Esophageal cancers rank 6th among all cancers worldwide and their frequency is reported as 6.4/100,000. It constitutes 1.5-2% of all cancers and 5-7% of digestive system cancers. It is known that the incidence varies according to geographical regions. It is more common in the Asian continent than in Europe and America. It is seen frequently in our country, especially in the eastern regions. Esophageal cancer is most common between the ages of 50-60 and is rare (0.2%) under the age of 30. It is approximately 3 times more common in men than in women. Esophageal cancer is located in the middle part of the esophagus in half of the patients, in the atl part in one third, and in the upper part in the rest. The treatment methods applied vary depending on the location.
CAUSES AND RISK FACTORS
Risk factors in esophageal cancer:
- Smoking, alcohol use and substance addictions
- Nutrition-related factors
- Genetic and environmental factors
- They can be listed as predisposing diseases.
Smoking, alcohol use and substance addictions
The most important cause of esophageal cancer in the USA and Western Europe is smoking and alcohol use. In other regions where esophageal cancer is common, nutritional factors are more prominent than smoking and alcohol. The effect of alcohol alone is quite low, but when combined with smoking, the risk of esophageal cancer increases depending on the dose and duration.
Nutrition-related factors
Beta carotene, A, B, C, E The antioxidant effects of vitamins, folic acid, riboflavin, trace minerals and metals magnesium, zinc, selenium and molybdenum are known to have effects on cell regeneration and cell division. Insufficient intake of these substances poses a significant risk, especially as a result of a diet rich in wheat, corn and rice and low in fresh fruits and vegetables. Smoking, alcohol, and inadequate intake of fresh vegetables and fruits are considered the three most important risk factors for esophageal cancer. These 3 factors were detected in 83% of patients with esophageal cancer. Vitamins A and B play a role in controlling proliferation in the esophageal mucosa. Deficiency in these may lead to the development of precancerous lesions. It is thought that it may have an effect on e.g.
Eating habits, especially excessive and frequent consumption of very hot drinks, are considered to be significant risk factors. Chemical carcinogens stored on the surface of the esophageal epithelium by smoking and environmental factors penetrate the epithelium with irritants such as hot drinks and alcohol and can reach the basal layer.
In our country, Eastern Anatolia, the habit of drinking very hot and large amounts of tea along with smoking is a common practice. Due to its location and the climatic conditions of this region; Difficulties in the transportation of fresh vegetables and fruits can be considered as the reasons for the frequent occurrence of esophageal cancer.
Genetic and environmental factors
It is thought that some tumor-preventing genes are eliminated or deleted in the development of esophageal cancer (p53, Rb, such as APC and MCC). For the development of esophageal malignancy, both copies of these genes must be eliminated or lost. P53 mutation was detected in 5 out of every 8 cases that showed epithelial dysplasia in Barrett's esophagus and developed adenocarcinoma. The fact that it was not detected in the other 3 cases was attributed to the multiclonal structure of the mucosa and other factors in the formation of cancer.
The emphasis is on environmental factors, especially the effect of carcinogenic compounds in water. Contamination of water with oil in oil regions, nitrogen compounds in water in some regions where the incidence is high, riboflavin deficiency in some regions, and esophageal cancer detected in animals in some regions support the effect of environmental factors. Among environmental factors, it has been suggested that exposure to asbestos, radiation and viral agents, nitroso compounds and carcinogens of food and beverages, contamination with seeds and microtoxins can cause specific mutation in DNA and thus play a role in etiopathogenesis, an example of which is that carcinogens in cigarette smoke can lead to characteristic gene mutation patterns. There are clues that p53 tumor suppressor gene mutations may be present among these.
Predisposing diseases
The incidence of cancer increases in some diseases of the esophageal mucosa, especially in high-risk areas, up to 80% of the population. a large part Esophagitis (inflammation of the esophagus) has also been detected. Esophagitis may develop as a result of heat-related, mechanical, chemical agents, radiation or gastroesophageal reflux. It is thought that environmental factors, generally from early stages of life, accompanied by the deficiency of certain factors in the diet, cause chronic mucosal inflammation. It is also suggested that food may cause esophagitis through mechanical irritation as a result of contamination with various seeds and silica. These cases should be closely monitored for esophageal cancer and should receive timely medical and surgical treatment in order to prevent the risk of esophageal cancer and to relieve existing symptoms.
Currently, cancer occurs in approximately 10% of esophagitis due to reflux disease, called Barrett's esophagus. The risk of development is 60-100 times higher than the normal population. Follow-up of these patients and early diagnosis provide 100% cure for malignancy. With good endoscopic follow-up, approximately 75% of cancer cases can be detected at stage 0, I or IIA. While the 5-year survival rate is around 20% in cases diagnosed outside these stages and underwent esophagectomy by endoscopic follow-up, this rate rises to over 60% in cases diagnosed early with endoscopic follow-up.
Achalasia is also a predisposing factor for the development of esophageal cancer. It is considered one of the diseases. It is reported that these people develop cancer 8-33 times more often than the normal population. The average time between the onset of symptoms attributable to achalasia, such as dysphagia, weight loss and chest pain, and the development of cancer is; is 20 years, and the frequency of cancer development in patients with achalasia is 3-4 per hundred thousand. It is reported that chronic inflammation in the mucosa, as a result of stasis and retention of secretions and food, predisposes to carcinoma.
SYMPTOMS
- Difficult in swallowing
- Weight loss
- Burning and pain in the chest area
- Vomiting, food coming back into the mouth
- Swelling in the neck
- Loss of appetite
- Hoarseness
- Bleeding
- Cough and feeling of suffocation
DIAGNOSIS METHODS
Esophagus Endoscopic examination is the most important diagnostic tool in all patients with suspected cancer. The importance of esophagoscopy is not only for diagnosis It is important not only in the diagnosis but also in determining how the treatment will be done.
TREATMENT
The choice of treatment in esophageal cancers depends primarily on the stage and location of the tumor; depends on many factors. In some cases where only surgical treatment or radiotherapy will not be sufficient, combined treatments may be considered. In advanced cases, surgical treatment can only be performed to ensure the patient's nutrition.
The location of the tumor is also important in choosing the treatment. In general, tumors in the lower 1/3 of the esophagus are easily treated surgically. Tumors in the upper section have less chance of surgery. While early lesions are suitable for surgery, invasion and metastases are reasons that require non-surgical methods. The length and depth of the lesion and the total size of the mass can direct the choice of treatment because it is 7-8 cm. The possibility of tumors longer than 1000 to invade neighboring tissues; is too much. On the other hand, the duration of symptoms is also important in terms of the stage of the disease.
Read: 0
