Esophagus is a hollow, muscular movements of the liquid feed cable from the throat to the stomach. The walls of the esophagus is composed of several layers of tissue, including mucous membranes, muscles and connective tissue. Esophageal cancer starts inside of the esophagus and spreads through the other layers as it grows.
Esophageal cancer is a cancer of the esophagus. There are various subtypes. Esophageal cancer often lead to dysphagia (difficulty swallowing), pain and other symptoms and is diagnosed at biopsy. Small tumors are localized and treated with surgery and advanced cancer treated with chemotherapy, radiotherapy or combinations. The prognosis depends on the extent of disease and other medical problems, but it is pretty poor.
Dysphagia (difficulty swallowing) is the first symptom in most patients. Odynophagia (painful swallowing) may be present. The liquids and soft foods are widely tolerated, and hard or bulky substances (such as bread and meat) causes many difficulties. Substantial weight loss is characteristic as a result of poor nutrition and cancer active. The pain, often the nature of combustion, can be severe and worsened by swallowing, and can be spasmodic.
The presence of the tumor may disrupt normal peristalsis (organized swallowing reflex), leading to nausea and vomiting, regurgitation of food, coughing and an increased risk for aspiration pneumonia. surface of the tumor can be fragile and bleed, causing hematemesis (vomiting blood). Compression of local structures occurs at an advanced stage, leading to problems such as the syndrome of superior vena cava (SVCO).
If the disease has spread elsewhere, this can lead to symptoms associated with it: metastases to the liver can cause jaundice and ascites, metastases to the lungs can cause shortness of breath, pleural effusion, etc.
There are several risk factors for esophageal cancer. Some subtypes of cancer are associated with specific risk factors:
- Age and sex. Most patients are over 60 years and it is more common among men.
- Smoking and excessive alcohol consumption increases the risk and time seems to increase risk more than these two individually.
- Swallowing lye or other caustic substances
- Certain foodstuffs such as nitrosamines
- An interview with the other head and neck cancer increases the risk of second cancer in the head and neck, including cancer of the esophagus.
- Plummer-Vinson syndrome (anemia and esophageal strips)
- Tylosis and Howel-Evans syndrome (hereditary thickening of the skin on the hands and feet)
- The disease gastroesophageal reflux disease (GERD) and Barrett's esophagus because of increased risk of developing cancer of the esophagus is due to chronic irritation of the lining (adenocarcinoma more common in this state), while all other risk factors predispose more for squamous cell carcinoma.
The risk appears to be lower in patients taking aspirin or related drugs (NSAIDs). Statistically, it appears that Helicobacter pylori is known to increase the risk of gastric cancer, actually decreases the risk of esophageal cancer (O'Connor, 1999), the exact mechanism of this phenomenon is unclear.
Eventhough the upper endoscopy procedure occlusive tumor may be suspected on barium swallow or barium, the diagnosis is best made with esophagogastroduodenoscopy (EGD, endoscopy), it implies the end of a flexible tube into the esophagus and the visualization of the wall . Biopsies taken of suspicious changes are then examined histologically for signs of cancer.
Most tumors of the esophagus. A very small percentage (less than 10%) leiomyoma (smooth muscle tumor) or gastrointestinal stromal tumors (GIST). The tumors are usually adenocarcinoma, squamous cell carcinoma and small cell cancer, sometimes the latter are a number of properties in lung cancer, and are relatively sensitive to chemotherapy than other types.
Location of the tumor is generally measured by the distance between the teeth. Esophagus (25 cm or 10 cm in length) is generally divided into three parts to determine the location. Adenocarcinomas tend to distal and proximal squamous cell carcinomas, but the opposite may be.
The barium enema for diagnosis of stomach cancer if a biopsy reveals cancer of the esophagus, the treatment depends on the severity of the disease. Establishing the development stage of the disease, commonly known as associated with computed tomography (CT), chest and abdomen. If you are suspected of bone metastases (eg, pain or fractures), bone scan may be performed, and bronchoscopy can be performed in cases of suspected tumor of the trachea or bronchi. In recent years, endoscopic ultrasonography (EUS) is increasingly used to evaluate the local lymph nodes, and is considered superior to CT in this indication.
- Cancer: TX (can not be assessed), T0 (can not be detected), Tis (carcinoma in situ), the lamina propria T1 (submucosal or attacks), attacks T2 (muscular propria) attacks T3 ( on the membrane), T4 (invading adjacent structures)
- Lymph nodes involved •: NX (can not be assessed), N0 (no), N1 (current)
- Metastases elsewhere: M0 (no metastases) or M1 (metastases now below). M1a is used for the metastases in certain situations, indicating M1b metastases outside the area.
The information is sometimes aggregated AJCC TNM stages:
- This is Stage 0:, N0, M0 (non-invasive tumor)
- Phase I: T1, N0, M0
- Stage II: T2 or T3, N0, M0
- Stage IIB: T1 or T2, N1, M0
- Stage III: T3, N1, M0 or T4, any N, M0
- Stage IV: Any T, any N, M1
- Stage IVA: Any T, any N, M1a
- Stage IVB: Any T, any N, M1B
Treatment depends on the cell type of cancer (adenocarcinoma or squamous cell carcinoma versus other types), stage of disease, the patient's general condition and other diseases present. On the whole, adequate nutrition must be ensured, and adequate dental care is crucial.
If the patient can not swallow at all, you can enter the esophageal stent to maintain the patent. Probes may be necessary to continue the diet for cancer treatment is given, and some patients require a gastrostomy (feeding hole in the skin, which gives direct access to the stomach). The last two are particularly important if you have a tendency to aspirate food or saliva into the airways, predisposing to aspiration pneumonia.
Surgery is possible if the disease is localized, which occurs in 20-30% of all patients. If the tumor is larger, but chemotherapy or local radiation therapy can sometimes shrink the tumor to a point where it becomes the "exploitation". Is the removal of the esophagus of the esophagus because it reduces the distance between the throat and stomach, the stomach or placed in the thoracic cavity or a piece of intestine is interrupted. If the tumor is cancer, surgery is not considered to be of any benefit.
Laser therapy is the use of high-intensity light to destroy cancer cells, it affects only the treated area. This is usually done if the cancer can not be removed surgically. Easing the embargo could help to reduce dysphagia and pain. Photodynamic therapy (PDT), the type of laser treatment requires the use of drugs that are absorbed by cancer cells, when exposed to a special light, the drugs begin to act and destroy cancer cells.
Chemotherapy depends on the type of tumor, but rather with cisplatin (or carboplatin or oxaliplatin) every three weeks with fluorouracil (5-FU) either continuously or every three weeks. In a recent study, the addition of epirubicin (ECF) was better than other similar regimens in advanced unresectable cancer (Ross et al 2002). Chemotherapy can be administered after surgery (complementary policy to reduce the risk of recurrence), preoperative (neoadjuvant) or if surgery is not possible in this case, cisplatin and 5-FU are used. In clinical trials comparing different combinations of chemotherapy, phase II / III REAL-2 trial - for example - compares four regimens containing epirubicin and cisplatin or oxaliplatin and capecitabine or fluorouracil continuous infusion.
Radiation therapy before, during or after chemotherapy or surgery, and sometimes their own control of symptoms. In patients with the disease, but the cons-local indications for surgery, radical radiotherapy "may be used, and radiotherapy.
Patients are often followed after treatment regime has been completed. Often, other therapy to improve symptoms and maximize nutrition.
the prognosis of esophageal cancer is quite poor. Five years, the prognosis is 6-16%. The options are limited when the cancer recurrence, and the emphasis is on symptom control and palliative care, when it does.
Esophageal cancer is a relatively rare form of cancer, but some regions have a much greater frequency than others: China, India and Japan and the United Kingdom seems to have a higher incidence, and the region around the Caspian Sea (Stewart andamp; Kleihues 2003).
The annual incidence ranges from 3.11 to 0.6 to 6 per 100,000 men and 100,000 women (Stewart andamp; Kleihues 2003).