20 May What you should know about esophageal cancer
This guide contains everything you need to know about esophageal cancer, incuding what it is, its symptoms, diagnosis, treatments and alternative therapies.
What is esophageal cancer?
The esophagus is a long, muscular tube connecting the throat to the stomach. It is responsible for transporting food from the upper part of the throat to the stomach so that it can be digested.
Cancer of the esophagus usually starts when cells that line the inside of it start to grow in an uncontrolled way.
This process does not happen suddenly. It may start with symptoms that could seem normal, but these cells start to transform gradually and become cancerous; therefore it is very common for this type of cancer to be diagnosed in the more advanced stages.
Symptoms of esophageal cancer can be easily confused with other diseases of the digestive or respiratory system, so they are not specific to the disease or conclusive. The most common symptoms of esophageal cancer include:
- Pain or difficulty swallowing
- Pain, pressure or heartburn in the chest
- Unexplained weight loss
- Burning sensation in the stomach or indigestion
- Frequent and persistent cough without a respiratory infection
- Vomiting blood
- Coughing up blood
- Bloody stools (dark stool)
- Painful joints
- Excessive belching
- Excess saliva
Causes of esophageal cancer
The specific causes of esophageal cancer are unclear, but there are some factors that increase your chances of suffering from this type of cancer.
Risk factors that increase your chances of suffering from esophageal cancer include:
- Tobacco and alcohol consumption: cigarette smoke contains carcinogens (substances that can contribute to the formation of cancer); the more exposure you have to them, the more likely you are to develop cancer. The combination of drinking and smoking increases the risk of cancer even more than drinking and smoking alone.
- Being over 55 years old
- Gastroesophageal reflux disease (GERD): if left untreated, this risk factor causes the mucosa (the lining of the esophagus) to be constantly exposed to stomach acid, this modifies the cells in the esophagus, generating a dysplasia, which can turn into cancerous lesions called metaplasia.
- Barrett’s Esophagus: normally found during an endoscopy and is considered as a precancerous lesion, requires monitoring.
- Diet low in fruit and vegetables: a low-fiber diet does not provide an adequate environment for proper mucosa function.
- Drinking very hot drinks: this can erode the tissue in the mouth and, as a result, trigger cellular change.
- Infection with Human Papillomavirus (HPV): especially if transmitted orally, this virus weakens the body’s defences and can modify the esophageal mucosa.
- Excessive consumption of yerba mate (herbal tea): more than a liter of this tea per day is associated with esophageal cancer.
- Exposure to radiation: patients with a history of breast cancer or lymphatic cancer who have undergone radiotherapy, have a greater chance of developing this disease 10 years after treatment.
There is no definitive way to prevent esophageal cancer, but you can reduce your risk of developing the disease by:
- Avoiding tobacco and alcohol
- Maintaining a healthy weight and monitoring any unexplained weight loss
- Eating more fruit and vegetables
- Avoiding very hot foods or drinks
- Treating gastrointestinal reflux as soon as possible
- Seeing your doctor for regular checkups
Testing and diagnosis
If esophageal cancer is suspected, the doctor will carry out one or several of the following tests:
- Analysis of medical or family history of esophageal cancer or digestive cancer in general
- History of previous diseases such as esophagitis, hiatal hernia; evaluation of the patient’s diet or lifestyle habits (smoking, alcoholism)
- Symptoms: difficulty swallowing food, feeling that food will not go down, burning sensation or pain in the sternum, excess saliva, frequent coughing without a respiratory disease, unexplained weight loss
- Physical exam: paying special attention to nutritional health and checking whether the patient has difficulty swallowing in order to rule out any respiratory symptoms
- Blood test: hemogram, kidney and liver function test. The results help determine the diagnosis.
- Upper gastrointestinal tract (GI) endoscopy: this is the first test that is requested, which allows for a definitive diagnosis by taking a biopsy and contributes to classifying the stage of the disease.
- Barium swallow: the patient is given a substance containing barium (radioactive substance), then multiple X-rays can be taken as they swallow. This test shows if there is something blocking the esophagus or if there are any changes in its functioning.
- Esophagoscopy: similar to an endoscopy, but it does not reach as far as examining the stomach and other structures.
- Chest X-ray: To assess whether or not there are any invasive lesions in the lungs.
- X-ray of the esophagus, stomach and duodenum: shows the characteristics of the tumor.
- Computerized tomography (CT) scan: the esophagus is observed through the thorax to determine the extent of the tumor and whether the lymph nodes have been compromised. An examination of the abdomen may also be requested to check for distant metastasis.
- A thoracoscopy and laparoscopy are used when the tomography shows evidence of metastatic lesions, a biopsy is taken to extract and analyze affected tissue.
- Biopsy: usually, a sample can be taken during the endoscopy to help reach a diagnosis. The tissue that is removed is then studied in a laboratory.
Treatment depends on several factors, but the most common treatments for esophageal cancer include:
Depending on how big the tumor is and the stage of the disease, surgery may be used to remove malignant tissue and part of the surrounding tissue. In more advanced cancers, part of the esophagus may be removed (esophagectomy), as well as the surrounding lymph nodes.
In an esophagogastrectomy, the part of the esophagus that is affected by cancer is removed (and the remaining healthy part of the esophagus is reconnected to the stomach), along with the surrounding lymph nodes and part of the stomach.
Radiotherapy uses high-energy rays to destroy cancer cells, either as a standalone treatment prior to surgery, or in combination with chemotherapy.
Medication is administered to destroy malignant cancer cells, attacking any remaining cells following surgery or radiotherapy. It can also be used prior to surgery to reduce the size of the tumor.
It is not selective, so it also attacks healthy cells. It has a number of side effects such as hair loss, nausea and vomiting, and a higher chance of infection.
It is used to treat the early stages of esophageal cancer. It consists of extracting cancerous tissue using an endoscope (instrument used to look inside the body) with special tools on the end.
In this treatment, drugs or other selective substances are used to identify and destroy cancer cells, without damaging normal cells.
The following therapies go hand-in-hand with conventional treatments:
Use of drugs that stimulate the patient’s own immune system, so that it can effectively recognize and destroy cancer cells.
Immunotherapy is based on the concept that antibodies (cells used in the immune system) can recognize and destroy cancer cells. These compounds are produced in a laboratory and are then administered to patients.
When immunotherapy is used for treating cancer, it is usually given in combination with other treatments, like chemotherapy. It can also be used as maintenance therapy to prevent the disease from coming back.
Although huge progress has been made towards understanding the role of the immune system in cancer, this is still a new treatment that requires further study.
Maintaining healthy habits is essential for controlling any disease:
Follow a balanced diet, eating at least 2 ½ cups of fruit and vegetables a day, as well as several portions of plant-based whole grains, such as grains, cereals, rice, pasta or pulses. Limit your consumption of red and processed meat.
You should also try to avoid fried, processed or irritating foods. Instead, eat more fresh food and avoid reheating meals that have been in the freezer for a very long time.
Regular exercise is recommended for your general health, but especially when you have cancer. Exercise improves blood flow and helps your metabolism work more efficiently. It also serves as a good distraction from your disease and allows you to make decisions with a clear mind.
Meditate, reflect, remember that you are the person who knows you and your body best. Get to know yourself and your body; sometimes, a bit of self-awareness can help you to better understand your disease and how best to combat it.
Trust your instincts and talk to your doctor about any changes as soon as you notice them.
Cannabinoids reduce general discomfort, since they help relieve nausea and vomiting, stimulate appetite and ease pain caused by some chemotherapy and radiotherapy treatments. It can promote the death of tumor cells, reducing their ability to spread and metastasize.
No research has been done on the effects of this drug on the progression, remission and halting of tumors specifically in esophageal cancer. However, cannabis has been shown to have positive results when tested on other types of digestive cancers, in terms of prognosis and life expectancy.
Coping and support strategies
We know that a cancer diagnosis can be a huge emotional challenge, so it is important that you keep your friends and family close and that you share your thoughts and feelings with them.
Letting your loved ones know how you are coping and being open to their support will help you feel stronger.
We are here to support and guide you. Find more information:
Tumores malignos del esófago [Gloria Fernández Esparrach, 2010]