Esophagus cancer

The esophagus is the tube of the digestive tract that connects the pharynx with the stomach. It descends from the neck through the mediastinum and passes through the diaphragm to enter the abdominal cavity and join the stomach. Its interior is lined by flat cells that form various layers and underneath them there is a layer of muscle cells that allow the esophagus to contract and through peristalsis to advance food.

How is it produced?

Between 85% and 90% of esophageal cancers are of the epidermoid or squamous type, that is, generated from the flat cells that line the inner surface of the esophageal duct. Approximately half are located in the middle third of the esophagus, while 35% occur in the lower third and 15% in the lower third.

Esophageal cancer affects 5 out of 100,000 people and the main risk factors are alcohol and tobacco use. Other risk factors are the ingestion of very hot food, the radiation esophagitis or the ingestion of caustic substances. There are other disorders that can predispose to squamous cancer of the esophagus, such as Plummer-Vinson syndrome, achalasia or certain thyroid disorders.

15% of esophageal cancers are adenocarcinomas, that is, they occur on tissues that contain glands. Most of these esophageal cancers settle on altered esophageal tissue due to gastroesophageal reflux, known as Barrett's esophagus. On the other hand, these types of cancers have also been linked to alcohol and tobacco, as has squamous esophageal cancer.

Esophageal cancer usually spreads contiguously to neighboring structures, as well as through the lymphatic pathway, especially at the left supraclavicular level. Likewise, it can lead to distant metastases in other organs, mainly in the liver, lung or pleura.

Symptoms

Most of these lesions, since they occupy a space within the esophageal duct, produce a difficulty in swallowing, a mechanical dysphagia, which is initially due to solid foods but that as the lesion grows it also becomes evident with the intake of food liquids. Dysphagia, with the passage of time, can also be motor, due to alteration of the swallowing mechanisms, which is known as achalasia. Difficulty feeding leads to significant weight loss with consequent asthenia.

Likewise, odynophagia, chest pain, regurgitation, vomiting, hypersalivation, or hiccups may occur. Due to the bleeding that can occur in the tumor mass, a state of anemia can be established.

Occasionally fistulas into the respiratory system can occur. This fact and the alteration of the swallowing mechanisms can lead to episodes of bronchoaspiration, with the consequent affectation of the airway and possible secondary respiratory infections. The esophageal tumor can compress various nerves adjacent to it, giving different symptoms depending on which nerve it compresses. If it affects recurrent nerves it can affect speech, giving what is known as a two-tone voice. If it affects the phrenic nerves, it can lead to dyspnea. In case of compressing fibers of the sympathetic nervous system, it can lead to Horner syndrome.

Diagnosis

Unfortunately, most of the time, this cancer is not diagnosed until the patient has symptoms of dysphagia, a fact that implies that the tumor is already advanced. Esophageal cancer should be suspected in all patients who report symptoms of dysphagia and present a picture of weight loss, asthenia, and lack of appetite.

Barium contrast radiography shows approximately 80% of esophageal cancers. However, since some lesions are very small, it is always appropriate to perform an endoscopy to be able to biopsy the lesion and thus obtain the definitive diagnosis.

Likewise, a chest radiograph, endoscopic ultrasound, and computerized axial tomography (CT) should be performed to determine the extent of the tumor. If the cancer occurs in the upper two-thirds of the esophagus, a bronchoscopy is necessary to determine whether surgical removal of the tumor is feasible.

Treatment

In principle, the primary therapeutic option would be surgery, especially in tumors smaller than 5 cm and that are not invasive. If the tumors were larger than this or were invasive, it could be considered to treat them by surgery or radiotherapy.

The surgery consists of the removal of the esophagus, as well as the adjacent nodes that could be affected by the disease. In the same intervention, the duct would be reconstructed by means of a gastroplasty, that is, the stomach would be used and it would be surgically altered, giving it the shape of a tube to join it to the pharynx area and allow the passage of food. In case of not being able to use the stomach due to previous surgeries or gastric problems, a portion of the colon could be used.

In cases where the tumor is disseminated, radiotherapy is usually chosen as treatment. Palliative surgical interventions can be performed, such as dilations or endotumoral prostheses (through the tumor).

However, despite surgical options, the 5-year survival of patients with esophageal cancer is not very high.

Precautionary measures

The main preventive actions to avoid esophageal cancer are to avoid its main risk factors, that is, alcohol and tobacco. Similarly, it is important to avoid excessively hot meals on a regular basis and certain substances such as nitrosamines. In case of suffering from gastroesophageal reflux, a fact that can condition the appearance of adenocarcinoma of the esophagus, it is advisable to visit a digestive specialist periodically for follow-up.