the esophagus to keep open during radiation therapy. This is called intraluminal intubation and dilation.

Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping by the division of cells. When chemotherapy is taken by mouth or by injection into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ or body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is dependent on the type and stage of cancer treatment.

Laser Treatment
Laser treatment is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Treatment by Stage
Stage 0 (carcinoma in situ)
Treatment of stage 0 is usually surgery.

Stage I esophageal cancer
Treatment may include:
• Surgery.
• Clinical trials of chemotherapy plus radiotherapy with or without surgery.
• Clinical trials of new therapies used before or after surgery.

Stage II esophageal cancer
Treatment of stage II esophageal cancer may include the following:
• Surgery.
• Clinical trials of chemotherapy plus radiotherapy with or without surgery.
• Clinical trials of new therapies used before or after surgery.

Stage III esophageal cancer
Treatment of stage III esophageal cancer may include the following:
• Surgery.
• Clinical trials of chemotherapy plus radiotherapy with or without surgery.
• Clinical trials of new therapies used before or after surgery.

Stage IV esophageal cancer
Treatment of stage IV esophageal cancer may include the following:
• External or internal radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
• Laser surgery or electrocoagulation as palliative therapy to relieve symptoms and improve quality of life.
• Chemotherapy.
• Clinical trials of chemotherapy.

Treatment options for relapse of cancer of the esophagus
Treatment may include:
• Use of any standard therapy, as palliative therapy to relieve symptoms and improve quality of life.

 

 

 

 

 

 

Info:

Lambros Zellos

MD MPH American Board of Thoracic Surgery Certified

American Board of Thoracic Surgery Certified
 

Dr.  Lambros Zellos  (lzellos@post.harvard.edu)   is a highly qualified thoracic surgeon and researcher with experience in studying mesothelioma, the cancer that affects the pleura and other membranes within the body's cavities.

He was trained at Harvard, and practiced thoracic surgery for a number of years at the Brigham & Women’s Hospital (the busiest thoracic surgery division of the Harvard Medical School with over 2800 thoracic procedures annually) at the rank of Instructor in Surgery.
 
Dr Zellos performed lung and esophageal resection, as well as lung transplants. He was named one of Boston’s 2007 top thoracic surgeons as voted by his peers. He treats thoracic malignant and benign disease, and specializes in the use of minimally invasive techniques that avoid painful rib spreading, also known as VATS (video-assisted thoracoscopic surgery).