What is Esophagus Cancer?
Esophagus cancer is one of the 10 most common types of cancer in the world, accounting for 3.1% of cases. According to the World Health Organization, approximately 1 million people were diagnosed with esophagus cancer in Turkey in 2020.
The esophagus, or food pipe, is a hollow tube through which food passes from the mouth and throat to the stomach for digestion. Its inner surface is lined with epithelial tissue, while the outer layer consists of smooth muscle and connective tissue that facilitate the movement of food. It is approximately 2 cm in diameter and 25-30 cm in length. Esophagus cancer, like other types of cancer, occurs due to the abnormal and uncontrolled growth of cells in the esophagus. The cancer typically begins in the cells lining the inner surface of the esophagus.
What Are the Types of Esophagus Cancer?
Esophagus cancer is divided into two main groups based on the type of cells involved.
Squamous Cell Carcinoma
The tumor forms in the squamous cells that line the inner surface of the esophagus. This type of cancer is more commonly found in the upper or middle part of the esophagus.
Adenocarcinoma
Mucus facilitates the movement of food. This type of esophagus cancer occurs in mucus-secreting cells. The tumor is usually located in the lower part of the esophagus, where it connects to the stomach.
What Are the Stages of Esophagus Cancer?
Stage 1
The tumor is only found in the inner lining of the esophagus. It has not spread.
Stage 2
The tumor has reached the muscular layer, which is an outer layer of the esophagus.
Stage 3
The tumor continues to adhere to the esophagus but has also spread to nearby lymph nodes.
Stage 4
In advanced stages, the tumor has spread to nearby organs such as the liver, bones, lungs, and lymph nodes at the entrance of the stomach.
Who Is More Likely to Develop Esophagus Cancer?
Although there is no specific cause for esophagus cancer, there are several risk factors that increase the likelihood of developing the disease. These include:
- Age
The risk of developing esophagus cancer increases with age, particularly after 60-70 years.
- Gender
Men are twice as likely to develop esophagus cancer compared to women. According to the World Health Organization, this rate is 4.2% for men and 2% for women.
- Obesity
Being overweight poses a risk for esophagus cancer, as it does for other types of cancer.
- Smoking and Alcohol
The consumption of tobacco and alcohol increases the risk of esophagus cancer. Additionally, drinking very hot beverages such as tea and coffee can also be a risk factor.
- Development of Barrett’s Esophagus due to Chronic Reflux Disease
Barrett’s esophagus refers to abnormal mucosal changes in the lower part of the esophagus. Individuals with this condition have an increased risk of cancer.
- Family History
Individuals with a family history of esophagus cancer are at higher risk.
- Consumption of Acidic or Alkaline Substances
Individuals who accidentally or intentionally consume acidic or alkaline substances are at risk for esophagus cancer.
- Dysphagia Disease Known as Achalasia
What Are the Symptoms of Esophagus Cancer?
The diagnosis of esophagus cancer is usually made based on the patient’s complaints. The presence of some of the following symptoms should raise suspicion of esophagus cancer:
- The most common symptom is difficulty swallowing. Initially, this manifests as food getting stuck while passing through the esophagus. At first, solid foods may be difficult to swallow, and over time, the patient may be unable to drink even water.
- Vomiting or regurgitation of swallowed food.
- Pain during swallowing.
- Weight loss and weakness.
- Heartburn.
- Chest pain.
- Persistent hiccups.
How is Esophagus Cancer Diagnosed?
The first test for diagnosing esophagus cancer is an X-ray of the esophagus with contrast. Additionally, an endoscopy may be performed to detect any abnormal conditions or irritation in the esophagus.
Imaging methods such as endoscopic ultrasound, computed tomography, MRI, or positron emission tomography (PET) are also used to understand the extent of disease spread or for post-treatment follow-up.
What Are the Treatment Methods for Esophagus Cancer?
The most effective treatment method for esophagus cancer is surgery. Other treatment methods include chemotherapy or radiotherapy.
Due to the location of the esophagus and its proximity to many vital organs and vessels, esophagus surgeries are more complex than many other surgeries. Different surgical techniques are used depending on the location of the cancer in the esophagus. These include:
- In tumors very close to the stomach, the lower part of the esophagus is removed through an incision made from the abdomen or chest cavity. After the removal, the remaining part of the esophagus is reconnected to the stomach within the chest cavity.
- Another surgical method is the complete removal of the esophagus. After the esophagus is removed, a new esophagus is created from the patient’s stomach or large intestine. This surgery is major, and patients are often older and may have other health issues. Therefore, the postoperative period can be challenging. To avoid such situations, preoperative preparation must be carried out very carefully and meticulously. Following the pathological evaluation of the removed tissue, additional radiotherapy or chemotherapy may also be administered.
Moreover, in early-stage cancers, instead of completely removing the esophagus, only the diseased area can be removed through endoscopy.
What Can Be Done If the Disease Is Advanced?
In some cases, the tumor in the esophagus cannot be removed. The main reasons for this include:
- The patient’s overall condition does not allow for such a major surgery.
- The cancer cannot be surgically removed.
- The cancer has spread to distant organs.
In such cases, patients with unresectable tumors may sometimes undergo radiotherapy to alleviate symptoms or shrink the tumor. During this time, an endoscopic stent may be placed to allow the patient to eat, or a gastrostomy (placing a tube in the stomach for feeding) may be performed.
What Should Be Considered After Esophagus Cancer Surgery?
The following should be considered after esophagus cancer surgery:
- Pay attention to the foods you consume. Eat the foods recommended by your doctor.
- Avoid sugar.
- Avoid consuming carbonated beverages.
- Try to establish a quality sleep routine.
- Regularly perform recommended exercises.
- Be careful to eat small but frequent meals.
Frequently Asked Questions
Which Department and Doctor Should Be Consulted for Esophagus Cancer?
Individuals suspected of having esophagus cancer should consult a general surgeon. Furthermore, the treatment of esophagus cancer is carried out with a multidisciplinary approach. Therefore, departments such as thoracic and esophagus surgery, gastroenterology, and oncology typically work together with the general surgery department. The diet and nutrition department also supports the process.
What Happens If Esophagus Cancer Is Not Treated?
Esophagus cancer is an aggressive disease. If left untreated, it can lead to the patient’s death.
How Should Esophagus Cancer Patients Eat?
The dietary regimen for patients may vary depending on the stage of esophagus cancer. In early-stage cancers, normal eating can continue. However, if the cancer is advanced, due to difficulty swallowing, patients are advised to consume liquid foods, avoid spicy foods, ensure that meals are well-cooked, and eat in small pieces.
Patients undergoing chemotherapy should avoid grapefruit as it can alter the effects of some medications.
Does Esophagus Cancer Recurrence?
There is a possibility of recurrence of esophagus cancer. It can recur in nearby tissues or in other areas such as the chest cavity or liver.
Is Barrett’s Esophagus Cancer?
Barrett’s esophagus is defined by abnormal mucosal changes occurring in the lower part of the esophagus. Its most significant causes are long-term reflux disease combined with excessive alcohol and tobacco use. Barrett’s esophagus is not cancer, but it is a significant risk factor for esophagus cancer.
