Signs, symptoms, stages and treatment of esophageal cancer
Content:
- Esophageal cancer symptoms
- Causes of esophageal cancer
- Stages and degrees of esophageal cancer
- Esophageal cancer treatment
What is esophageal cancer?
Esophageal cancer is a malignant neoplasm that develops from epithelial cells located in the mucous membrane. To date, this cancer is most often found in elderly people over 60 years of age. The male half of the population is several times more likely to experience this malignant neoplasm. According to available medical statistics, esophageal cancer accounts for 40% of all existing cancers.
Currently, patients diagnosed with esophageal cancer have several types of this malignant neoplasm:
- carcinoma;
- adenocarcinoma;
- squamous cell carcinoma of the esophagus.
A cancerous tumor can be localized in any part of the esophagus:
- most often (in 55% of cases), a malignant neoplasm is detected in the lower esophagus;
- in 35% of cases, cancer is detected in the middle part of the esophagus;
- the upper esophagus accounts for only 10% of cancers.
In most cases, this category of patients is faced with tumors identified:
- in the stomach;
- in the larynx;
- in the nerve trunks of the diaphragm and chest.
Modern medicine uses the following classification when diagnosing cancer of the esophagus:
- endophytic cancer. This type of neoplasm grows in the submucosal layer of the walls of the esophagus;
- exophytic cancerous tumor. This type of neoplasm grows and fills the lumen of the esophagus. Over time, it begins to rise above the mucous membrane of the esophagus;
- mixed cancer. Ulcers often form at the site of this type of cancer, since the neoplasm itself is prone to rapid decay.
How long do you live with esophageal cancer?
With the timely diagnosis of esophageal cancer, patients open up rather bright prospects for a full recovery.
If patients go to a medical institution when primary symptoms appear and a malignant neoplasm is detected at stages 1-2, they will (in almost all cases) be guaranteed a cure without further relapses.
The main problem with this cancer is its slow and often asymptomatic course. Most patients seek help at a late stage in the development of a malignant neoplasm. With an advanced stage of esophageal cancer, even with good care and high-quality treatment, doctors determine the patient's lifespan not exceeding 6 years.
If this cancer is not treated (at a late stage of development), patients are destined to live no more than 8 months.
In case of metastasis of the patient's body, doctors in most cases no longer prescribe surgical treatment, since there is no point in this. The only treatment technique that can extend the life of a patient by at least a year is radiation therapy.
According to the statistics published in the specialized media, patients who have had their cancerous tumor surgically removed, and who have undergone courses of radiation and chemotherapy have the following life expectancy:
- patients who have been operated on for stage 1 esophageal cancer - in 90% of cases recover completely;
- patients who have been operated on for cancer of the esophagus at the 2nd stage - recover in 50% of cases;
-
patients who underwent surgical treatment at the 3rd stage of esophageal cancer survive in 10% of cases, and their life expectancy is more than 5 years.
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Esophageal cancer symptoms
At the initial stage of the development of a malignant neoplasm in the esophagus, patients may not show any symptoms. The patient feels well and does not notice any deviations from the norm.
At a later stage in the development of this disease, the following symptoms are observed:
- difficulty swallowing food;
- spasms in the esophagus;
- hoarseness;
- hiccups;
- pain sensations appearing in the chest;
- squeezing sensations in the chest;
- sharp pain syndrome;
- a feeling of pain or burning that occurs while eating;
- in connection with the narrowing of the esophagus, the patient can only swallow liquid food;
- severe exhaustion (occurs due to malnutrition and lack of necessary nutrients by the body);
- constant feeling of hunger;
- weakness, lethargy;
- loss of performance;
- blockage of the esophagus (as a result, swallowed food comes back);
- there is an unpleasant (sometimes fetid) odor from the patient's mouth;
- nausea;
- nervousness;
-
vomiting reflex;
- stagnation in the esophagus;
- plaque on the tongue;
- belching;
- sore throat;
- the appearance of a tracheoesophageal fistula;
- cancerous cachexia;
- development of hypersalivation;
- violation of the heart rhythm;
- asthma attacks;
- the appearance of signs of stridor breathing;
- an increase in the size of the lymph nodes, etc.
With metastasis of a tumor of the esophagus, the following symptoms may be observed:
- chest pain;
- severe shortness of breath, which occurs even with little physical effort;
- a swelling is formed, the place of localization of which is the supraclavicular fossa;
- strong and prolonged cough, etc.
In the event that metastases have struck other internal organs of the patient, he may experience the following symptoms:
- lethargy;
- fast fatiguability;
- prostration;
- drowsiness;
- painful sensations;
- slight increase in temperature;
- apathy;
- depressive conditions, etc.
For successful treatment of malignant neoplasm of the esophagus, it is necessary to diagnose this disease in a timely manner. That is why it is important for patients to identify the first alarming symptoms of esophageal cancer in order to receive quality medical care. The sooner a tumor is detected, the more chances patients have for a successful recovery and survival.
Causes of esophageal cancer
To date, modern medicine has managed to determine the main causes of the development of malignant neoplasms in the esophagus.
The causes of esophageal cancer include the following:
- excess weight (any stage of obesity) has a direct impact on the functioning of the digestive tract. Overweight people have increased pressure in the abdominal cavity. Over time, they develop reflux, against the background of which a burn of the walls of the esophagus is formed with hydrochloric acid (food is thrown into the esophagus from the stomach, along with concentrated gastric juice);
- passion for various diets that negatively affect not only the organs of the gastrointestinal tract, but also the entire human body as a whole;
- frequent consumption of spicy, peppery and pickled dishes;
- craving for too hot food, from which a burn of the walls of the esophagus can occur;
- accidental intake of fluids that can cause a chemical burn to the walls of the esophagus (in some cases, the effects of a chemical burn may appear after several years);
- bad heredity. Numerous studies of esophageal cancer carried out by scientists from around the world have shown that the likelihood of developing esophageal cancer increases several times due to a mutation in the p53 gene. Due to the fact that the tissues cease to receive proper protection and malignant neoplasms begin to develop in the esophagus;
- any mechanical effect on the esophagus (injuries sustained when swallowing solid food that can damage the walls of the esophagus) can provoke the degeneration of epithelial cells into cancerous ones;
- smoking and drinking alcoholic beverages. Among patients who have been diagnosed with esophageal cancer, there is a large number of people suffering from alcoholism (this addiction was the main cause of their disease). Frequent intake of alcohol thinns the lining of the esophagus, resulting in the destruction of its cells. The same situation is with another addiction - smoking. Carcinogenic substances that enter the patient's lungs cause irreversible changes in the epithelial cells. When lighting his first cigarette, everyone should remember that he consciously falls into a risk group and may soon develop esophageal cancer;
- papillomavirus, found in human blood, can cause the appearance of malignant neoplasms in the esophagus (scientists associate this with a mutation in the cells of the esophagus, which is caused by this virus);
- insufficient amount of vitamins, minerals and other nutrients that must be supplied to the human body every day. The cells of the esophageal mucosa lose the ability to perform the functions assigned to them, as a result of which they can be reborn, etc.
See also: Other Cancer Causes and Risk Factors
Stages and degrees of esophageal cancer
Modern medicine defines 4 stages of esophageal cancer:
- At the first stage, the patient may not notice any changes in his body. When eating solid food, he has to drink liquid so that the food can reach the stomach.
- In the second stage of esophageal cancer, the patient may develop nutritional problems. Many patients at this stage of cancer switch to liquid foods, mashed potatoes and cereals.
- At the third stage of esophageal cancer, patients have a narrowing of the food passage, which makes even the process of swallowing fluid difficult and painful.
- At the fourth stage of cancer, the patient has a complete obstruction of the esophagus.
Esophageal cancer grade 1
The first stage of esophageal cancer is very often not accompanied by pronounced symptoms. The malignant neoplasm is very small in size and practically does not bother the patient. At this time, damage to the mucous membranes of the walls of the esophagus, as well as the submucosa, occurs. Cancer at the first stage does not grow into the muscle layer of the esophagus and therefore responds very well to surgical treatment. Patients do not have a narrowing of the lumen of the esophagus, they can eat well, since they do not experience discomfort either during or after eating.
Esophageal cancer grade 2
At the 2nd stage of development of esophageal cancer, the following organs are affected:
- mucous membranes of the walls of the esophagus;
- muscle membranes;
- submucosa.
At this time, the malignant neoplasm does not go beyond the affected esophagus. In many patients, the lumen of the esophagus is narrowed, and therefore, they have to switch to liquid food. When examining a patient, specialists can detect single metastases that affect regional lymph nodes.
Esophageal cancer grade 3
At the 3rd stage of development, a malignant neoplasm grows into all layers of the walls of the esophagus. In patients, the tumor affects the serous membrane, as well as the paraesophageal tissue. Against the background of the development of cancer, the lumen of the esophagus narrows and patients have a problem with nutrition, since it becomes problematic for them to swallow solid foods. In parallel, tumor metastasis occurs (metastases are found in regional lymph nodes). The organs located near the esophagus are not damaged at this stage of cancer development.
Esophageal cancer grade 4
At the 4th stage of esophageal cancer in patients, tumor metastasis occurs, in which both regional and distant lymph nodes are affected. The cancerous tumor spreads to the peri-esophageal tissue. Malignant neoplasm also captures the walls of the esophagus, serous membrane and nearby organs. Most patients at this stage of cancer develop an esophageal tracheal or esophageal bronchial fistula.
Esophageal cancer treatment
Before prescribing treatment for a patient who has symptoms characteristic of oncological diseases, a thorough examination should be carried out by the attending physician.
The patient is assigned a number of diagnostic measures that will determine the exact type of tumor, its stage of development and localization:
- X-rays (this is done with a contrast agent that makes the esophagus visible on an X-ray). With the help of this study, specialists determine the localization of a malignant neoplasm, its shape and size. Thanks to the X-ray, the oncologist can anticipate possible complications that the type of cancer under investigation will cause;
- Laparoscopy. This type of diagnosis allows you to identify metastases in the internal organs of the patient;
- Ultrasound examination. Through this study, specialists determine the exact size of the malignant neoplasm, as well as the presence of lymph nodes that are affected by metastases;
- Tomography (performed by using the optical sensor). This technique was recently developed by scientists and almost immediately began to be used in specialized medical institutions. Through an endoscope, the specialist examines the structure of the neoplasm. Thanks to the latest equipment, it is possible to determine the structure of tumor tissues to a depth of 1.5-2 mm. All information collected by the sensor is transferred to a computer and then decrypted by a specialist. In the event that such equipment is installed in a medical institution, patients may not be biopsied, since the obtained data on the neoplasm is sufficient to prescribe therapy. Also, patients are prescribed positron emission tomography. Immediately before the research, the patient is injected with glucose (radioactive). Its property lies in the fact that it can selectively accumulate in cancer cells. The patient is placed in the center of a specially equipped room, and a scanner begins to rotate around him, which takes pictures of a cancerous tumor (it recognizes neoplasms, the size of which is 5-10 mm);
- Laparoscopy. With this diagnostic technique, the patient is punctured in the abdominal cavity (near the navel) with a laparoscope needle, after which a tube with an optical device is inserted into the hole. Specialists have the opportunity to determine the localization of a malignant neoplasm, its exact dimensions, and also take biological material, which is immediately transferred for histological studies;
- Bronchoscopy. It is prescribed in the case when the doctor suspects a metastatic lesion of the larynx, trachea, bronchial tree, etc.;
- Esophagogastroduodenoscopy. When conducting this type of examination, specialists carefully examine not only the esophagus, but also other organs of the digestive tract. Thanks to the endoscope, it is possible to examine the inner surface of the esophagus, as well as to take biological material for laboratory research (it is carried out under a microscope). With the help of esophagogastroduodenoscopy, it is possible to detect a malignant neoplasm at an early stage of development and timely prescribe treatment to the patient, etc.
Without fail, patients are assigned a full laboratory examination, in which:
- blood chemistry;
- clinical blood test;
- general urine analysis;
- histological analysis of biopsy;
- tumor markers SCC, CYFRA 21-1, TPA.
To date, patients who have a malignant neoplasm in the esophagus are prescribed the following treatment methods:
- surgery;
- radiation therapy;
- chemotherapy;
- complex therapy (this technique includes surgical treatment, medication, radiation and chemotherapy);
- the combined method (it combines surgical manipulations with radiation components).
During abdominal surgery, the esophagus is partially or completely removed. The surgeon carefully examines the lymph nodes that are affected by metastases and removes them. In the event that during the removal of a malignant neoplasm it is not possible to save the patient's esophagus, the surgeon uses the tissue of the small or large intestine to restore this organ of the digestive tract.
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When carrying out surgical treatment, patients are able to restore the lumen of the esophagus. A malignant neoplasm can be completely removed if it is located in the middle or lower part of the esophagus. In some cases, the surgeon removes part of the esophagus and together with the upper stomach. The rest of the esophagus is sewn to the stomach and after a series of rehabilitation measures begins to function fully. According to statistics, mortality rates for patients who underwent surgical treatment fluctuate around 10%.
Not all cancer patients can undergo surgical removal of malignant neoplasms of the esophagus. The following restrictions apply:
- metastasis of cancer to the lymph nodes and other internal organs;
- the patient's age should not exceed 70 years;
- the presence of severe chronic diseases;
- problems with the heart, blood vessels and lungs, etc.
When a malignant neoplasm is localized in the middle part of the esophagus, an opening is created on the anterior wall of the peritoneum (during surgery). Subsequently, the patient will be fed through a tube that will be inserted into this hole. With this location of the tumor, in most cases, the esophagus is completely removed along with the lymph nodes affected by metastases. A year later, after the surgical intervention, the patient undergoes a thorough examination to identify metastases. If they are not found, a second operation is prescribed, the purpose of which is to create an artificial esophagus (for which the patient's small intestine tissue can be used).
Endoscopic surgery. In the early stages of the development of a malignant neoplasm, patients can undergo more sparing surgical treatment - endoscopic surgery. During the surgical procedure, the patient is introduced through the mouth through the endoscope tube, at the end of which an optical device is attached. With the help of special instruments, the specialist performs bougienage, the purpose of which is to restore the lumen of the esophagus.
Radiation therapy. One of the modern methods of treatment of malignant neoplasm of the esophagus is radiation therapy. This technique is ideal for the category of cancer patients for which surgical intervention is contraindicated (this is associated with diseases of the bronchopulmonary or cardiovascular system, etc.). Radiation therapy is often carried out in the postoperative period, due to which the number of relapses of the disease in patients is significantly reduced and the process of metastasis of the body is prevented. It is also worth noting that in inoperable patients, after radiation therapy, malignant neoplasms are greatly reduced in size. During radiation therapy, healthy cells of the patient's body are not negatively affected, and patients do not experience strong side effects.
In the combined treatment of esophageal cancer, patients are prescribed a course of radiation and chemotherapy for several weeks before surgery. This combination greatly increases the chances of a successful treatment. In parallel, a complete diet is developed for patients, which includes vitamins, protein preparations, as well as various nutritious fluids. Doctors recommend that cancer patients drink natural juices and fruit drinks. If patients are unable to swallow even liquid food, they are fed with a tube.
Diet. In order to increase the patient's chances of successfully treating esophageal cancer, he needs to be provided with proper care and nutrition. An insufficient amount of nutrients, vitamins and trace elements can lead to a violation of the mental state of an oncological patient and the appearance of various complications. The patient should eat semi-liquid food, which will not contain any particles that can close the lumen of the esophagus. The food should be varied, nutritious and rich in vitamins and minerals. Patients diagnosed with esophageal cancer should eat 8-10 small meals a day.
It is strictly forbidden for this category of patients to consume: fried and smoked foods, fatty foods, alcohol and carbonated drinks. You also need to give up another addiction - smoking. In addition to proper nutrition, the patient must strictly observe personal hygiene.
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Correctly selected treatment in 70% returns patients the opportunity to return to a full life and eat solid foods.
Chemotherapy for esophageal cancer
In the treatment of oncological diseases, in addition to surgical interventions, chemotherapy has a great effect. During its implementation, patients, depending on the localization and etiology of the malignant neoplasm, are injected with special drugs. The main purpose of these drugs is to destroy cancer cells. In cancer of the esophagus, chemotherapy is usually given from stage 2 of the disease.
Correctly selected drugs for chemotherapy can not only slow down the growth of a malignant tumor and prevent its cells from dividing, but also work to destroy them completely. Unfortunately, any chemotherapy has a number of side effects and has a negative effect on healthy cells in the body. In most cases, against the background of taking such drugs, patients develop problems with bone marrow cells, hair (their follicles are destroyed and baldness occurs), intestines, oral mucosa, etc.
Chemotherapy for esophageal cancer is performed when the patient is diagnosed with a certain form of malignant neoplasm:
- small cell esophageal cancer;
- poorly differentiated form of esophageal cancer.
Chemotherapy is almost always done in parallel with other treatments. According to statistics obtained as a result of many years of research by scientists from around the world, the greatest effect is achieved in the treatment of cancer of the esophagus in the case when radiation therapy is performed along with chemotherapy. This treatment method is completely aimed at destroying cancer cells, while the malignant neoplasm is significantly reduced in size.
Special drugs can be prescribed to patients, both before surgery, and after surgery. During chemotherapy, drugs can be administered either orally or intravenously.
Chemotherapy is prescribed for cancer patients as follows:
- starting from the 2nd and 3rd stages of esophageal cancer, special drugs prevent the further development of cancer and destroy cancer cells. Chemotherapy is prescribed to patients in the preoperative and postoperative period;
- starting from the 4th stage of esophageal cancer, patients undergo palliative treatment. The main task of this therapy is to slow down the growth of a malignant neoplasm. All these therapeutic measures can prolong the patient's life.
During chemotherapy, patients with esophageal cancer are prescribed anticancer drugs:
- Bleomycin;
- Vindesine;
- Mitomycin;
- Pharmorubicin;
- 5-fluorouracil, etc.
The author of the article: Bykov Evgeny Pavlovich | Oncologist, surgeon
Education: graduated from residency at the Russian Scientific Oncological Center. N. N. Blokhin "and received a diploma in the specialty" Oncologist"
