Malignant tumor of the esophagus is a disease where malignant cells originate from the tissue of the esophagus. Esophagus has a shape of a hollow tube which transfers food and fluids from the oral cavity to the stomach.
Who is endangered?
Patients with malignant tumor of the esophagus disc cells (squamous cell carcinoma) have increased frequency of other primary tumors of the head and neck and / or lungs. These other primary tumors can be discovered before, after or in the time of the diagnosis of malignant tumor of the esophagus. These malignant tumors can be related to smoking and alcohol abuse. It has been proved that nutrition with a lot of fat, small amount of proteins and low caloric nutrition also increase the risk of malignant tumor of the esophagus.
What are the symptoms?
Troubles with swallowing (dysphagia). That is the most common complaint, but in general it is not noticed until the lumen of the asophagus is narrowed down to one half or 1 / 3 of normal, because of its elasticity.
- vomiting blood
- heartburn
- saliva leakage
- bad breath
- regurgitation of food
- chest pain that is not connected to eating
- weight loss is usual and often significant (more than 10% of total body weight)
- cough that is caused by swallowing warns that there is some local widening in the trachea resulting with tracheoesophageal fistula.
Routine screening with the purpose of discovering malignant tumors of the esophagus is not usual in the western hemisphere because the disease is relatively rare. Mass examination is suitable for high risk areas, like China and Japan. If there are symptoms the doctor will usually do a special x-ray examination that is called ingestion of barium.
For this test the patient drinks a fluid that contains barium, and that allows the esophagus to be more visible in the x-ray. The doctor can also examine the inside of the esophagus with a narrow, lighted tube that is called endoscope. Endoscope is inserted through the mouth and down the throat into the esophagus. Before the testing, a local anesthetic is applied on the throat, so the patient can feel no pain.
The advantage of endoscopy is that it allows direct visualization of the abnormality, and also taking the tissue for histopathological analysis. If the doctor notices tissues that don’t have a normal appearance, he will remove a small part of the tissue so it could be examined under a microscope for determining the malignant cells. This procedure is called a biopsy. X-ray with barium doesn’t facilitate the biopsy but it is less invasive and it can also identify small abnormalities. The doctor can also examine the interior of the trachea with another narrow lighted tube. This is called bronchoscopy. It should be done so the spreading of malignant tumors to the trachea could be discovered in all cases of malignant tumors of the esophagus.
Treatment
Therapy of choice and disease prognosis depends on the stage of the malignant tumor (is it only in the esophagus or has it spread to other places) and general health condition of the patient. For treating the patient with malignant tumor of the esophagus all kinds of treatments are used:
- surgery (removal of the malignant tumor),
- radiation therapy (using high doses of radiation that can have different sources of origin for destroying malignant cells),
- chemotherapy (using medication for destroying the malignant tumor cells).
Surgery is the most common choice for treating malignant tumors of the esophagus. The doctor removes the esophagus and binds the rest of the healthy part with the stomach so the patient can still swallow. To make that bond sometimes a part of intestines or a plastic tube can be used. The doctor will probably remove lymph nodes around the esophagus and check them under the microscope so he can see if they contain malignant cells.
Radiation therapy uses x-rays or other high energy rays so the cells of the malignant tumor can be destroyed. Radiation can be applied from a device which is outside the body or by introducing materials that contain radiation through thin plastic pipes in the area where malignant cells have been found. When using radiation therapy for treating a malignant tumor, sometimes a plastic tube is introduced into the esophagus so it can keep it open.
Chemotherapy uses medication for killing cells of a malignant tumor. Chemotherapy can be ingested through tablets or it can be introduced into the body with a needle through a vain or a muscle. Chemotherapy is called systemic treatment because the medication enters the bloodstream, runs through the body and it can kill cells of malignant tumors in the whole body. If the malignant tumor is in a late stage and resection is not possible any more, surgical or endoscopic treatment can reduce some of the symptoms. Esophagus can be widened and prosthesis can be installed to help with swallowing. Chemotherapy and radiation therapy can improve the course of the disease and the length of survival.
Prevention
Reduce or completely stop smoking or excessive use of alcohol.