The esophageal Carcinoma is the hollow, muscular tube about 25 cm in length, which serves as a conduit for the passage of fluids and food from the pharynx to the stomach. It is located in the back of the chest and in front of the spine. Passage of food through the esophagus occurs involuntarily without the knowledge of the person but may be felt when ingesting food of bigger size, when we eat too quickly or when we drink fluids which are too hot or too cold. Contraction of the esophageal muscles helps in propelling the food towards the stomach, also known as peristalsis. The esophagus has two sphincters (one at the lower end and the other at the upper end) when we eat food the sphincters relax and allows food to pass into the stomach and it contracts when food reaches the stomach preventing the reverse flow into the esophagus.
Esophageal carcinoma is the malignant tumor arising from the lining epithelium of the esophagus. It is 4 times more common in male than in females. Most of the people suffering from esophageal cancer remain symptoms less for years. It shows symptoms very late and is often diagnosed in the terminal stages.
Types of Esophagus Carcinoma
There are two types of Esophageal Carcinoma are:
- Squamous cell carcinoma
Squamous cell carcinoma arises from the part of the esophagus lined by the stratified squamous cells, i.e. mainly in the upper third of the esophagus.
Adenocarcinoma arises the part of the esophagus lined by simple columnar cells, i.e. in the lower third of the esophagus.
Risk factors for esophagus carcinoma
The exact cause of the esophageal carcinoma is still unknown to us despite the advancement of science and technologies. However, researchers have identified some risk factors which show strong links to esophageal cancer.
The risk factor is not a cause, but these factors are present in the most of the cases of esophageal cancer. People having the risk factors more likely develop esophageal cancer. The chances of people not suffering from esophageal carcinoma in the presence of the risk factors are present too.
Some risk factors which have a direct association with the esophageal cancer are as follows:
Use of the tobacco in the form of chewing or smoking increases the risk for the squamous cell carcinoma. Smoking for a long period of time or smoking large number cigarettes in a day increases the risk for esophageal cancer.
- Alcohol abuse
Consumption of a large amount of alcohol or consumption of alcohol for the long period of time increases the risk of esophageal cancer mainly squamous cell carcinoma.
People Smoking tobacco, along with drinking alcohol have a double risk of esophageal cancer than in person consuming only one of these two.
- Chewing Betelnut
Chewing betel nut is a common lifestyle in some parts of Asia such as India, Bangladesh, Nepal etc. This habit may lead to squamous cell cancer of the esophagus.
It is a motility disorder of esophagus in which the lower esophageal sphincter fails to relax resulting in accumulation of the food and fluid in the lumen of the esophagus.
- Barret’s esophagus
It is a clinical condition in which the lining if the esophagus is converted from the stratified squamous epithelium to the simple columnar epithelium due to chronic exposure of the lower esophagus to the refluxed gastric acids.
Barrett’s esophagus is caused by
- Gastroesophageal reflux disease (GERD): It is a clinical condition in which the gastric acids flow back into the esophagus.
- Obesity: when fat accumulates in the center of the abdomen, it increases the risk of gastroesophageal reflux diseases
These over a long period of time causes Barrett’s esophagus.
Symptoms of Esophageal Carcinoma
Patients may not have symptoms in the early stage of esophageal cancer or it may present with the symptoms like heartburn, chest pain, Foreign body sensation, dyspepsia, iron deficiency anemia etc.
Progressive dysphagia (inability to swallow solid food followed by inability to swallow the fluids ) is the most common symptom of esophageal cancer.
Signs of Esophageal Carcinoma
Esophageal cancer may not reveal any signs in the early stages. Moreover, esophagus lies in the bony thorax that’s why physical examination may be used only when it has spread to the lymph nodes above the clavicle and below the jaw or liver which may be palpable then.
Diagnosis of Esophageal Carcinoma
Diagnosis starts with the symptoms of the patients, clinical examination of the abdomen and the lymph nodes and is confirmed by the following investigations.
- Upper gastrointestinal endoscopy
A thin, flexible tube containing the camera is inserted into the esophagus through the oropharynx to visualize the lining of the esophagus stomach and the duodenum. If abnormal changes are seen biopsy is done is sent to the lab for the histopathological examination.
- Radiological examination
Barium swallow X-ray: you are asked to drink a special fluid which will be bright in the X-ray. X-ray shows the irregular filling defect, shoulder effect, above dilatation and below rat tail appearance.
CT scans of the chest and abdomen are preferred nowadays to see the extent of esophageal cancer.
Treatment of Esophageal Carcinoma
Surgery is the best modality if the treatment and is curative in the majority of the cases. Chemotherapy and radiotherapy along with the surgery are the three options available to treat esophageal cancer.
According to the location, treatment can be done as follows:
- Cancer of Lower third of esophagus
Surgical excision followed by the anastomosis with the stomach (esophagus – gastrostomy) is the treatment of choice. Excision of the malignant part of the esophagus and reconstruction by the stomach jejunum or transverse colon may also be performed.
- Cancer of the middle third of the esophagus
Radiotherapy is the treatment of choice in the carcinoma of the middle third of the esophagus. Radiotherapy means a use of high energy radiation to kill the cancer cells.
- Cancer of the upper third of the esophagus
Radical excision followed by the colonic transplantation ( pharngo-esophageal-laryngectomy)
Use of the drugs to kill the cancer cells constitute the chemotherapy. Drugs such as Cisplatin, 5-fluorouracil, epirubicin are given before and after surgery known as perioperative chemotherapy for treatment of the adenocarcinoma of the esophagus which is locally advancing.
Prevention of the esophageal carcinoma
Esophageal carcinoma can be prevented with by following measures:
- Cessation of smoking.
- Avoiding consumption of alcohol, caffeine, chocolates as much as possible.
- Limiting the consumption of the fatty foods
- Obese people should start losing weight from the word go by controlling diet as well as involving in physical activity.
- Avoid carbonated drinks such as coca cola, Fanta etc.
- Eat plenty fruits and vegetables.
- Reduce consumption of the nonsteroidal anti-inflammatory drugs such as ibuprofen and if not possible, take with anti ulcers such as omeprazole, rabeprazole etc.
- To maintain the gastric juice in its anatomical position try to sleep in a tilted bed where the top half of your body is about 10 to 15 cm above the lower half.
- Sleep on the left side of the body. When we sleep on the right side of the body stomach is in a position higher than the esophagus which may apply pressure to the lower sphincter of the esophagus to relax and hence the acids fro stomach reach the esophagus. So to prevent it stop sleeping on the right side.