Esophageal Cancer

Esophageal Cancer Definition

To understand esophageal cancer, it’s important to understand the functions of the esophagus. The esophagus is a long tube running from the throat to the stomach. It is hollow inside, so when swallowing it moves food from the back of the throat to the stomach where it can be digested.

Esophageal cancer is a cancer that occurs anywhere in the esophagus, although it usually starts in the cells that line its interior. This cancer can spread to nearby tissue or even metastasize (spread) to distant organs, lymph nodes, or tissues far away from the esophagus. As the sixth most deadly cancer, it’s important to understand how to prevent and treat this terrible disease.

Esophageal Cancer Stages

Staging is the process of figuring out how much cancer is in the patient’s body, and if the esophageal cancer has spread. Staging will also take into account how much the cancer has spread. In other words, a series of tests will determine how serious the esophageal cancer is, and provide doctors with a template for treatment and a prognosis for the patient.

At first, staging seems very confusing because it appears to be written in code. In its simplest terms early stages of cancer have a lower numeric value while advanced cancers have a higher value. Stage 0 esophageal cancer is in the earliest stage, and Stage IV esophageal cancer is in its most advanced stage.

It’s important to note that every patient’s cancer is unique. If you have esophageal cancer, it is entirely unique to your body. Still, doctors will use cancer staging to select treatments that have the best chance of working, based on historical data. This is why some treatment protocols work for some patients, yet fail to work for others.

Breaking the esophageal cancer staging code
Doctors use the TNM system to stage esophageal cancer, which is a system created by the American Joint Committee on Cancer. This system uses three pieces of information to assess esophageal cancer, abbreviated with a single letter. These are broken down as follows.

• T – Tumor – This factor determines how far the cancer has grown into the wall of the esophagus, and whether it’s spread to nearby organs or tissues.

• N – Nodes – This factor determines whether the esophageal cancer has spread to any lymph nodes in the vicinity of the esophagus.

• M – Metastasis – This factor determines whether the cancer that originated in the esophagus has spread to distant organs or lymph nodes.

Each letter will be followed by a numeric value that offers doctors more specific details about each of the various topics. Staging for esophageal cancer is unique because it can be treated in different ways. For this reason, there are different staging systems used for each individual situation.

The surgical stage (pathological stage) – Most cases of esophageal cancer require surgery when it’s first detected. The surgical stage is determined by thoroughly examining the tissue removed from the patient during this surgery. Because surgery is so common, this is the most common staging system used by physicians.

The clinical stage – In some situations, surgery isn’t possible. Sometimes it’s done after treatment is provided. In these cases, the results of a biopsy, physical exam, and imaging tests are complied to create the clinical stage. This is not as accurate as the surgical stage, so it has limitations for use because the cancer may have spread further than the test is capable of calculating.

The postneoadjuvant stage – If the patient receives chemotherapy or radiation therapy before surgery is performed, a postneoadjuvant stage is determined after the surgery is completed.

Doctors will also look at their patient’s esophageal cancer under a microscope to get a better look at the tissue. They will then assign the cancer a grade with low grade cancers less likely to grow and spread than high grade cancers. These grades are broken down as follows.

• GX – This means the grade is unknown
• Grade 1 – This means the cancer cells are relatively close in appearance to normal esophagus tissue
• Grade 2 – This means the cancer cells appear somewhere between normal and very abnormal
• Grade 3 – This means that the cancer cells appear very abnormal

The location of certain cancers within the esophagus may also be included in the grading, which will read as either upper, lower, or middle. Obviously, these designations correspond to those areas in the upper, lower, and middle parts of the esophagus.

Is the esophageal cancer unresectable or resectable?
Staging is obviously a very complex process with a host of variables that must be weighed to create a comprehensive look at the prognosis and determine a treatment protocol with the best chance of success.

Doctors are often interested I whether the esophageal cancer is unresectable or resectable, which means whether it’s inoperable or operable. Usually, if the cancer has spread too far for it to be entirely removed, it is considered unresectable. For the most part, Stage 0 through Stage II esophageal cancers are resectable, as are some Stage III cancers. However, if the patient isn’t in good health, they may not be able to undergo surgery.

If the cancer has spread to lymph nodes or organs in distant parts of the body, it is considered unresectable. In these cases, other treatments will be necessary.

Esophageal Cancer Symptoms (signs of Esophageal cancer)

There are specific symptoms of esophageal cancer that help doctors find it when a patient exhibits them. If a patient does not have any symptoms, finding the cancer is not only rare, it’s usually accidental. Unfortunately, many patients with esophageal cancer do not experience symptoms until the cancer is in an advanced stage. This makes the cancer more difficult to treat.

What follows is a breakdown of the most common symptoms and signs of esophageal cancer. If you are experiencing any of these symptoms, you should speak with your doctor right away.

Sign #1 – Trouble Swallowing
Having trouble swallowing is the most common symptom associated with esophageal cancer. Patients with this symptom may get the feeling like their food is stuck in the back of their throat, or may even gag or choke after swallowing. At first, the symptom may be mild, but as the esophagus’s opening gets smaller, symptoms will get worse.

Many patients are unaware that their swallowing problem is being caused by the early stages of esophageal cancer. They take smaller bites of food and chew slower, but the problem still gets worse over time. Meat is more likely to get stuck, so they stop eating this food. Some may even stop eating anything other than soft foods and liquids. If the cancer keeps growing, eventually liquids will be hard to swallow.

In an effort to help food pass through the esophagus, the body produces more saliva to act as a lubricant. This may lead patients to complain that they’re coughing up a lot of mucus, which is another sign of esophageal cancer.

Sign #2 – Chest Pain
Some patients suffering from esophageal cancer complain of discomfort or pain in their chest. They may even describe it as a burning sensation or pressure in the middle part of the chest. The patient naturally believes that they simply have heartburn, so they aren’t even concerned about whether they may have cancer.

Sign #3 – Weight Loss
For about 50% of patients with esophageal cancer, unexplained weight loss is a symptom. They may lose weight because of their problem swallowing or because the cancer is causing to lose their appetite. Others may lose weight because the cancer causes their metabolism to increase.

Other common symptoms related to esophageal cancer
While the three symptoms listed above are the most common, there are some other symptoms that may also indicate a problem. These symptoms include:

• Chronic coughing
• Hoarseness
• Hiccups
• Pain in the bones
• Vomiting
• Sore throat
• Black stool (from bleeding into the esophagus)
• Anemia (caused by blood loss)
• Fatigue or tiredness

Just because a patient exhibits any of the aforementioned symptoms does not mean that they have esophageal cancer. In fact, many of these symptoms are more common with other illnesses. But if you’re having trouble swallowing or are worried that your symptoms could be because of cancer, you should schedule an appointment with you doctor.

Esophageal Cancer Statistics

When assessing your personal health, statistics can be misleading. Still, information regarding your risk of getting esophageal cancer, and your chances of beating it, can help you decide on treatment and offer some hard data based on your gender and age.

It is estimated that in 2018, more than 13,400 men and more than 3,800 women will be diagnosed with esophageal cancer. That is a total of more than 17,200 patients, of which about 15,800 will die from the disease. About 1 in 132 men and 1 in 455 women will be diagnosed with esophageal during their lifetime. This represents a slight decrease over the last few years when compared with historical data.

White men are more likely to be diagnosed with esophageal cancer than black men, but that gap has been closing over the last ten years. However, white men are more likely to be diagnosed with adenocarcinoma, and black men are likely to be diagnosed with squamous cell carcinoma. Other races have lower rates of esophageal cancer.

In the United States, esophageal cancer makes up only one percent of all diagnosed cancers, but this number is far larger in other parts of the world, especially Asia and Africa. Only 40 years ago, only about 5% of patients diagnosed with esophageal cancer lived five years after developing the disease. Today, that number has risen to 20%. The earlier the cancer is diagnosed, the better odds the patient has for survival.

If the esophageal cancer is localized, which means it’s only growing in the esophagus, the rate of survival jumps to 43%. If the cancer is regional, which means it’s only spread to nearby tissues and lymph nodes, the rate of survival is 23%. If the cancer has spread to distant lymph nodes or organs, the rate of survival drops to 5%.

Patients with adenocarcinomas have a better outlook than those with squamous cell carcinomas, as a general rule. As mentioned above, statistical survival rates are based on large amounts of data and play no role in any individual’s situation. Your cancer is unique to your body, so it’s vital that you talk to your doctor about your health and treatment options.

Causes of Esophageal Cancer

While modern medicine is unable to say exactly what causes esophageal cancer, there are risk factors that make getting this terrible disease more likely. DNA is a chemical that resides in cells lining the esophagus. Some genes control cell behavior, telling them when to divide, grow, or die. Other genes slow down the division process or even make cells die at the right time. Esophageal cancer can be caused by alterations to the DNA that turn off these genes.

Scientists believe that tobacco and alcohol use can damage the DNA in the lining of the esophagus. DNA damage may also occur from:

• Achalasia
• Plummer-Vinson syndrome
• Reflux

It’s also possible to inherit DNA mutations from parents. However, esophageal cancer does not seem to be passed on from parents to children, so genetic factors are not believed to be a major reason for developing esophageal cancer.

When breaking down the various risk factors for esophageal cancer, it’s important to understand that some can be mitigated and others cannot. While a person can quit smoking, their age cannot be altered. Still, risk factors that can be changed show that there are certain ways for many people to reduce their risk of developing esophageal cancer. Studies show that there are certain factors that can increase a person’s risk of developing either squamous cell carcinoma or adenocarcinoma. Still, just because a person has multiple risk factors doesn’t mean they will develop the disease, while someone without any risk factors may develop the cancer.

The risk factors for esophageal cancer include:

Age – More than 85% of esophageal cancer cases occur in people over the age of 55.

Gender – Men are far more likely to develop esophageal cancer than men.

Acid reflux disease – Some people have a health issue which causes stomach acid to escape into the lower section of the esophagus. This problem is also called gastroesophageal reflux disease. This acid helps digest food, so it is very powerful. It may even cause pain or heartburn, but some people don’t experience any symptoms.

People with reflux are slightly more at risk of developing esophageal cancer. The more frequent the symptoms, the more likely they are to contract the disease. Still, reflux is quite common, and most people who suffer from the issue will never develop esophageal cancer.

Barrett’s esophagus – If acid reflux disease continues for a long period of time, the inner lining of the esophagus may become damaged. This will alter the cells in the lining of the esophagus with cells that are more resistant to the stomach acid. This is called Barrett’s esophagus.

Symptoms of the condition include heartburn, but many people won’t have symptoms of any kind. People who suffer from this condition are much more likely to develop adenocarcinoma of the esophagus, but most will not ever develop the disease.

The cells may become abnormal over time, which can lead to an even greater risk of developing esophageal cancer. This is called dysplasia, which is a pre-cancerous condition.

Alcohol and tobacco – The use of tobacco includes smoking cigarettes, pipes, cigars, and even chewing tobacco. Tobacco use is considered a major risk factor for esophageal cancer. A pack-a-day smoker is twice as likely to develop esophageal cancer as a non-smoker. If someone quits smoking, their risk of developing squamous cell carcinoma is reduced, but the risk of developing adenocarcinoma remains the same.

Consumption of alcohol also increases the risk of developing esophageal cancer, and the more a person drinks, the higher the risk factor. Combining the two habits raises the risk factor far more than using either of the substances by themselves.

Obesity – Overweight people have a higher chance of developing esophageal cancer than people who are weight proportionate. It is believed that this is because they are more likely to have acid reflux issues.

Diet – it is believed that some substances can increase the risk of esophageal cancer if they are a part of a person’s diet. These assertions are not proven, but it could explain why this cancer is so prevalent in certain countries.

While eating processed meat may be a risk factor for developing esophageal cancer, diets full of healthy fruits and vegetables are linked to lower risk. Some scientists believe that this is because these foods have certain vitamins and minerals that may prevent the onset of cancer.

Esophageal Cancer

It is also believed that drinking very hot liquids on a routine basis can damage the lining of the esophagus and increase the risk of cancer.

Achalasia – This is a condition where the muscle located in the lower part of the esophagus will not relax as it does in a normal body. This causes liquid and food to collect in the lower esophagus instead of traveling to the stomach. This causes it to become distended, irritating the cells because of prolonged exposure to the food. People suffering from this condition are far more likely to develop esophageal cancer.

Tylosis – This rare disease causes small growths in the esophagus. Even though it’s inherited, people with this condition have a high risk of developing esophageal cancer and should be monitored closely.

Work exposure – Exposure to certain chemicals and fumes could increase a person’s risk of developing esophageal cancer. It’s important to protect yourself from exposure to any potentially toxic chemicals or fumes at your workplace.

History of cancer – People who previously had any type of cancer are at higher risk of developing squamous cell carcinoma of the esophagus. These include mouth cancer, lung cancer, and throat cancers, which all happen to be cancers caused by smoking tobacco.

HPV infection – HPV stand for Human Papilloma Virus, which is a broad range of viruses. Some of them cause warts to grow, and have been linked to various cancers. Signs of HPV infection have been found in over 30% of esophageal cancer patients in Africa and Asia. However, this link doesn’t exist in the United States, which is difficult to explain.

If you are at higher risk for developing esophageal cancer, you should do your best to eat healthy and quit smoking and drinking. Be sure to talk to your doctor about how to lead a healthier lifestyle so you can minimize your risk of contracting this sometimes preventable disease.

Esophageal Cancer Screening and Prevention

Screening is a process where doctors test for cancers at regular intervals in an attempt to find the disease in its earliest stages. While there are some cancers that can be targeted using this method, screening for esophageal cancer is not practiced in the United States. However, patients with Barrett’s esophagus may seek routine endoscopic examinations when recommended by their doctor.

To prevent the onset of esophageal cancer, prevention is considered the best method. What are some of the things you can do to prevent developing this deadly disease?

Quit the use of tobacco and alcohol
The link from smoking and drinking to esophageal cancer are undeniable, especially when both habits are a part of a person’s lifestyle. Those who smoke and drink are far more likely to develop many other forms of cancer, so quitting smoking and limiting alcohol consumption makes good sense.

Eat right and exercise
A healthy diet and daily exercise will keep body weight under control, which is proven to reduce risk factors associated with esophageal cancer. Additionally, the vitamins that come from eating vegetables, greens, and fruits, may also help protect your body from developing esophageal cancer, and many other cancers. Keeping the immune system in top condition should be everyone’s primary goal, and healthy lifestyle is the key to achieving this goal.

Seek treatment for conditions that cause esophageal cancer
If you have acid reflux or Barrett’s esophagus, it’s important to seek treatment before these conditions cause irreparable damage to your esophagus. If Barrett’s esophagus has progressed to the point where you have dysplasia, it’s even more vital to seek treatments that prevent full blown cancer.

If you have Barrett’s esophagus, there is some scientific data that indicates taking aspirin, ibuprofen, or other anti-inflammatory drugs can reduce the risk of developing esophageal cancer. However, there are potentially harmful side effects of taking these drugs on a daily basis, so it’s important to weigh these risks with help from your doctor.

Esophageal Cancer Treatments
Because every patient’s esophageal cancer is unique to their body, you may have multiple treatment options to consider. The nature of your cancer cells, whether the cancer has spread, and your overall health will likely play a role in treatment. It’s important to remember that any treatment is ultimately your choice. It is recommended that you discuss your treatment options with your doctor and with loved ones who you trust.

Surgery is often recommended as a first step in treatment for esophageal cancer, but it’s not always possible. Surgery may focus on removing a small tumor from the esophagus, removal of a portion of the esophagus, or removal of the entire esophagus and part of the stomach.

Surgery poses serious risks to the patient, and complications resulting from surgery may include bleeding, infection, and leakage from the part of the esophagus reconnected to the stomach. Further treatments to deal with these complications may be necessary.

Chemotherapy is the use of chemicals to kill cancer cells. This treatment is often used in patients before and after surgery, or to minimize the symptoms associated with esophageal cancer. In some cases, chemotherapy may be used in tandem with radiation therapy. There are many side effects associated with chemotherapy.

Radiation therapy uses high powered X-ray beams that are targeted to kill esophageal and other cancer cells. Most of the time the beam is focused on the outside of the body, but in some cases the beam is aimed internally. Radiation therapy may be used before or after surgery, or in tandem with chemotherapy. It may also be used to alleviate the symptoms and complications of advanced esophageal cancer.

Side effects of radiation therapy are many and can be quite severe. It’s also possible to damage tissues and organs near the esophagus, which will further complicate the recovery process.

Alternative Treatments Used for Esophageal Cancer

If an esophageal cancer treatment falls outside of mainstream protocols, it is considered “alternative.” If these treatment are used in tandem with mainstream treatments like chemotherapy and radiation therapy they are considered “complementary” treatments. If they are used as primary treatment, then they are called “alternative.”

Some alternative treatments for esophageal cancer focus on the body’s natural healing abilities, also called the immune system. The goal is to reinforce this natural defense system so it can effectively fight the cancer cells. Because of esophageal cancer’s high mortality rate using mainstream treatment protocols, many patients opt for treatment that is less destructive and less invasive.

Boosting the immune system is often accomplished with diet, vitamin supplements, and other alternative therapies like acupuncture and relaxation techniques. These alternative treatments can be especially helpful for patients using them in a complementary manner.

Some alternative esophageal cancer treatments focus on the individual patient in an attempt to understand what treatments have the best chance of success against their particular cancer. Because every cancer is unique the individual, the idea is to use highly focused testing in an effort to see what will work best on that cancer, rather than using the one-size-fits-all approach based on cancer staging.

As with any medical treatment, cancer treatment is a personal choice that requires careful consideration. Always explore your options in detail so that you can make the best choices regarding treatment.

Vitamins and Supplements Used in the Treatment of Esophageal Cancer

Vitamins play a key role in the prevention of esophageal cancer, but vitamins and supplements are rarely used in mainstream treatment protocols. Doctors that practice alternative treatment protocols contend that this approach is misguided, so supplements are often used by these physicians in an effort to boost the body’s natural cancer fighting abilities.

As an example, Vitamin B6 and Vitamin C are both proven to boost the body’s immune system,and the latter has been shown to regenerate tissues. Vitamin E and Vitamin A have been shown to help fight infection, which could be extremely helpful as the body tries to heal itself after an invasive treatment like surgery.

Before using any supplement or vitamin, you should consult with your doctor and make sure it won’t hinder other treatments you may be receiving.

Natural Remedies that May Help Esophageal Cancer

There are number of natural remedies that many believe have the power to fight cancer or act in a supporting role to minimize symptoms. Side effects caused by treatment may also be alleviated with certain natural remedies. Some of the most common natural remedies and treatments used by esophageal cancer patients include massage, physical therapy, acupuncture, and counseling.

Dealing with the emotional stress of esophageal cancer can also take a toll. The high mortality rate of the disease and the many side effects of treatment can also lead to depression. Natural remedies like hydrotherapy, herbal preparations, and dietary supplements, may also help combat the overwhelming feelings of despair that often accompany development of the disease.

Before using any natural remedy or treatment, be sure to speak with your doctor and make sure it won’t cause more damage than good. Also remember that a healthy lifestyle, good nutrition, and daily exercise are the best ways to prevent the onset of cancer.

For more information about esophageal cancer, contact a friendly member of the Causenta team.