What is Esophageal Cancer?

What is the Esophagus?

The esophagus is the tube through which ingested food and liquids pass from the throat to the stomach.

25 to 30 centimeters long and 2 to 3 centimeters wide, the esophagus has inner walls lined with mucous tissue and surrounded externally by muscle tissue. This tissue, contracting during swallowing, pushes food downwards towards the stomach, to which the esophagus is connected by a valve called the cardia, which allows food to descend, preventing it from rising.

The mucosa lining the end of the esophagus is rich in mucus-producing glands, which lubricate the esophageal walls and facilitate the passage of swallowed food.

What causes an esophageal tumor?

An esophageal tumor results from the uncontrolled growth of cells lining the inside of this organ, or cells that form the mucus-producing glands. Much more rarely, it originates from the outermost muscle cells.

What are the symptoms of esophageal cancer?

Esophageal cancer generally manifests as swallowing problems (dysphagia). Difficulties usually appear gradually, first with solid foods, then with liquids.

Other symptoms include difficulty swallowing, a feeling of weight or chest pain after swallowing, reflux, heartburn, hoarseness (lowering or change in voice tone), weight loss, black stools (indicating digestive tract bleeding), a feeling of discomfort behind the sternum, and fatigue.

Therefore, individuals experiencing these symptoms should consult their doctor promptly for a thorough examination.

Diagnosis of Esophageal Cancer

Endoscopy is particularly useful for diagnosis. It involves inserting an instrument (endoscope) into the esophagus and stomach, with the possibility of also performing an endoscopic biopsy (removal of a small piece of suspicious tissue for histological diagnosis). Esophageal ultrasound allows examination from the inside to assess the degree of invasion of neighboring tissues.

An X-ray of the esophagus with contrast medium, a chest X-ray, and a CT scan of the chest and abdomen are also performed to rule out metastases. Positron emission tomography (PET) scan is often useful for staging.

Treatment of Esophageal Cancer

Surgical Treatment of Esophageal Cancer

Esophageal removal surgery (esophagectomy) is the cornerstone of esophageal cancer treatment. This technique is sometimes the only treatment, but most often it is combined with chemotherapy and radiotherapy, depending on the clinical stage, as part of integrated treatment. During this operation, the surgeon generally removes all or part of the esophagus. He then restores the continuity of the digestive system by interposing a viscus, generally the remaining part of the stomach or a section of intestine. This procedure always involves at least two, sometimes three, areas of the body: neck, chest and abdomen. It is therefore a complex and delicate procedure. Surgeons today opt for interventions using both traditional open techniques and minimally invasive techniques (laparoscopy, thoracoscopy). The minimally invasive approach is less traumatic for the body because surgical maneuvers are performed through very small incisions into which cannulas are placed that allow the passage of very fine instruments operated from the outside. In general, minimally invasive esophagectomy requires a shorter hospital stay, involves less postoperative pain, and is followed by faster patient recovery. Minimally invasive esophagectomy yields excellent clinical and oncological results when performed by experienced surgeons.

Chemotherapy and Radiotherapy

Depending on the extent of the tumor, defined by the preoperative clinical stage or the pathological and postoperative staging, doctors may recommend radiotherapy in combination with chemotherapy (chemoradiotherapy). These therapies can be performed before or after surgery to improve the results obtained with surgery alone.

In more advanced stages of the disease, not accessible to surgery, chemotherapy and radiotherapy can be used alone or in combination as definitive treatment.

Risk Factors for Esophageal Cancer

Several factors increase the risk of developing esophageal cancer. The main ones are:

• Smoking,
• High alcohol consumption
• Consumption of very hot foods and drinks,
• An inadequate diet,
• Overweight and obesity,
• HPV viral infection.

80 to 90% of esophageal cancers are caused by alcohol and tobacco consumption, and their simultaneous consumption multiplies the risk by up to 100 times.

People who have suffered from acid regurgitation and heartburn (gastroesophageal reflux) for years also have an increased risk of developing esophageal cancer.

Peptic esophagitis, Barrett's esophagus, and achalasia are predisposing factors for esophageal cancer.

Genetic factors that influence the occurrence of esophageal cancers include palmoplantar tylosis (a rare hereditary disease causing skin thickening on the palms and soles) and esophageal papillomatosis.

Prevention of Esophageal Cancer

Avoiding alcohol and tobacco are the main precautions to prevent esophageal cancer.

In most cases, esophageal cancer develops from Barrett's esophagus. The most effective way to prevent it is to reduce the risk of gastroesophageal reflux causing chronic esophagitis by decreasing the consumption of coffee, alcohol and cigarettes, as well as addressing overweight and obesity. In some cases, plastic surgery of the esophageal hiatus is indicated.

Although several antacid medications can control reflux symptoms, there is no scientific evidence of their effectiveness in reducing the onset of Barrett's esophagus.

While no screening test is available for healthy patients, early diagnosis through periodic esophago-gastroscopies is crucial to detect malignant tissue transformation. In patients with esophageal mucosa simply transformed into gastric mucosa, an endoscopy is recommended every two or three years.