What is Esophageal Cancer?
The esophagus is a part of the digestive system that connects the throat (pharynx) to the stomach. It is located between the trachea and the spine, measuring approximately 25 cm (9.8 inches) in length, 2-3 cm (0.8-1.2 inches) in diameter, and 4 mm (0.16 inches) in wall thickness. Its primary function is to transport swallowed food to the stomach. The esophageal wall consists of mucosa and muscle, but unlike other organs, it lacks a protective membrane surrounding the muscle, making it easier for cancer to spread.
Esophageal cancer originates from the mucosal lining of the esophagus, forming a tumor that grows and may ulcerate. As the tumor enlarges, it can invade surrounding organs such as the bronchi, aorta, pericardium, and pleura. Advanced esophageal cancer can spread to nearby lymph nodes (in the neck or abdomen) and distant organs like the liver, lungs, and bones via the bloodstream.
Symptoms of Esophageal Cancer
- Feeling of food obstruction when swallowing
- Tingling or burning sensation in the esophagus
- Chest pain and back pain
- Unintentional weight loss
- Coughing during meals
- Hoarseness
- Asymptomatic in early stages
Diagnosis
- Barium Swallow X-ray: A contrast-enhanced X-ray to examine the esophagus.
- Esophagoscopy (Endoscopy): A direct visual examination of the esophagus using a flexible camera.
- Ultrasound and CT Scan: To assess tumor size and metastasis.
- Blood Tests and X-rays: Used for staging and surgical evaluation.
Treatment of Esophageal Cancer
Treatment options include surgery, radiation therapy, chemotherapy, and additional methods such as hyperthermia therapy and immunotherapy, depending on the patient’s condition.
Surgical Treatment
Surgery involves removing the affected
section of the esophagus along with surrounding lymph nodes and tissues. The remaining esophagus is typically connected to the stomach. In some cases, a portion of the colon may be used to create a new esophageal passage. If the tumor completely obstructs the esophagus and cannot be removed, an alternative route may be created for food intake, or the esophagus may be widened through repeated procedures.
Radiation Therapy
Radiation therapy uses high-energy rays to destroy cancer cells and prevent tumor growth. It can be applied before surgery to shrink the tumor, after surgery to eliminate residual cancer cells, or as a primary treatment if surgery is not an option. Treatment usually involves five sessions per week, often on an outpatient basis. Internal radiation therapy may require a short hospital stay.
Chemotherapy
Chemotherapy involves the use of anti-cancer drugs to destroy cancer cells. It is primarily used when the cancer has metastasized to other organs. It can be administered alone or combined with radiation or surgery. Chemotherapy is a systemic treatment, meaning the drugs travel through the bloodstream to reach cancer cells throughout the body. The regimen consists of treatment cycles with rest periods in between. Side effects may include mouth ulcers, nausea, vomiting, and hair loss, which generally subside after treatment.
Hyperthermia Therapy
This method targets cancer cells, which are sensitive to heat, by raising the tumor temperature to 43°C (109.4°F) to induce cell death. Hyperthermia therapy is often combined with radiation or chemotherapy to enhance treatment effectiveness.
Photodynamic Therapy
This technique involves administering a light-sensitive drug that remains in cancer cells longer than in normal cells. After 24-72 hours, a specialized light is applied to the tumor, activating the drug to produce toxic substances that destroy the cancer cells.
Endoscopic Mucosal Resection (EMR)
For small tumors (2.0-3.0 cm or less) confined to the inner lining of the esophagus, endoscopic mucosal resection is used to remove the cancerous tissue with minimal invasiveness.
Esophageal Stenting
For patients unable to undergo surgery, a stent (a tube made of silicone or metal) may be inserted into the esophagus to keep it open and allow food passage.
Side Effects, Management, and Prognosis
Surgery remains the primary treatment for esophageal cancer, with the 5-year survival rate significantly improving in the last decade, reaching nearly 50%. However, if the cancer has spread to multiple lymph nodes or distant organs, recurrence within 1-2 years after surgery is common. Early detection is crucial for successful treatment outcomes. Therefore, it is essential to pay close attention to esophageal health in daily life.
