Esophageal (esophageal) cancer: symptoms, causes and drugs

Definition

What is esophageal cancer?

Esophageal cancer is a type of cancer that develops in the esophagus. The esophagus, also known as the esophagus, is a part of the body that resembles a hollow tube and connects the throat to the stomach.

To reach the stomach, anything that enters your mouth, especially food and drink, must pass through the esophagus. This organ is located just behind the respiratory tract (trachea) and in front of the spine.

This cancer can occur anywhere along your esophageal organs. However, generally starting from the inner lining of the esophagus wall, then growing outward through other layers.

Some of the layers of the esophagus include the mucosa, epithelium, lamina propria, submucosa, muscularis propia, and adventitia.

Esophageal cancer is divided into several types, namely:

Squamous cell carcinoma

This type of cancer usually occurs in squamous cells that are in the mucosal layer. Cancer cells are most common in the neck area (esophageal cervix) and the upper two-thirds of the chest cavity (upper and middle chest esophagus).

Adenocarcinoma

This type of cancer starts in the glandular cells that make mucus. Most often, adenocarcinoma occurs in the area of ​​the lower third of the esophagus.

In some conditions, namely Barrett's esophageal glandular cells begin to replace the squamous cells in the lower part of the esophagus, causing adenocarcinoma.

Other types of esophageal cancer

Apart from adenocarcinoma and squamous cell types, there are also other types such as lymphoma, melanoma, and sarcomas that also attack the esophagus. However, this type of cancer is very rare.

How common is this cancer?

Esophageal cancer is a type of cancer that is quite common in Indonesia, although the cases are not as high as lung cancer or breast cancer. According to 2018 Globocan data, 1,154 new cases were recorded with a death toll of 1,058 people.

Signs & symptoms

What are the signs and symptoms of esophageal cancer?

Esophageal cancer symptoms usually do not appear early in the disease progression. Symptoms will begin to appear when the cancer has entered an advanced stage, starting from stage 2, 3, or 4.

Symptoms of esophageal cancer (esophagus) that commonly occur are:

Difficulty swallowing

The most common characteristic of esophageal cancer is difficulty swallowing. This condition is also known as dysphagia and is described as the sensation of food stuck in the throat, making it easy for a person to choke.

Symptoms may appear occasionally. However, over time it gets worse because the tumor narrows the passage of food in the esophagus.

Usually, people who experience this cancer characteristic of the esophagus will produce more thick saliva (saliva) in their mouth.

Chest pain

In addition to difficulty swallowing, the chest will also feel painful or uncomfortable. Not in the right or left chest area, but in the middle area. Some also feel a burning sensation in the chest and this is also called heartburn .

The pain usually appears a few seconds after swallowing food. This pain is called odynophagia. This happens because food or drink that passes through the esophagus cannot enter smoothly because of a tumor.

Other accompanying symptoms of esophageal cancer

In addition to the symptoms mentioned above, there are others who experience other symptoms. Symptoms of esophageal cancer that accompany these include:

• Weight loss due to difficulty eating and decreased appetite for food.
• Hoarseness and frequent vomiting
• Bleeding in the esophagus. Blood will flow into the digestive tract, making the stool blackish in color.
• Anemia (low red blood cell count), which makes the body tired quickly.
• Pain in the bones indicates the cancer has spread to the area.

Every person is very likely to experience symptoms differently. In fact, some of them also experience symptoms not mentioned above.

When to see a doctor?

If you experience the symptoms mentioned above and they do not improve within 2 weeks, see a doctor immediately. Especially, those of you who were diagnosed with Barrett's esophagus.

Precancerous conditions that increase the risk of this cancer are caused by chronic stomach acid. Ask your doctor about signs and symptoms of cancer that indicate a worsening of the condition.

Cause

What causes esophageal cancer?

The cause of esophageal cancer (esophagus) is not known with certainty. Even so, scientists have found a variety of factors that can increase the risk.

Scientists believe that this disease is related to damage to the DNA in the cells that line the inside of the esophagus. This leads to a common cause of cancer, namely DNA mutations.

The existence of mutations or DNA damage makes a series of orders for the cell to go awry. Cells will continue to divide uncontrollably and do not die. As a result, cells will accumulate to form abnormal tissue and become cancerous.

Risk factors

What increases the risk of esophageal cancer?

Various factors can increase the risk of esophageal cancer are:

Increased age and male gender

The risk of esophageal cancer increases with age. As many as 15% of cases of this cancer, occur under the age of 55 years. In addition, most of the affected patients are men rather than women.

Smoking and alcohol habits

Smoking or chewing tobacco can increase the risk of esophageal cancer. The reason is, cigarettes or tobacco contain chemicals that can irritate the lining of the esophagus so that it is possible to make the cells around it become abnormal. A person who stops smoking shows a reduced risk of this disease.

Apart from smoking, drinking alcohol can also increase the risk. Especially if alcohol is consumed in excess. The risk is greater if you have a habit of drinking alcohol as well as smoking.

Excessive consumption of processed meat

Eating large amounts of processed meat can increase the risk of many types of cancer. The risk will increase if the intake of fruits and vegetables is minimal.

Frequent drinking of hot around 65 ° C can also damage the cells lining the esophagus, increasing the risk of cancer.

Lack of activity and obesity

People who don't exercise, aka lazy to move, tend to be overweight (obesity). This condition can increase the risk of gastroesophageal reflux that leads to cancer.

GERD history

GERD or g astroesophageal reflux disease is a condition when stomach acid rises into the esophagus. People who have this problem are prone to irritation of the esophagus. In the long run, this irritation can lead to cancer.

History of Barrett's esophagus

Acid reflux that reaches the esophagus for a long time can damage the lining of the esophagus. As a result, the squamous cells that line are replaced by glandular cells, which naturally cannot protect the lining of the esophagus from stomach acid.

This condition will cause Barrett's esophagus. If you have this disease, the risk of cancer is very high.

Certain health problems

The risk of cancer also increases in people with the following conditions:

• Achalasia (muscles at the lower end of the esophagus don't relax properly, making food difficult to swallow). The average cancer develops in the 15-20 years after achalasia occurs.
• Tylosis (a rare congenital condition that causes extra growth of cells in the top layer of the skin and esophagus).
• Plummer-Vinson syndrome (a rare syndrome in which thin tissue protrudes from the inner lining of the esophagus causing constriction.
• Injury to the esophagus from accidentally ingesting lye, lye, or other chemicals that damage the lining of the esophagus.
• Infected with the HPV virus (human papilloma virus) which causes the growth of warts (papilloma).
• There are family members with a history of lung cancer, oral cancer, and throat cancer.

Diagnosis & treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is esophageal cancer diagnosed?

Your doctor will ask you to undergo a series of medical tests to diagnose esophageal (esophageal) cancer, such as:

• Physical test. Examination of the symptoms that are felt and check the changes in the body that have occurred. The doctor will also look at your and your family's medical history.
• Barium swallow. You swallow barium fluid and take an X-ray, so you can see a clear picture of the condition of the esophagus.
• CT scan.X-ray test to see the spread of cancer cells to other organs.
• MRI (magnetic resonance imaging) scan.Uses radio waves and a strong magnet to produce a more detailed picture of your esophagus.
• PET (positron emission tomography) scan. Inject radioactive substance into the body. This substance is more easily absorbed by cancer cells. With a special camera, cancer cells that have absorbed the radioactive substance will be detected.
• Endoscopy.Using an endoscope through the throat into the esophagus and stomach to check the condition.

How is esophageal cancer treated?

Ways to treat esophageal cancer that doctors usually recommend are:

1. Operation

Surgery can usually be combined with chemotherapy and radiotherapy. Some of the types of surgery performed by the surgical team are:

• Surgical removal of a small portion of the esophagus (esophagectomy).
• Surgical removal of part of the esophagus and upper part of the stomach (esophagogastrectomy).
• Surgical removal of lymph nodes that are affected by cancer.

The side effects of this cancer treatment are bleeding, infection, lung complications, and voice changes.

2. Chemotherapy

Chemotherapy is a treatment aimed at killing cancer cells. Chemotherapy drugs can be injected or taken directly. Some chemotherapy drugs used to treat esophageal (esophageal) cancer are:

• Carboplatin and paclitaxel (Taxol).
• Oxaliplatin and 5-FU or capecitabine.
• Cisplatin and 5-fluorouracil (5-FU) or capecitabine.
• Cisplatin and Irinotecan (Camptosar).
• Paclitaxel (Taxol) and 5-FU or capecitabine.

Chemotherapy can cause side effects such as nausea, vomiting, diarrhea, hair loss, and body fatigue.

3. Radiation therapy or radiotherapy

Radiotherapy uses high-power X-ray light to kill cancer cells. Generally, this therapy is done using a machine that emits radiation from outside (external), or inserts radiation substances into your body (internal).

Home care

What are some lifestyle changes or home treatments for esophageal cancer?

Until now, home treatments, such as herbal remedies (natural) or alternative remedies have not been proven to cure esophageal (esophageal) cancer. So, you still have to prioritize the treatment recommended by your doctor.

In addition, adopt a lifestyle that is healthy and suitable for cancer patients, such as:

• Avoid smoking, chewing tobacco, and it's best to stop drinking alcohol first.
• Apply a diet with lots of fruits and vegetables and maintain a healthy weight.
• Eating habits must change, such as eating small portions, chewing longer, and being careful.
• Adjust daily activities, so as not to worsen symptoms.

Prevention

How do you prevent esophageal cancer?

Although not 100% prevent esophageal cancer, the following ways can still help some people to reduce the risk, namely:

• Quit smoking as soon as possible and avoid inhaling secondhand smoke.
• Limit drinking alcohol.
• Reduce consumption of processed meat. Instead, increase your intake of vegetables, fruit, nuts and seeds.
• Maintain a diet and exercise routine to keep your weight under control.
• For those of you who have certain health problems that can increase the risk of esophageal cancer, regular health checks to the doctor are necessary.