Esophageal Cancer

Esophageal cancer arises from cells lining up in the esophagus. There are two major types, squamous cell carcinoma and adenocarcinoma, depending on the type of cells that are malignant. Squamous cell carcinoma (SCC) occurs most often in the upper and middle parts of the esophagus. The highest rates of SCC are found in Asia (particularly in China and Singapore), Africa, and Iran. Adenocarcinoma (AC) usually begins in the cells of mucus-secreting glands in the lower part of the esophagus. AC is largely a disease of Caucasians.

Symptoms of esophageal cancer are not specific. Patient may experience difficulty swallowing, loss of weight, unexplained anemia, dark stools, fatigue, etc.

Risk factors of esophageal cancer

Male gender, smoking, genetics, etc are risk factors to both SCC and AC. There are also some factors associated with different types of cancer.

Squamous Cell Carcinoma (SCC)

1. alcohol

2. Dietary factors

  • Pickled vegetables and other food-products
  • Toxin-producing fungi
  • Betel nut chewing
  • Ingestion of very hot foods and beverages (such as tea)

3. Underlying esophageal disease (such as achalasia and caustic strictures)

4. Human papilloma virus

5. Tylosis. It is a rare disease associated with hyperkeratosis of the palms of the hands and soles of the feet and a high rate of esophageal SCC

Adenocarcinoma (AC)

1. Barrett's esophagus

2. Obesity

3. Increased esophageal acid exposure (such as, GERD, Zollinger-Ellison syndrome)

Diagnosis and treatment of esophageal cancer

Diagnosis is based on risk factors, clinical presentation, blood works and one or more of the following tests:

  • Barium esophagram
  • CT
  • EGD and Biopsies

Once diagnosis is confirmed by EGD and biopsies, next step is to see if the tumor has spread or not, which is called staging. Staging helps the surgeon decide should surgical interventions are needed and how. Several tests are available for this purpose:

  • CT
  • MRI
  • PET
  • EUS

Treatments usually involve chemotherapy, surgery, radiation therapy, etc based on the detailed information of the cancer.

References:

  1. PubMed Health.
  2. Wikipedia.
  3. Mayo clinic online health information.
  4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
  5. The Little Black Book of Gastroenterology-by David W. Hay.
  6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.


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