The esophagus is a hollow tube-shaped organ that carries food and drinks from the throat to the stomach. The esophagus starts from the end of the oral cavity and continues behind the trachea in the rib cage and ends at the level of the diaphragm at the beginning of the stomach in the abdomen. When a person swallows, the esophageal muscle layers contract and push food into the stomach. In adults, the esophagus is approximately 25 cm. Esophageal cancer is one of the cancers with the highest geographical distribution difference according to local eating habits. High frequencies are reported in the Middle East and Far East, including especially the eastern and southeastern Anatolia regions of our country. There are two different types in microscopic examinations (Squamous (squamous cell) cancer and adenocarcinoma). While the incidence rate is 170/100,000 in China, Japan and the south of Africa, this rate reaches 500/100,000 in the east of Asia. While squamous cell cancer is seen in these societies, adenocarcinoma is more common in developed countries. In the USA and European countries, the rate is 21/100,000. In our country, esophageal cancer is more common in the eastern provinces.
Esophageal Cancer Risk Factors
Environmental factors and nutritional habits are responsible for esophageal cancer rather than genetic predisposition. Not storing food in a proper hygienic environment, consuming it for a long time, inappropriate additives, smoked meat, raw foods and nitrosamines in canned foods pave the way for cancer. In those with poor oral health, other factors include less chewing of food, very hot drinks, mineral deficiencies (zinc, etc.), tobacco and cigarette use, and exposure to radiation.
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Age: Esophageal cancers are more likely to occur in middle age. and is more common in older ages. Especially people over the age of 60 are at greater risk.
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Gender: It is more common in men than women.
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Tobacco use: Esophagus It is one of the most important risk factors for cancer.
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Alcohol use: Chronic or excessive alcohol use is another important risk factor.
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Barrett Esophagus: Some chronic changes develop in the lower end of the esophagus in people who are exposed to stomach acid for a long time. Gastroesophageal reflux In this disease, stomach acid goes into the esophagus and causes damage to the tissues in the lower part of the esophagus. The cells in this irritated part of the esophagus are replaced by gastric mucosa cells. This condition, known as Barrett's esophagus, can lead to esophageal adenocarcinoma over the years. If you have indigestion and reflux complaints, be sure to go to a health institution for examination.
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Other types of irritation: Other factors that predispose to squamous cancer are untreated achalasia, a swallowing disorder seen at the lower end of the esophagus. It causes human papillomavirus (HPV) infection and esophageal stenosis.
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Children accidentally drink caustic liquids as a result of caustic chemicals such as bleach, which should be taken into consideration at home, in different bottles. As a result, stenosis occurs in the esophagus and cancer may develop in the future. In addition, the risk is higher in people who drink hot drinks for a long time. Accordingly, the incidence of esophageal cancer is higher in the Van and Erzurum regions of our country, where drinking very hot tea is common.
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Cancer history: Patients with other cancers of the head and neck region, including esophageal cancer, in the head and neck region. The possibility of a secondary cancer occurring has increased.
Protection
The most important factors for protection against esophageal cancers are environmental factors. Additionally, stay away from tobacco and tobacco products and consume alcohol in a limited manner. Do not consume very hot drinks. Consume smoked foods and canned foods very consciously. Increasing the intake of uncooked vegetables and fruits reduces the possibility of esophageal cancer. Pay attention to your oral health. Especially keep children away from liquids such as bleach that can burn and irritate the esophagus. Be sure to take your reflux disease treatment and stomach complaints seriously. In such cases, be sure to consult the nearest health institution.
Symptoms of Esophageal Cancer
The most common clinical symptoms are; weight loss, difficulty swallowing and feeling stuck while eating. A painful feeling of swallowing and sticking while eating, which started approximately 6 months before consulting a health institution. usur There is a feeling of food regurgitation and pain in the upper abdomen. The pain may be in the back between the shoulder blades or behind the breastbone and radiate towards the throat. Weight loss can be very noticeable. Sometimes lymph nodes in the neck can be palpable. Bone pains, weakness, dry cough and hoarseness are other less common symptoms.
Diagnosis of Esophageal Cancer
The esophagus is examined with optical light cameras called endoscopy and pathology is examined. A sample (biopsy) is taken for diagnosis. An ultrasound examination called endosonography is performed to investigate adhesion from inside the esophagus to surrounding tissues. If necessary, advanced imaging tests called computerized tomography (CT), magnetic resonance (MRI), and positron emission tomography (PET) are requested for the patient. There are no tumor markers and screening programs checked in the blood as in some cancers.
Staging in Esophageal Cancer
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Stage I: Cancer cells only It is located in the uppermost layer of the inner part of the esophagus
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Stage II: Cancer involves the deep layers of the esophagus or there is spread to neighboring lymph nodes.
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Stage III: Cancer has invaded deep parts of the esophageal wall or has spread to lymph nodes or tissues next to the esophagus. There is no spread to other parts of the body.
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Stage IV: The cancer has spread to other parts of the body. Esophageal cancer can spread to any part of the body, including the liver, lungs, brain and bones.
Treatment for Esophageal Cancer
Treatment It depends on the general condition of the patient, the extent, location and size of the tumor. Patients are often treated by a specialized group such as a digestive system surgeon, medical and radiation oncologist.
Surgery:
If the patient's tumor is not at an extensive stage and has spread to other organs. Otherwise, the first treatment is to surgically remove the tumorous esophagus. Very successful results are obtained in our country in patients diagnosed at an early stage. Complete removal of the esophagus is called esophagectomy. The surrounding lymph nodes are cleaned. The stomach and the remaining part of the esophagus are combined to enable the patient to swallow. Change With traditional methods, the operation is completed by reconstructing the esophagus from the stomach or intestines. The main treatment method for esophageal tumors is surgery, but the surgical mortality is relatively high and even in cases where the tumor is removed, the 5-year survival is around 20% due to local and systematic recurrences.
Radiation Therapy (Radiotherapy):
It involves using high-energy rays to kill cancer cells. Radiation therapy only affects the cells in the area being treated. Chemotherapy and radiotherapy may be combined to shrink the tumor before surgery. In some cases, radiotherapy may be given to prevent recurrences after surgery. If the tumor cannot be removed surgically, radiotherapy is often used to make swallowing easier and reduce pain.
Chemotherapy:
It is the use of anticancer drugs to kill cancer cells. In esophageal cancer, drug treatment called chemotherapy can be applied, taking into account the general condition of the patients before or after surgery. Chemotherapy can be used together with radiotherapy to shrink the tumor before surgery or as a primary treatment instead of surgery.
Palliative Treatment Methods:
An expander called a stent is placed in the area with esophageal obstruction. Food can be passed through by applying an umbrella, and sometimes external nutrition can be provided by placing tubes called gastrostomy in the stomach. Relieving obstruction helps reduce symptoms, especially those related to swallowing problems.
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