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Clinical Description
Esophageal cancer occurs in the tube that carries food from the mouth to the stomach. According to the American Cancer Society, about 16,470 Americans will be diagnosed with esophageal cancer this year. Esophageal cancer affects men three to four times more often than women and affects 50% more African Americans than Caucasians.
Although survival rates have improved over the years, esophageal cancer is usually diagnosed when it has advanced and is difficult to treat.
Types of Esophageal Cancer:
Squamous cell carcinoma occurs in the cells lining the esophagus. This type of esophageal cancer is more common in African-Americans.
Adenocarcinoma is the most common type of esophageal cancer. It occurs in glandular tissue, most often in the lower part of the esophagus near the stomach.
Symptoms of Esophageal Cancer
Esophageal cancer symptoms are often not evident during its early stages or may be nonspecific. Symptoms may include difficulty swallowing (dysphagia), pain/ discomfort in the throat or chest, hoarseness, chronic cough, persistent hiccups, unexplained weight loss.
Risk Factors of Esophageal Cancer
Esophageal cancer is most commonly diagnosed in people over the age of 60. It is more common in men than in women. Tobacco in any form increases a chance of developing esophageal cancer, especially squamous cancer. Long term or heavy alcohol use is another risk factor. The combination of smoking with significant alcohol use is the most important risk factor for squamous cell cancer of the esophagus.
Barrett’s esophagus – a condition caused by chronic reflux of acid from the stomach into esophagus, increases the risk of esophageal adenocarcinoma.
How Esophageal Cancer is Diagnosed
Diagnosis of esophageal cancer involves a combination of physical exam, blood tests, imaging studies, and a procedure called an endoscopy. The purpose of an endoscopy is to look at the interior lining of the esophagus using a thin tube with a camera at the end, called an endoscope. The endoscope is inserted through the mouth after anesthetic is administered to make the patient comfortable during the procedure. Samples of tissue may be removed from the esophagus during this procedure and then examined for cancer cells. In certain situations in which the tumor is blocking the esophagus, the doctor will perform special techniques during the endoscopy to dilate the esophagus.
Once a diagnosis of esophageal cancer is made, it is important to determine if and how far cancer may have spread. This process is called staging and it is important in guiding what treatment would be most helpful to the patient. Computed tomography (CT) and Positron Emission Tomography (PET) are often used for staging of the disease. Endoscopic ultrasound can also be used to provide more information for staging. Endoscopic ultrasound involves insertion of a thin tube with an ultrasound probe through the mouth into the esophagus.
In some cases esophageal cancer may be localized higher up in the chest. In these cases a bronchoscopy may be needed to evaluate for tumor spread into the trachea or bronchi. A bronchoscopy is involves the insertion of a thin tube with a camera at the end which is introduced through the mouth and slipped into the trachea and bronchi. As in the case of an endoscopy samples may be taken to examine for the presence of cancer cells.
Treatment Options for Esophageal Cancer at Tufts Medical Center
Treatment of esophageal cancer depends on several important factors, the stage of disease and on the patient’s overall health. Stage is measured by the size of the tumor, how deeply it invades different layers of the esophagus, and whether it has spread to nearby organs and lymph nodes or other parts of the body.
Surgery is the most common treatment for esophageal cancer, and is used alone or in combination with chemotherapy and radiation therapy. Surgery alone may offer cure if cancer has not spread beyond the esophagus. Surgery can also help to relieve symptoms.
Prior to surgery, a minimally invasive procedure known as laparoscopy to determine whether surgery would have benefit, is commonly used. During this procedure, a thin tube with a camera at the end is inserted through a minimally invasive incision in the abdominal wall, allowing for inspection of critical organs and for removing tissue samples to be checked for cancer cells. To examine the lymph nodes inside the chest, a similar tube, called a thoracoscope, is used. These procedures further define the extent of the cancer spread prior to surgery.
Surgical approaches:
Esophagectomy: The tumor and the surrounding tissues are removed. This is a general term. There are many different approaches to remove the esophagus and the surrounding lymph nodes. Your surgeon will explain the differences and select the best method.
Chemotherapy – can be used alone or in combination with surgery and/or radiation therapy. Chemotherapy may also be used to relieve symptoms of advanced cancer. The drugs most commonly used to treat esophageal cancer are 5-Fluorouracil. Cisplatin, Carboplatin, Oxaliplatin. Paclitaxel, Docetaxel, Irinotecan, Capecitabine.
Radiation Therapy – commonly used in combination with chemotherapy and is usually administered before surgery. Radiotherapy also can be used to relieve symptoms of esophageal cancer.
Patients with esophageal cancer often benefit from treatment that aims to relieve symptoms. One of such procedures is stenting – in which a metal mesh stent is inserted into the esophagus to help keep it open to improve swallowing. Radiation therapy – can also help with symptoms of obstruction by shrinking the tumor.
Clinical Trials Available for Patients
Our patients have access to novel therapies through participation in both Tufts Medical Center clinical trials and national clinical trials.
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