Malignant tumor of the esophagus is a disease where malignant cells come from esophageal tissue. Esophagus looks like a hollow pipe that transfers food and drinks from the oral cavity to the stomach.
Who is at risk
Patients with malignant tumors of squamous cells of the esophagus (squamous carcinoma) have increased incidence of other primary tumors in the head, neck and / or lungs. These other primary tumors can be discovered before, after or while diagnosing a malignant tumor of the esophagus. These malignant tumors can be associated with smoking and alcohol abuse. It is proven that a diet with a lot of fat, little proteins and low calorie diet also increase the risk of malignant tumor of the esophagus.
What are the symptoms
- trouble with swallowing (dysphagia). That is the most common complaint, but generally it is not noticed until the lumen of the esophagus isn’t reduced to one half or 1 / 3 of a normal one, because of it’s elasticity.
- vomitting blood,
- heartburn,
- saliva drip,
- stench,
- regurgitation of food,
- chest pain that is food related,
- weight loss is common and often very significant (more than 10% of total body weight),
- cough that is caused by swallowing warns for a local spread in the trachea with a resulting tracheoesophageal fistula.
Which tests is doctor going to run
Routine screening to discover a malignant tumor of the esophagus is not that common in the western hemisphere because that disease is relatively rare. Mass examination is suitable for high risk areas, like China and Japan. If there are symptoms a doctor will usually do a special X-ray examination which is called Ingestion of barium. For this test, the patient drinks a liquid that contains barium and that makes the visibility of the esophagus on the X-ray better. The doctor can also examine the inside of the esophagus with a thin, lit tube which is called endoscope. Endoscope is retracted into the mouth, down the throat and into the esophagus. Before testing, a local anesthetic is applied so no pain can be felt. The advantage of endoscopeis that it provides the doctor with a direct visualisation of the abnormality, as does taking the blood for histopathological analysis. If the doctor sees tissues that don’t look normal, he will remove a small piece of tissue so it can be examined under the microscope for determination of malignant cells. The procedure is called a biopsy. X-ray with barium doesn’t make the biopsy easier, but it is less invasive and it can also identify small abnormalities. The doctor can also examine the inside of the trachea with a thin, long lit tube. This is called bronchoscopy. It should be done in all cases of malignant tumor of the esophagus so the spreading of malignant tumors on the trachea can be determined.
Treatment
Therapy of choice and disease prognosis depend on the stage of the malignant tumor (is it only in the esophagus or has it spread to other areas) and general health condition of the patient. Treating a patient with a malignant tumor of the esophagus all kinds of treatment are used:
- surgery (malignant tumor removal),
- radiation therapy (using high doses of radiation which can have different sources of origin for destroying malignant cells),
- chemotherapy (using medication to destroy malignant tumor cells).
Surgery is the most common choice for treating malignat tumors of the esophagus. The doctor removes the esophgus 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.
The 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 therapty 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 prothesis 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 quit smoking and drinking alcohol.
Complications
Great weight loss which is a result of inadequate food ingestion. Spreading of the tumor to other areas in the body.