Esophageal Cancer

The following is information curated on the topic of Esophageal Cancer, one of the 15 health conditions covered by the VA for Camp Lejeune victims. The information is collected from various scientific resources, including the Mayo Clinic, the NIH, MD Anderson, the Oxford Journal and others.

Esophageal cancer is cancer that occurs in the esophagus. Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus, but in people in the United States, it occurs most often in the lower portion of the esophagus.

Signs and symptoms of esophageal cancer include:

  • Difficulty swallowing (dysphagia)
  • Weight loss without trying
  • Chest pain, pressure or burning
  • Worsening indigestion or heartburn
  • Coughing or hoarseness

Early esophageal cancer typically causes no signs or symptoms.

Types of esophageal cancer

Esophageal cancer is classified according to the type of cells that are involved. The type of esophageal cancer you have helps determine your treatment options. Types of esophageal cancer include:

  • Adenocarcinoma. Adenocarcinoma begins in the cells of mucus-secreting glands in the esophagus. Adenocarcinoma occurs most often in the lower portion of the esophagus. Adenocarcinoma is the most common form of esophageal cancer in the United States, and it affects primarily white men.
  • Squamous cell carcinoma. The squamous cells are flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs most often in the middle of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide.
  • Other rare types. Rare forms of esophageal cancer include choriocarcinoma, lymphoma, melanoma, sarcoma and small cell cancer.

It’s thought that chronic irritation of your esophagus may contribute to the DNA changes that cause esophageal cancer. Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:

  • Drinking alcohol
  • Having bile reflux
  • Having difficulty swallowing because of an esophageal sphincter that won’t relax (achalasia)
  • Drinking very hot liquids
  • Eating few fruits and vegetables
  • Having gastroesophageal reflux disease (GERD)
  • Being obese
  • Having precancerous changes in the cells of the esophagus (Barrett’s esophagus)
  • Undergoing radiation treatment to the chest or upper abdomen
  • Smoking

Complications

As esophageal cancer advances, it can cause complications, such as:

  • Obstruction of the esophagus. Cancer may make it difficult or impossible for food and liquid to pass through your esophagus.
  • Pain. Advanced esophageal cancer can cause pain.
  • Bleeding in the esophagus. Esophageal cancer can cause bleeding. Though bleeding is usually gradual, it can be sudden and severe at times.

Testing

The following tests and procedures may be used:

  • Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Barium swallow : A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.
  • Esophagoscopy : A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer. When the esophagus and stomach are looked at, it is called an upper endoscopy.
  • Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy is usually done during an esophagoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but may lead to cancer.

Stages

  • After esophageal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the esophagus or to other parts of the body.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • The grade of the tumor is also used to describe the cancer and plan treatment.
  • The following stages are used for squamous cell carcinoma of the esophagus:
    • Stage 0 (High-grade Dysplasia)
    • Stage I squamous cell carcinoma of the esophagus
    • Stage II squamous cell carcinoma of the esophagus
    • Stage III squamous cell carcinoma of the esophagus
    • Stage IV squamous cell carcinoma of the esophagus
  • The following stages are used for adenocarcinoma of the esophagus:
    • Stage 0 (High-grade Dysplasia)
    • Stage I adenocarcinoma of the esophagus
    • Stage II adenocarcinoma of the esophagus
    • Stage III adenocarcinoma of the esophagus
    • Stage IV adenocarcinoma of the esophagus

For a more detailed assessment, visit this link: http://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq#section/_129

Treatments

  • There are different types of treatment for patients with esophageal cancer.
  • Patients have special nutritional needs during treatment for esophageal cancer.
  • Six types of standard treatment are used:
    • Surgery
    • Radiation therapy
    • Chemotherapy
    • Chemoradiation therapy
    • Laser therapy
    • Electrocoagulation
  • New types of treatment are being tested in clinical trials.
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up tests may be needed.

Proton Therapy Video – MD Anderson: http://www3.mdanderson.org/streams/AudioPlayer.cfm?xml=cfg%2FCNL-Esophageal-Proton-Therapy–mp3


 

Environmental risk factors for squamous cell carcinoma include exposure to asbestos, perchlorethylene (common dry cleaning solvent), and fuel-burning appliances (e.g., space heaters, fireplaces, stoves). – See more at: http://www.healthcommunities.com/esophageal-cancer/risk-factors.shtml#sthash.JCkyQNy9.dpuf


 

Environmental Exposure information regarding Esophageal cancer from the National Institutes of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2685172/

 

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