Esophageal cancer is a malignant neoplasm that develops from cells that cover its mucous membrane. It can occur at any age, but is more often diagnosed in men after the age of 60. In most cases, the process is localized in the lower and middle parts of the esophagus. Among other oncological pathologies, it takes 5-7%. There are mainly 2 types - adenocarcinoma and squamous cell carcinoma. In the absence of treatment, the tumor grows and spreads to nearby organs: bronchi, trachea, aorta, pericardium.
Reasons
At the moment, the reasons for the development of esophageal cancer are not fully understood. The effect on its mucous membrane of various irritating agents is important: thermal, mechanical, chemical. As a result of this, esophagitis first occurs, and then cells begin to divide more intensively, malignant degeneration of tissues occurs and cancer develops.
It is possible to single out a number of conditions that contribute to the development of the disease. These include:
- Hereditary predisposition.
- Esophagus injury by solid food or foreign objects.
- Human papilloma virus.
- Deficiency of vitamins A, E, group B weakens the body's defenses, which promotes cell regeneration.
- Esophageal burns due to consumption of excessively hot food, accidental ingestion of various chemicals into the digestive system.
- Precancerous conditions – Barrett's syndrome, esophageal achalasia.
- Irrational nutrition - oversaturation of the diet with nitrates, marinades, excessively spicy or salty dishes.
- Smoking – tobacco smoke contains carcinogens that cause pathological processes in epithelial cells.
- Regularly consumed alcoholic beverages. Alcohol burns the mucous membrane and contributes to its thinning.
Esophageal cancer: symptoms
In the very initial stage, the disease has an asymptomatic course.
If esophageal cancer develops, the first symptoms appear when the tumor increases in size. The neoplasm grows and narrows the esophagus, it becomes difficult for the patient to swallow solid food. There is a feeling that it does not pass and it should be asked for water. Many do not react to this symptom, considering it a temporary phenomenon. But if you are examined during this period, a good prognosis for treatment will appear. After a few weeks, problems arise when swallowing already soft food, as well as saliva and liquids.
If you suspect esophageal cancer, the signs of the disease can be quite general. These include:
- pain in the chest, which sometimes radiates to the back;
- vomiting;
- weight loss even with a normal diet;
- hoarseness, transformation of voice timbre due to tumor compression of the nerves that control the vocal cords;
- hypersalivation (increased salivation);
- hiccup;
- bad breath;
- seizures;
- general weakness, unbearable fatigue;
- increasing temperature.
The complex of the listed signs is a reason to consult an oncologist, who will prescribe a comprehensive examination of the body in order to make the correct diagnosis.
Esophageal cancer can metastasize to nearby and distant organs, and sometimes very early. This process is manifested by various specific symptoms. When it spreads to the larynx and trachea, there is a constant cough that cannot be treated. Lung metastases can cause shortness of breath. When the tumor spreads to the brain, consciousness becomes confused, headache, convulsions are possible. Esophageal cancer metastases to the intestines are manifested by blood in vomitus, stools, iron deficiency anemia.
In the later stages, complete blockage of the esophagus is possible. It will become almost impossible to swallow, as a result of which secretions constantly accumulate in the oral cavity. Due to the inability to eat, the patient develops exhaustion.
Classification of esophageal cancer
Staging allows you to determine the spread of the tumor in the patient's body. This is an important determination of treatment tactics. In this pathology, stages 0 to IV are distinguished:
- 0 stage or tumor in situ. The process is located within the epithelium. Histological examination reveals pronounced dysplasia. It is clinically asymptomatic.
- Esophageal cancer stage 1 – a small neoplasia, with clearly defined contours, grows into the mucous membrane. At this stage, the lumen of the esophagus is still practically not narrowed, so the passage of food is not difficult. There may be a need to wash down solid food with water. There are no metastases.
- Esophageal cancer stage 2 - the neoplasm grows into the muscular shell, but does not spread beyond the walls of the esophagus. The patency of the esophagus is disturbed, problems with nutrition arise, so patients switch to semi-liquid puree-like food. Metastases occur, affecting regional lymph nodes (more often single).
- Esophageal cancer stage 3 - circular lesion of the organ by a tumor, germination of its entire wall occurs. Esophageal canal becomes very narrow, so it is difficult to even swallow liquids. The neoplasm is no longer localized exclusively in the esophagus. Multiple metastases spread to regional lymph nodes.
- 4th stage - the growth of the process into all the membranes of the organ wall, the tumor goes beyond it. There are metastases in distant organs, regional lymph nodes as stationary metastatic clusters. Complete obstruction of the esophagus. If stage 4 esophageal cancer is diagnosed, the prognosis for life is unfavorable.
Forms of cancer
Two forms of esophageal tumor are most often observed. Their name comes from the cells that started the malignant growth:
- Squamous cell cancer – the process affects the flat cells of the mucous membrane of the esophagus. The most frequent localization is in the upper and middle part of the organ. It is also called "epidermoid carcinoma".
- Adenocarcinoma – glandular cells that are located in the mucous membrane and produce mucus are affected. Most often, the location is the lower part of the esophagus, closer to the stomach.
Diagnostics
When a tumor of the esophagus is suspected, a gastroscopy is first performed. The doctor uses special endoscopic equipment to examine the mucous membrane of the esophagus and other nearby organs (stomach, duodenum). If suspicious areas are found, a biopsy is taken - a piece of tissue for histological examination. Endoscopic ultrasound can be performed during gastroscopy. The examination helps to examine the layers of the esophageal wall and regional lymph nodes, which allows you to determine the spread of the neoplasm. This is important for therapeutic tactics.
The diagnosis can be confirmed with the help of radiological studies. CT of the abdominal and thoracic cavities is most often performed. X-ray with barium contrast is prescribed if necessary. The patient drinks a special liquid before the examination, then pictures are taken. Bronchoscopy may be required.
The tissue sample obtained during gastroscopy is examined, the histological type of neoplasm (adenocarcinoma, squamous cell carcinoma) is established. After completing a comprehensive examination, the oncologist forms a diagnosis. After the operation, the pathologist must examine the distant tumor and lymph nodes.
Esophageal cancer: treatment
The tactics of treatment depends on the location of the neoplasm and its spread. Operative or combined treatment can be carried out: a combination of the radiation method, chemotherapy and surgery. Chemotherapy has almost no effect, so it is used only as part of complex treatment.
For tumors in the lower or middle part of the esophagus, surgical intervention is performed. The advantage of this method is the restoration of the lumen of the organ. During the operation, the esophagus is removed completely or resected with subsequent reconstruction. In order to restore the continuity of the gastrointestinal tract, organ plastic surgery is performed, for which the stomach and colon are used.
Chemotherapy and radiation therapy are used as an adjunct to surgical treatment. They are carried out before the planned surgical intervention. These methods make it possible to reduce the tumor and improve the long-term results of the operation.
The palliative method is indicated when the process is started for temporary relief of the condition. For this purpose, the following options are used:
- In the case of distant metastases, growth of a neoplasm into the tracheobronchial tree, a large-diameter tube is inserted through the site of obstruction of the esophagus. This will allow the patient to swallow liquid food and saliva.
- In order to preserve the lumen, dilators with silicone tubes are used or the esophagus is embolized (use of a probe).
- In case of absolute dysphagia (absence of swallowing), a gastrostomy is applied.
- Restoration of the lumen of the organ is carried out with the help of cauterization with a laser.
- At a high risk of surgery, radiation and chemotherapy bring temporary relief.
Esophageal cancer: prognosis
Compared to other oncological processes, esophageal cancer has a slow development. Most often, the patient goes to the hospital with an advanced process, since there are no obvious specific symptoms in the early stages of the pathology. In the presence of metastases, it makes no sense to carry out an operation, so radiation therapy is prescribed.
The success of therapeutic measures directly depends on the prevalence and speed of tumor growth, the presence of concomitant diseases, metastasis and the general condition of the patient.
Prevention
The method of primary prevention is careful monitoring of patients who are at risk. The vigilance of polyclinic doctors is important during the examination of persons suffering from Barrett's syndrome, chronic esophagitis, achalasia of the cardia. If suspicions of esophageal cancer have already appeared, age plays not the least role - the disease develops more often in the elderly. Therefore, if there are any symptoms indicating this pathology, it is necessary to conduct a thorough diagnostic examination. Early diagnosis makes it possible to increase the effectiveness of pathology treatment.
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