Esophageal Cancer And Its Treatment

Esophageal carcinoma was first described in the 19^th century, and the first surgical resection was done by Frank Torek in 1913. Esophageal carcinoma arises in the mucosa of the esophagus. The esophagus is a 10 shuffle long tube that connects the throat with the stomach. There are two types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. If not treated, esophageal cancer can invade the submucosa and muscular layers of the esophagus and eventually spread to local structures such as the aorta, recurrent laryngeal nerve, tracheobronchial tree, the liver and lungs.

What is the incidence of esophageal cancer?

Esophageal cancer is infrequent. In 2008 the CDC reported 16,470 cases of esophageal cancer and 14,280 deaths.

What are the risk factors for esophageal cancer?

Risk factors for esophageal cancer include age (more likely in persons over 60), more current in male, smoking (the most important risk factor after age), alcohol use, barrett’s esophagus, history of swallowing lye or other caustic substance, history of head and neck cancer.

What is Barrett’s Esophagus?

Barrett’s esophagus is caused by long term gastric reflux. Medically and histologically speaking, it is when the cells on the distal esophagus change in histology to cells in the stomach due to the constant irritation to the stomach acid. The importance of Barrett’s esophagus is that it is a premalignant condition that could lead to adenocarcinoma of the esophagus.

What are the symptoms of esophageal carcinoma?

1. Dysphagia – Difficult swallowing first to solid then to liquids.
2. Weight loss- second most common symptom
3. Pain- usually the pain is felt in the epigastric and retrosternal area.
4. Hoarseness- means unresectability due to invasion of the recurrent laryngeal nerve.

What are the current recommendations for screening and surveillance?

Screening: no acceptable screening method. The American College of Gastroenterology guidelines suggest that patients with long tern gastric reflux are more likely to have Barrett’s Esophagus and should undergo endoscopy.

Surveillance: recommended in patients with Barrett’s esophagus.

How is esophageal cancer diagnosed?

Endoscopy and biopsy

How is esophageal cancer staged?

Staging is extremely important for prognosis and treatment come. CT scan and endoscopic ultrasound are the two exams use for staging. Endoscopic ultrasound is the most sensitive test for staging and to determine the penetration of the tumor. Bone scan is indicated in patients with complaint of bone wound.

What are the alternatives for treatment of esophageal cancer?

There are five treatment options depending on stage of the tumor.

1. Surgery- the most common type used. It is used in stage 0, I, II and III cancer.
2. Radiation- used in stage I, II and III.
3. Chemotherapy- used in stage II,III and IV
4. Laser therapy and electrocoagulation- used in Stage IV to relief symptoms.

Sources:

1. GI liver secrets third edition
2. National Cancer institute
3. My occupy experience as a Gastroenterology.

Tags: adenocarcinoma colon prognosis, adenocarcinoma esophagus prognosis, adenocarcinoma pancreas prognosis, adenocarcinoma prognosis, adenocarcinoma stage 4 prognosis, pancreatic adenocarcinoma prognosis

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