Esophageal Cancer: Symptoms and Treatment
Tumor of the esophagus
What is esophageal cancer?
Esophageal cancer, (also spelled: oesophageal), is a rapid growth of unhealthy cells that affect the lining of the esophagus. Depending on how quickly it is discovered will determine at what depth the cancer has infiltrated the layers of lining, or metastasized to surrounding lymph nodes and organs of the body. Often a tumor grows from the lining and blocks the esophagus, causing discomfort and inability to swallow.
There are two main types of esophageal cancer: squamous cell carcinoma and adrenocarcinoma.
Squamous Cell Carcinoma
A squamous cell is a flat, thin cell that lines the surface of the esophagus. It is the most prevalent of the two cancers, worldwide. It is heavily linked to smoking and alcohol, as its main sources of irritants. Squamous cell tumors usually grow in the middle of the esophagus.
The adrenocarcinoma affects the lower area of the esophagus, and is the more common form in the United States. It predominantly affects older Caucasian males. The cancer begins in the cells of mucus secreting glands in the esophagus.
The mortality rate is not high for those who receive a diagnosis of esophageal cancer. About 40% survive for one year; 13% survive for five years; and only 1-10 survive for ten years or more. (Statistic is based on data from 2008.)
Worldwide, the countries with the highest rate of cases are Southern and Eastern Africa, and Eastern Asia. The countries with the lowest number of cases include Western and Middle Africa, and Central America.
In the United States, over 13, 000 new cases are diagnosed each year.
In the United Kingdom, there were 23 cases daily discovered with esophageal cancer in 2008.
Other countries with high rates of esophageal cancer include: parts of China, Japan, Thailand, Belgium, Iceland, Iran, and India.
What is the esophagus?
The esophagus is the long, muscular tube that moves food from the mouth and into the stomach. It begins at the mouth and includes the throat, the esophagus, the sphincter at the lower end, into the entry of the stomach.
What are the risk factors for esophageal cancer?
You are at higher risk for developing esophageal cancer if you are:
3. Drink alcohol frequently
4. Are obese
5. Do not regularly include fruits and vegetables in your diet
6. Have GERD
7. Have Barrett's esophagus
8. Have Achalacia-a medical condition where the lower sphinctor leading into the stomach cannot relax enough to allow food to enter from the esophagus.
9. Have Tylosis-a hereditary medical condition in which the palms and soles have an excess of skin. Frequent screening should be done early on if diagnosed with this.
10. Are over 50 years old.
11. Frequently eat foods preserved in lye, such as lutefisk.
12. Frequently drink hot liquids, beverages or soups, that may irritate the esophagus.
Symptoms of Esophageal Cancer
Worldwide, our lives have been thwarted with various stressors. In the developed countries of the world there is an ongoing fight for financial success, career pressures, balancing home and family, and trying to fit more into a 24 hour day.
In undeveloped countries, the stressors are different-poverty, war, malnutrition, and a lack of available medical intervention can result in poor health.
Anyone who watches television knows that the solution for heartburn is what the advertisers want us to believe: take a Tums or two; drop a couple of Alka Seltzers into a glass of water for fizzy relief; or take the little purple pill, Prilosec, to reduce acid secretions and neutralize existing stomach acid.
But, we need to be aware that if there is ongoing indigestion caused by a reflux of acid moving out of the stomach and past the sphincter that usually prevents a back wash of food and fluid back into the esophagus, taking over-the-counter medication to relieve the symptoms may not be the solution.
In fact, indigestion that increases in occurrences and intensity is one of the early warning signs of esophageal cancer. It is an indicator that the lining of the esophagus is being irritated consistently, and that is not healthy.
Other signs of esophageal cancer:
1. A diagnosis of GERD, (gastroesophageal reflux disease).
2. Barrett's esophagus disease-medical professional's consider this may be a precancerous condition.
3. Difficulty swallowing food.
4. Pain in the chest or back-some feel a pressure and think they are having a heart attack.
5. Weight loss, not from diet or exercise.
6. Frequent nausea or vomiting.
7. Vomiting blood.
9. Cough that does not go away or increases in intensity.
10. Change in vocal sounds-hoarseness, or gruffness to voice.
11. Frequent choking while eating.
If you, or anyone you know, has any or several of these symptoms, please see a physician immediately for an examination.
Tests that help diagnose esophageal cancer:
Here are several common tests that may help to clearly identify the pathology within the esophagus:
Barium swallow, or esophagography. This is a medical imaging procedure that checks the gastrointestinal tract. During the procedure, the patient will swallow a Barium contrast, (usually Barium Sulfate), which then coats the esophagus and stomach. Since the Barium shows up on the X-rays as opaque, any distortion will be noted on the images that are taken. Several different angles of images are taken for a complete picture. These images will be reviewed for any pathologies.
Biopsy may be taken from the tissue to examine the cells for normalcy.
EGD, or Esophagogastroduodenoscopy may be done to examine the digestive tract and take a biopsy. This is done as an outpatient procedure and usually only a topical anesthesia is used, although it is sometimes coupled with a sedative to calm anxious patients.
CT Scan-a CT scan stands for computed tomography. It is a noninvasive process that takes cross sectional images of parts of the body; in this case the thoracic region to examine the esophagus. This test helps to determine the stage the cancer is in.
PET Scan-a PET scan stands for Positron Emission Tomography and is a nuclear medical imaging procedure in which a three dimensional image of a particular body part is taken. This test also helps to pinpoint the stage the cancer is in.
Endoscopic Ultrasound, (EUS), combines the procedure of an ultasound with the tool of an endoscope. By combining the two the physician gets a much clearer image to examine, that is well defined.
Diagnostic Tests Explained:
Treatment for esophageal cancer:
Depending on the findings that were assessed by your physician, you may have one of several types of treatment, or a combination. The types of treatment include:
1. Chemotherapy: drug treatment; chemicals that kill off the cancer cells.
2. Radiation: high powered energy beams that are directed at the area affected by cancer, to kill the unhealthy cells. This can be either internal, or external.
3. Surgery-an operation that will remove the tumor, or affected areas in the body. Usually advanced stages, which have metastasized to the lymph nodes or other organs of the body, will prevent the use of surgery as a measure of treatment.
What is Palliative Care?
Often what happens in cases of esophageal cancer is that the early symptoms are ignored until the pain, weight loss, or inability to swallow cannot be ignored any longer. By this time, the cancer is usually in an advance stage of III or IV. In these cases surgery is usually not an option, especially if it has metastasized, (spread), to the liver. In situations such as these palliative care may be the only option. What is 'palliative care'? Palliative care are methods of care to make the patient as comfortable as possible.
Some of the ways to increase comfort of patients are:
1. Placing a stent in the obstructed esophagus to enable the patient to eat and drink. As time goes on, the patient becomes less interested in food, and the appetite reflex shuts down. But, although patients lose interest in food and eating, patients continue to need hydration.
2. Usually a feeding tube is used as a means of active treatment, such as offering liquid nutrients. However, there are situations in which a feeding tube is placed for the sole purpose of maintaining a pain free transition. In these cases the tube is utilized as a means of administering crushed pain medications and fluids.
3. Smaller, frequent meals of nutritious shakes or smoothies are ideal.
4. The use of pain medications is helpful to keep the patient comfortable.
5. Alternative therapies, such as massage, relaxation techniques, and guided imagery can be very useful for a patient to feel relaxed and decrease any fear or anxiety.
6. As a means of a support system, keeping a connection with family and friends is very important. The patient will be facing many emotions, including fear, anger, and sorrow. Finding a strong listening ear, or therapist, is beneficial.
Losing a loved one to cancer:
My personal experience:
I have had first hand experience both professionally, and personally, with caring for someone with esophageal cancer. My husband died of esophageal cancer only 12 weeks after being diagnosed with the disease. Although it was a surreal experience at the time, and took many months to recover from the suddenness of the disease, there were many early signs that he ignored throughout our marriage.
In addition to that, he was obese, smoked, and drank. He had a genetic component for cancer within the family, and he was a Caucasian male. He fit many of the risk factors.
For those interested in reading my personal account of the journey spent with him in his last weeks of life, you can read about it by following this link: http://denisehandlon.hubpages.com/hub/A-Journey-to-Meet-Death
Or, you can order the book: The Disenfranchised: Stories of Life and Grief when an ex-spouse dies edited by Peggy Sapphire, and published by Baywood Publishing. As one of the contributing authors of this unique collection of stories, I can attest that it is more than reading about what someone's life was following their spouse's death. There is a commentary following each contribution that adds to the value of this anthology.