What is Esophageal Cancer
What is Esophageal Cancer? Esophageal cancer is a disease that occurs due to abnormal growth of epithelial tissue in the esophagus (esophagus). Esophageal cancer can occur in any portion of the esophagus, but this condition generally occurs at the bottom.
There are two types of esophageal cancer, squamous cell carcinoma and adenocarcinoma. Squamous cell cancer occurs in flat cells forming part of the esophageal surface, whereas adenocarcinoma occurs in cells that produce mucus to lubricate foods that pass through the esophagus.
Squamous cell cancer usually occurs in the upper part of the esophagus whereas adenocarcinoma generally occurs in the lower part of the esophagus, especially in the part near the sphincter that limits the stomach and esophagus.
Symptoms of Esophageal Cancer
The symptoms of esophageal cancer can be observed as follows:
- Difficult to swallow (dysphagia). This symptom is the first symptom caused by a tumor in the esophagus. Tumors that appear to cause constriction of the esophageal space so that food is difficult to swallow. In severe conditions, the patient may experience difficulty drinking.
- Weight loss without dieting and loss of appetite.
- Chest pain that feels like being depressed or burning.
- Cough and raspy voice.
- Vomiting or vomiting blood in more severe conditions.
In the early stages, esophageal cancer usually will not show any symptoms, making it difficult to detect. But if you have a strong risk factor for esophageal cancer, such as having been diagnosed with Barrett’s esophageal disease, consult your doctor for diagnosis and treatment as early as possible. In addition, immediately consult a doctor if you experience one or more of the above symptoms
Causes of Esophageal Cancer
The cause of esophageal cancer can not be ascertained. However, based on studies conducted, it is suspected the main cause of esophageal cancer is a mutation in the DNA of the esophageal epithelial tissue. This mutation causes the regeneration of epithelial cells to become abnormal and uncontrolled. Uncontrolled esophageal epithelial cell growth can lead to tumor formation in the esophagus and spread to other tissues. Some factors that can increase the risk of esophageal cancer are as follows:
- Drinking alcohol. This habit can cause irritation and inflammation of the esophageal epithelial tissue. Irritation and inflammation of epithelial tissue may increase the risk of esophageal cancer.
- Smoke. The content of toxins and harmful compounds in cigarettes can cause irritation of the esophageal epithelial tissue. The longer a person’s smoking habits, the higher the risk of esophageal cancer in that person.
- Obesity. The risk of esophageal cancer in obese individuals is greater than for normal people because obese people have a higher risk of gastro esophageal reflux (GERD) and Barrett’s esophageal disease. Both GERD and Barrett’s esophagus can increase the risk of esophageal cancer
- Diet. Less eating fruits and vegetables can increase the risk of esophageal cancer.
- Food or hot drinks. Often consuming hot foods or beverages can cause inflammation and irritation of the esophagus, thus increasing the risk of esophageal cancer.
- Radiation therapy. A person undergoing radiation therapy in the chest or upper abdomen is at risk for esophageal cancer.
- Bile reflux.
In addition to these risk factors, there are several diseases associated with esophageal cancer. The following diseases may increase a person’s risk for esophageal cancer
- Gastro esophageal reflux disease (gastro esophagial reflux disease) or GERD. GERD disease is a muscle weakening condition in the upper abdomen that causes stomach acid to rise to the esophagus. Stomach acid can cause irritation of the esophageal epithelial wall, thus increasing the risk of cancer. However, it should be noted that not all people with GERD have esophageal cancer.
- Eofagus Barrett. This disease occurs when the lower part of the esophagus undergoes changes in the structure of epithelial tissue due to chronic inflammation caused by acid reflux of the stomach. Changes in the structure of epithelial tissue may increase the risk of esophageal cancer. About 1 in 100 people with Barrett’s esophagus will have adenocarcinoma.
- Achalasia. A condition that causes widening of the lower part of the esophagus
- Peterson-Brown-Kelly Syndrome. A rare syndrome caused by iron deficiency and changes in the structure of the mouth and esophagus.
- Tylosis, a condition of genetically induced skin disease
Diagnosis of Esophageal Cancer
The doctor will diagnose esophageal cancer through questions about the patient’s symptoms, as well as a series of additional checks such as:
- Endoscopy. Diagnosis via endoscopy is done by observing the condition of the esophagus using a thin tube bending (scope) with the camera at the edges. Visual observation is done to see the presence of cancer or irritation of the esophagus.
- Biopsy. Sampling of tissues performed in conjunction with endoscopic procedures. The tissue taken is then sent to the laboratory for further examination.
- Gastroscopy. If a positive patient is diagnosed with esophageal cancer, the doctor will estimate the extent of cancer spread. This measurement is done by using gastroscopy to see the spread of cancer in the esophageal wall. Diagnosis can be done by other methods such as ultrasound, CT scan, or PET scan.
From the results of the above examination, can be determined the stage of cancer experienced by patients, namely:
- Stadium in situ. At this stage, cancer cells have been attached to the esophageal surface but have not yet penetrated the inner lining of the esophagus.
- Stage 1. At this stage, the cancer has penetrated the first layer of the esophagus, and can spread to surrounding lymph nodes.
- Stage 2. At this stage, the cancer cells have spread to the deeper layer of the esophagus and may spread to the surrounding lymph nodes.
- Stage 3. At this stage, cancer cells have spread to the deepest layer of the esophagus and also to other organs and surrounding lymph nodes.
- Stage 4. At this stage, cancer cells have spread to various organs in the body (metastasis).
Eofagus Cancer Complications
In certain cases, esophageal cancer can cause complications in patients. Some of the complications that can arise from esophageal cancer include:
- Cancer / blockage Cancer of the esophagus can cause the esophageal diameter to shrink so that food and drink will be difficult to pass through the esophagus or even blocked at all.
- Pain. Esophageal cancer that has reached an advanced stage can cause pain in patients.
- Esophageal haemorrhage. Esophageal cancer can cause bleeding in the esophagus. Bleeding usually appears gradually but in some cases, bleeding may appear suddenly.
Treatment of Esophageal Cancer
Treatment of esophageal cancer will be adjusted to the diagnosis and stage of cancer suffered. The types of treatment for esophageal cancer include:
Surgery. Done to remove cancerous tissue in the esophagus and can be done with or without any combination of other treatments. The type of surgery is divided as follows:
- Surgery to remove small tumors. This type of surgery is performed for very small tumors and is present only on the surface of the esophageal wall. This type of surgery is performed on early-stage cancer by cutting the cancerous part along with healthy esophageal tissue around the cancerous tissue
- Surgery to partially cut the esophagus (esophagectomy). In esophagectomy, surgery is done by cutting the esophagus containing cancerous tissue along with the lymph nodes around the cancerous tissue. The stomach and the rest of the esophagus are reconnected by pulling the lower esophagus to the base of the cut.
- Surgery to partially cut the esophagus and upper part of the stomach (esofagogastrektomi). In this type of surgery, the esophagus contains cancer tissue, nearby lymph nodes, and the top of the stomach is cut. The rest of the stomach and esophagus are then reconnected. If necessary, a small portion of the large intestine is cut to connect the esophagus and healthy stomach.
Oesophageal cancer surgery has several risks of serious complications that patients need to consider such as infection, bleeding, and leakage at the location of the joint between the esophagus and the stomach. The surgeon concerned will assess the patient’s condition prior to surgery.
EMR. In addition to esophagectomy, there is a method of tissue cutting that can be done to treat esophageal cancer that is endoscopic resection mucus or EMR (endoscopic mucosal resection). This method is done by cutting the cancer cells in the esophagus through an endoscope that is inserted through the mouth so that surgery is not necessary.
Chemotherapy. To treat cancer by using certain chemical compounds to kill cancer cells. Chemotherapy may be performed before or after surgery or combined with radiation therapy. In patients with advanced cancer, chemotherapy can be used to relieve cancer symptoms. Common side effects from chemotherapy include:
- Loss of appetite
- Weight loss
- Increase the risk of infection
- Easily bleeding or bruising
Radiation therapy to treat esophageal cancer using high-energy rays. The radiation used is external radiation or radiation done in the body near the cancer tissue (brachytherapy). Radiation is the most widely used treatment of esophageal cancer, especially in advanced cancer that can block food through the esophagus. Side effects of radiation therapy include:
- Pain or have difficulty in swallowing.
- Dry throat.
- Skin becomes reddish.
- Hair loss in areas of the body affected by radiation therapy.
Radiation is generally combined with chemotherapy before or without surgery. However, the combination of radiation and chemotherapy increases the side effects of both for the patient.
Treatment of esophageal cancer complications can be done through the following methods:
- Eliminate oesophageal obstruction. If the cancer in the patient constricts the esophageal diameter, the surgeon may use a metal tube (stent) to open the esophagus in the narrowed portion, so that the food can still pass through the esophagus.
- Food tube / hose. The tube or food hose is installed in the patient to feed the food directly into the stomach or intestine without passing through the esophagus. This method can be used to allow time for the esophagus to recover post-cancer therapy.
Prevention of Eofagus Cancer
In order for esophageal cancer can be prevented and the risk of the emergence of cancer can be lowered, the steps that need to be done are as follows:
- Quit smoking. Smoking can increase the risk of esophageal cancer with toxin compounds in tobacco.
- Reduce and stop alcohol consumption. For alcohol drinkers, should reduce the amount of alcohol consumed per day. As for those who do not drink, you should not start drinking alcohol.
- Increase consumption of fruits and vegetables.
- Keep your weight balanced.