Esophageal cancer: symptoms, treatment, severity, prognosis
Cancer of the esophagus among other malignant neoplasms ranked sixth in frequency. The disease is characterized by an aggressive course, with early metastasis and poor prognosis. As a rule, most patients were over 60 years old, and the identification of esophageal cancer in young people – more a coincidence. Among patients dominated by men. Perhaps this is due to the greater prevalence of harmful habits among representatives of the stronger sex.
Noticed a clear link with cancer of the esophagus geographical areas. Thus, the most often tumors occur among residents of the Central Asian region, Iran, China, Korea and Japan. Siberia is also quite a high incidence of cancer of the esophagus. In many ways, this feature is connected with the nature of power. The use of rough, very hot, spicy foods, lots of seasonings and preservatives contribute to chronic inflammation and damage esophageal mucosa, leading ultimately to malignant transformation its cells.
In addition to tumors in the esophagus there are inflammatory, degenerative changes, scarring, but the proportion of cancer is about 80% of all lesions of this organ, and these changes are often precursors of malignant tumors (pre-cancer).
Causes of tumors of the esophagus
Cancer does not occur suddenly. Healthy mucosa is unlikely to be the soil where you will grow the tumor. Various lesions of the surface epithelium, inflammatory processes predispose to disruption of cell division, prevent normal resumption of the cell cover, which can cause cancer. Since most of the changes in the mucosa of the esophagus sooner or later lead to cancer, almost all of them are considered pre-cancerous conditions.
Signs of esophageal cancer is often found after one or two years from the moment of its appearance, when the tumor has reached considerable size, so all pre-processes should be under the strict supervision of a specialist, and patients should be regularly held study of the state of the mucosa.
Among the precancerous processes the most important are:
- Esophagitis – inflammation of different nature;
- Diverticula – a diverticulum of the mucosa, accompanied by esophagitis or the damage of the epithelial layer of the mucosa of the esophagus;
- Hernia hiatal;
- Barrett’s esophagus, in which the offset into the esophagus of the joint zone of the gastric glandular epithelium with esophageal flat;
- Leukoplakia is the appearance of the plots of keratinization of stratified squamous epithelium, detectable in the form of white spots. Leukoplakia in almost half of cases lead to cancer;
- Scarring due to burns acids, alkalis, hot products, permanent injury to coarse poorly chewed food;
Do not forget about the role of external factors, such as Smoking, increase the risk of cancer several times, and the abuse of alcohol, which increases the chance of the disease 12 times. Eating habits, as mentioned above, often play a crucial role. Too hot and rough food and drinks, plenty of condiments, overeating will inevitably lead to inflammation, arsereview and other changes of the mucosa. This is to remember lovers of hot tea and coffee, hot peppers and pickles that adversely affect the digestion in General.
In some cases the cause may be the human papillomavirus. These studies were conducted in China found a clear correlation between infection and cancer.
The development of molecular biotechnology has allowed to define genetic risk factors of esophageal cancer. So, p53 gene mutation, responsible for normal cell division, accompanied by not only cancer of the colon and other organs, but also carcinoma of the esophagus.
A favorite place for crab is the middle third of the esophagus, where it is found in more than half of patients and lower chest region and the abdominal Department, which affected a third of patients. This is because in these areas there is a natural contraction (in place of division of the trachea into the main bronchi, and also in the zone of transition of esophagus through the diaphragm). As they say, where subtly there and tear, and in places of narrowing of the mucosa most closely contacts with all kinds of damaging agents and is very susceptible to damage.
Looks like cancer?
Tumors of the esophagus can grow in a site facing the lumen of the organ (exophytic), or in the form of ulceration deep into the wall (endophytic). A special form is the so-called circular cancer, covering the esophagus in the form of a ring and narrowing of its lumen.
Exophytic cancer superficially resembles a cauliflower, turned into the lumen of the esophagus is easily injured when passing pieces of food, bleed and ulcerate.
Endophytic tumors ulcerate early, grow quickly in all layers of the esophageal wall and affect the surrounding tissue, making them extremely unfavorable.
When circularly cancer tumor forms a semblance of a whitish ring around the entire circumference of the esophagus, but the length of the body grows slowly. This process causes a disturbance patency and expansion of the esophagus above the lesion neoplastic lesions, so the early manifestations are a violation of passage of food through the esophagus, dysphagia, vomiting.
The most common histological form (more than 90% of cases) is squamous cell carcinoma of the esophagus, which becomes the covering stratified squamous epithelium. If tumor cells are able to synthesize the Horny substance, the cancer will be called cornified. This species is considered to be differentiated in contrast to neorogovevayuschy cancer cells which have lost the ability to form keratin, and therefore it is more malignant, and poor prognostic.
Much less frequently in the esophagus are diagnosed with adenocarcinoma – glandular tumor, originating from the glands of the submucosal layer or sections of gastric epithelium, is shifted here in Barrett’s esophagus, as a result of the hernia, metaplasia etc.
As any malignant tumor, esophageal cancer tends to metastasize – to spread through the lymphatic and blood pathways. This process occurs very intensively, because the esophagus is equipped with the widest network of lymphatic capillaries in the thickness of the wall, and tumor cells are found beyond the visible borders of the tumor.
Localization of nodal metastases is determined by the location of cancer growth. So, if the tumor is located in the upper esophagus, it affects the cervical lymph nodes, on the average – the lymph nodes around the esophagus, the trachea and bronchi, and mediastinal. In the case of growth of a carcinoma in the lower third of the organ, metastases are discovered in the lymph nodes subdiaphragmatic region.
In contact with cancer cells in the blood vessels secondary tumor nodules most often found in the liver, lungs, skeletal system.
Traditionally, to highlight the stages of a malignant tumor uses the TNM system, taking into account the spread of cancer, metastasis, lesion of adjacent organs.
It is customary to identify four stages of esophageal cancer:
Manifestations of esophageal cancer
Symptoms of esophageal cancer for a long time does not manifest, and arise when the tumor reaches considerable size. They are associated primarily with disorders in food intake (feeling of difficulty swallowing, the obstacles to passage of food, podergivani, etc.). Manifestations depend on the order in which the esophagus, a neoplasm.
Patients in the early stages of the disease to the doctor is not in a hurry, and the first signs of the tumor in the form of podergivani, swallowing, feeling the spasms of the esophagus blamed on other diseases of the gastrointestinal tract. Increasing weakness and fatigue of elderly people often do not mind, after all, age brings about changes in habitual way of life. Unfortunately, in such situations, recourse may be delayed, and the treatment of far advanced cancer will be very difficult.
Like most other malignancies, cancer of the esophagus is characterized by a General and local symptoms. Local signs of cancer can be considered:
- Dysphagia – impaired swallowing and passage of food through the esophagus;
- Pain syndrome;
- Esophageal vomiting;
- Excess secretion of saliva.
Common symptoms associated with cancer intoxication, the release of tumor products of metabolism, and a violation of the process of the meal, with subsequent absorption of nutrients.
The insidiousness of the disease consists in the fact that for a long time, significant indications do not exist, and even lovers to eat can not pay attention to any changes, washing down the food with water and thereby facilitating its acceptance.
Defieciencies violations, as the first signs of esophageal cancer, however, testify to his extensive failure. Impaired swallowing may at first wear transient in nature, appearing in the admission of too hard food in large chunks, but subsequently becomes permanent. Patients tend to wash down food with water, change the diet, avoiding dense components. Over time, the tumor greatly narrows the lumen of the esophagus, eating can become almost impossible. The symptom of dysphagia is diagnosed in more than 75% of patients.
In some cases after persistent and prolonged dysphagia may feel some relief but it is not indicative of improvement, and is a sign of the disintegration of the tumor tissue.
Narrowing of the esophagus and impaired patency inevitably entail esophageal vomiting when eaten, not being able to move into the stomach through the esophagus struck back.
Pain syndrome may be of a permanent nature and occur in connection with food and the act of swallowing. Often the pain is localized behind the sternum, in the epigastrium. The cause of the pain is not only a lesion of a wall of the esophagus, nerve endings and blood vessels, and spasms of it when trying to swallow food. Sometimes painful sensations arise in the back in connection with the germination of cancer of adjacent organs and tissues, and metastasis to the spine.
Common signs of esophageal cancer, such as weight loss, weakness, fatigue, loss of ability to work, persistent fever, in fact, are early symptoms, but often they are overlooked from the patient. These changes should be always taken into consideration, even despite the lack of pronounced symptoms from the specific organ.
In advanced stages, possible hoarseness, inflammation of the mediastinum (mediastinitis, pericarditis), the formation of fistula in bronchi with the formation of abscesses in the lungs, pneumonia. Often the bleeding is not massive, but it is likely when growing cancerous tissue in larger vessels.
The literature describes rare cases of synchronous cancer of the stomach and esophagus, when the two tumors are developed simultaneously and independently from each other, having different structures. In these patients, symptoms of dysphagia, as a rule, come to the fore, and carcinoma of the stomach can be identified even by accident with a further thorough examination of the gastrointestinal tract.
It should again be recalled that most of the described characteristics of malignant tumors occur with a significant amount of damage to the esophagus, so do not ignore even seemingly minor difficulties when eating and changes overall health. The prognosis is always serious, and the sooner treatment begins, the more effective it will be.
Diagnosis of esophageal cancer
Painful, increasing dysphagia and worsening of the General condition of the patient forced sooner or later to go to a doctor for the elucidation of the causes of these symptoms. Already in the primary treatment, questioning and examination of the patient, the doctor with high probability may suspect cancer of the esophagus.
First, the patient will be assigned to the General analysis of blood, urine, coagulogram, biochemical blood analysis, study of electrolyte metabolism, etc. it is possible to detect anemia, the decrease of protein in blood serum, changes in acid-base balance and blood clotting.
For the diagnosis of carcinoma of the esophagus are used:
Additionally may be had a CT scan, bronchoscopy, chest x-ray, ultrasound of abdominal organs, laparoscopy.
The main and very informative way to detect cancer and to clarify its localization and prevalence, is x-ray with contrast. As a contrast agent traditionally used barium sulfate. On radiographs in most cases the cancer fails to detect the presence of a defect in a particular division of the esophagus, narrowing its lumen, open folds in areas of tumor growth. In the case of fistula in the trachea or bronchi, the contrast will spread into the respiratory tract and lung tissue.
Radiography is carried out after endoscopic examination of the esophagus, which is mandatory in cases of suspected carcinoma. Using optics to examine the inner surface of the body, the lesion, determine the area distribution of the tumor and the state of the mucosa in General. The modern method is endoscopic ultrasound, in which it is possible to determine the depth of germination of the esophageal wall by tumor and the nature of changes in regional lymph nodes.
Endoscopic examination the doctor always takes pieces of tissue from the affected areas of the mucosa that undergo cytological and histological study. Detection of cancer cells in this case leaves no doubt in the presence of a malignant tumor, and finally confirms the disappointing diagnosis.
The majority of patients with common forms of cancer are shown bronchoscopy to exclude the possibility of tumor invasion into the respiratory system. CT allows to examine the state of other organs of the mediastinum and lymph nodes.
In case of possibility of metastasis resort to ultrasonic research of abdominal cavity organs (liver in particular), scintigraphy, or radiography of bones.
The combination of tumors of the esophagus cancer of the larynx is extremely rare, but it is possible due to the common causal factors (Smoking, alcohol). In addition, the tumor of the upper esophagus may spread to the larynx and cause its defeat, therefore, such cases need careful diagnosis of the source of the cancer with the involvement of laryngoscopy and biopsy.
How to overcome cancer?
The choice of treatment of esophageal cancer is always fraught with many difficulties. This is due to difficulty of access to the body, often with extensive spread of the tumor, the impossibility of carrying out simultaneous operations. You should also consider that the vast majority of patients are elderly and have concomitant diseases of the heart, lungs, etc.
The main and most effective way of dealing with the disease remains surgery. The use of radiation exposure is limited due to low sensitivity to tumors and the possibility of complications after the vote.
The transaction type is selected in each case individually and depends on the location of the cancer and its stage. As practice shows, one-stage operations give the best results in comparison with treatment in several stages.
The most radical and the most traumatic is considered complete removal of the esophagus (extirpation), which requires mandatory plastic surgery in the future. Given the difficult condition of the patients, the vastness of the destruction and old age, the extirpation spend no more than 5% of cases of esophageal cancer.
Resection of the esophagus, or destruction of its parts, it is possible for cancer of the middle and lower third of the body and is necessarily accompanied by simultaneous plasticity stomach.
In all cases surgical treatment is also the removal of lymph nodes during lymph drainage and fiber.
Improvement of surgical techniques allows us to produce and minimally invasive intervention as a palliative for advanced forms of cancer. So, apply endoscopic removal of the tumor within the mucosa and submucosa layer used cryo — and laser destruction of carcinoma.
With esophageal obstruction, particularly due to tumors of the upper third, produce a restoration of the lumen using laser irradiation of the tumor tissue in multiple sessions. For sustainable impact after the destruction of the tumor using various plastic or metal prostheses or stents. This approach allows to improve the quality of life in 75% of patients who get an opportunity to take solid food through the mouth.
Radiation therapy is not very effective in cancer of the esophagus and is used mainly in case of impossibility of surgical treatment and also before and after the operation in the case where there is a risk of tumor dissemination or deradicalise its removal. Perhaps as external beam radiation and intracavitary introduction of the probe with the radiopharmaceutical directly into the esophagus. A positive result can be obtained with a combination of radiation and surgical treatment.
Chemotherapy more effective when combining several drugs at the same time and applied more often if nizkoeffektivnyj cancers.
Traditional medicine with the involvement of all available modern methods of treatment allows to extend the life of the sick and ease their suffering, which cannot be said about the use of folk remedies as their primary mode of action. First, neither herbs, nor baking soda, nor any other sorts of «miracle» formulas are not able to destroy cancer cells completely and to restore the patency of the esophagus. Secondly, take into of traditional medicine quickly leave the area of tumor growth and into the stomach without exerting any influence locally. On this basis, it is not necessary to hope for a miracle, it was better and more correct to refer to specialists-oncologists.
In addition to these events, patients should be adequate anesthesia, fill the deficit of vitamins, protein, trace elements, correction of existing metabolic disorders.
In the process of treatment and rehabilitation great importance is given to diet. Food for esophageal cancer should include easily digestible foods rich in all necessary nutrients. First preference is given to liquid and semi-liquid dishes, but gradually, as the restoration of patency of the esophagus in the diet are and solid products. Of course, should be excluded from the consumption of alcohol, coffee, pickles, smoked meat and excessively hot or cold food.
Survival of patients with esophageal cancer depends on many factors: stage of disease, age, presence of comorbidity, type and scope of treatment. So, in cancer the first stage, about half of patients live 5 years or more, but the presence of metastases reduces this figure by half. In the third stage of cancer survive about a quarter of cases, and in untreated forms, the prognosis is unfavorable for patients remains to live about 5-8 months.
As you know, any disease is easier to prevent than to treat, so quitting Smoking and alcohol abuse, proper and healthy diet, the restriction of strong tea, coffee can be the preventive measure that will greatly reduce the possibility of cancer.