Esophageal cancer

Esophageal cancer is an often fatal malignancy (something that progresses andbecomes worse with time) that develops in tissues lining the hollow, muscular canal (esophagus) along which food and liquid travel from the throat to thestomach. It starts in the inner layers of the lining of the esophagus and grows outward. In time, it can block the passage of food and liquid, making swallowing painful and difficult. Squamous cell carcinoma, the most common typeof esophageal cancer, can develop at any point along the esophagus. Adenocarcinoma starts in glandular tissue not normally present in the lining of the esophagus. Esophageal cancer is three times more common in men than in women, and among blacks than among whites. Men and women between the ages of 45 and 70 are at the greatest risk. The cause of esophageal cancer is unknown. Risk factors include heavy drinking or smoking, especially, when combined; adiet low in fruits, vegetables, zinc, riboflavin, and vitamin A; swallowinghousehold cleansers containing chemicals that can burn and destroy cells; a condition called achalasia; a rare inherited disease called tylosis; and a condition called esophageal webs. Patients with early esophageal cancer may be hoarse and have hiccups or elevated calcium levels, but symptoms generally don't appear until the tumor has grown so large that the patient cannot be cured. Dysphagia (trouble swallowing or a sensation of having food stuck in the throat or chest) is the most common symptom. Painful swallowing usually means that a large tumor is blocking the opening of the esophagus.

A barium swallow is usually the first test performed if esophageal cancer issuspected. This special x-ray highlights bumps or flat raised areas on the normally smooth surface of the esophageal wall and detects large, irregular areas that narrow the esophagus in patients with advanced cancer, but it can't provide information about disease spread beyond the esophagus. A double contrast study is a barium swallow with air blown into the esophagus to improve theway the barium coats the esophageal lining. In esophagoscopy, a thin lightedtube (esophagoscope) is passed through the mouth, down the throat, and intothe esophagus to remove abnormal cells for biopsy. Once a diagnosis of esophageal cancer has been confirmed, tests are performed to determine whether thedisease has spread (metastasized) to tissues or organs near the original tumor or in other parts of the body. This is called staging. In Stage 0, cancer cells are confined to the inner lining of the esophagus. Stage I esophageal cancer involves only a small part of the esophagus. In Stage IIA, cancer has invaded the thick, muscular layer of the esophagus that propels food into the stomach and may involve connective tissue covering the outside of the esophagus. In Stage IIB, cancer has spread to lymph nodes near the esophagus and mayhave invaded deeper layers of esophageal tissue. Stage III esophageal cancerhas spread to tissues or lymph nodes near the esophagus or to the trachea (windpipe) or other organs near the esophagus. Stage IV cancer has spread to distant organs like the liver, bones, and brain. Recurrent esophageal cancer develops, after treatment, in the esophagus or another part of the body. Endoscopy and CAT scans provide images of tumors and the extent of disease and indicate the chances that all cancer can be surgically removed. Endoscopic ultrasound determines how deep cancer cells are in the esophagus and may measure disease spread and predict surgical outcomes better than CAT scans. Treatment for esophageal cancer is determined by the stage of the disease and the patient's health. The most common operations are: Esophagectomy, which removes the cancerous part of the esophagus and nearby lymph nodes and is performed only on patients with very early cancer that has not spread to the stomach; and esophagogastrectomy, which removes the cancerous part of the esophagus, nearby lymph nodes, and the upper part of the stomach. These procedures significantlyrelieve symptoms and improve the nutritional status of more than 80% of patients with dysphagia. Surgery can cure some patients whose disease has not spread beyond the esophagus, but more than 75% of esophageal cancers have spreadto other organs before being diagnosed. Patients too ill for surgery may betreated with radiation, delivered by machine or implanted near cancer cells inside the body. Radiation alone won't cure esophageal cancer, but it relievesdysphagia almost as effectively as surgery. Post-operative radiation kills cancer cells that couldn't be surgically removed. Radiation is also used to control bleeding and relieve symptoms in patients who can't be cured. Oral or intravenous chemotherapy alone will not cure esophageal cancer, but pre-operative treatments can shrink tumors and increase the probability that cancer canbe surgically eradicated. Regular barium swallows and other imaging studiesdetect recurrence or spread of disease or new tumor development. An experimental treatment, photodynamic therapy (PDT), kills cancer cells by laser beam.PDT cured some early esophageal cancers during preliminary studies. Althoughesophageal cancer carries a poor prognosis, recent advances in multiple therapies for this disease offer some hope. There is no known way to prevent esophageal cancer.

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