Esophageal Cancer
Roughly 13,000 Americans develop this cancer each year and 12,000 die from it. It is more commonly seen in men than women. Smoking and tobacco use along with alcohol impose a great risk in development of this cancer. The incidence of adenocarcinomas of esophagus has been rising dramatically since 1970 in both United States and Europe. This rise has been purely due to Barrett's Esophagus and subsequent development of almost all of adenocarcinomas of esophagus.
Causes
Following is list of factors that increase the risk of esophageal cancer:
- Barrett's Esophagus
- Tobacco
- Alcohol
- High fat, low protein diet
- Exposure to nitrosamines
- Esophageal irritation
Signs and Symptoms
Very few cases are diagnosed at early stages. Most patients present with later stages of this cancer, at which point they complain of difficulty in swallowing solid food. Others may present with
- Weight loss
- Loss of appetite
- Cough
- Hoarseness
- Bone pain
- Shortness of breath
Diagnosis
When there is suspicion of this condition, patients should be seen by a specialist who will perform a physical examination followed by endoscopy to visualize the esophagus. A CT scan or MRI are vital procedures in the workup of a patient with these cancers. If an abnormal area is seen in the endoscopy or physical examination, then a biopsy is performed and the tissue sample is sent to the pathologist. If patients present with a lump in the neck or an enlarged lymph gland, a fine needle aspiration or a surgical biopsy may be indicated.
Treatment
Most patients are treated with a combination of Surgery, Chemotherapy and Radiation therapy. Surgery is most appropriate for patients in the very early stages of a disease, especially when the location of cancer makes it easy to operate. Even for patients with more advanced disease, a combination of chemotherapy and radiation therapy may control a disease in a high percentage of patients. Cancers that are located in the upper esophagus are almost always treated with chemotherapy and radiation. The majority of patients are treated with a combination of 5-FU and Cisplatinum and radiation. This regimen has become a standard for the majority of esophageal cancers. 5-FU is given as a continuous infusion over four to five days and Cisplatinum is given in one dose on Day 1 of 28-day cycles. The same regimen is repeated every four weeks. Patients benefit from having a Port-A-Cath for administration of chemotherapy. The most significant side effects of this regimen are:
- Hair loss
- Nausea, vomiting
- Low white blood count
- Anemia
- Soreness of the mouth
Other drugs may also be used in some form of combination:
Leucovorin, Methotrexate, Bleomycin, Carboplatin, Cytoxan
Radiation therapy
Radiation to the esophagus is a treatment offered over six to eight weeks. Patients may exhibit the following side effects:
- Soreness and dryness in the mouth
- Skin irritation
- Difficulty swallowing
Most of these side effects will subside after completion of Radiation; however, some may persist for a very long period of time (Dry mouth).
Prognosis
The prognosis depends on the extent of the disease at diagnosis, as well as response to treatment. Most patients with early stage cancers can be cured. In others, the disease can be successfully controlled with treatment for a period of time that may vary from months to years. If the disease reoccurs, the treatment will most likely be chemotherapy or possibly surgery.
Special Situations
Patients with advanced esophageal cancer may develop any of the following complications:
- Pleural effusion
- Superior Vena Cava obstruction
- Spinal cord compression
- Brain metastasis
- Bone metastasis
- Paraneoplastic syndromes
- High calcium level
- Pain
Follow-up
After completion of treatment in any combination that might have taken place, patients need to remain under surveillance for possibility of recurrence of cancer. Follow-up should be scheduled on a regular basis, initially every one to three months for a period of one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. In each follow-up visit, patients are examined and a chest x-ray is normally obtained every few months. A CT scan of chest, bone scan and endoscopy are performed once a year.
Treatment of the disease will depend on the stage and extent of the reoccurred disease. Most patients are treated with chemotherapy utilizing the same agents mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas to which the cancer has spread. If patients experience pain, various pain medications may be used to alleviate pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from hospice.
Esophageal Cancer
Esophageal Cancer
Esophageal Cancer
Esophageal Cancer
Esophageal Cancer
