What is the treatment for esophagus cancer

Esophageal cancer

What is esophageal cancer?

Esophageal cancer is the malignant growth of cells in the esophagus. A distinction is made between Barrett's carcinoma and squamous cell carcinoma.

Frequency, causes and risk factors:

In western industrialized countries, esophageal cancer accounts for 2% of all cancers and often occurs in the 6th-7th grade. Decade of life. Men are three times more likely to be affected than women. Esophageal cancer is more common in Africa, Asia and the Caribbean.

Causes are irritating substances such as high-percentage alcohol, hot drinks, food containing nitrite (cured meat) and smoking. Betel nuts, which are popular in Asia, contain harmful substances which, if consumed regularly, can cause cancer in the digestive tract.

Esophageal cancer can also develop as a result of permanent irritation from gastric juice ( Reflux or heartburn called). The tissue of the esophagus adapts to the constant irritation in that it remodels (metaplasia) but is more prone to degenerate into cancer. This clinical picture is called Barrett's esophagus. Only treating the causative reflux can prevent dangerous progression.

Also the consequences of a Achalasia, a permanently closed sphincter of the lower esophagus , can lead to inflammation of the gullet (esophagitis) and ultimately contribute to the development of cancer. In general, it can be said that factors that lead to inflammatory processes in the esophagus favor the development of esophageal cancer.

Esophageal cancer symptoms

Esophageal cancer only makes itself felt late through symptoms. The cancer can cause difficulty swallowing, frequent belching, and pain behind the breastbone. Like many cancers, esophageal cancer can be associated with weight loss (tumor cachexia), and weight loss can be a life-threatening complication, especially if the tumor interferes with food intake. If the cancer presses on surrounding areas (e.g. windpipe, nerves), hoarseness, irritable cough and breathing difficulties can occur. Coughing up blood is possible with tissue damage.

Treatment and surgical methods for esophageal cancer

In early forms of esophageal cancer, removal with an endoscope can lead to healing. If radical surgery is possible, it is called a resection of the esophagus. This involves removing parts of the esophagus and the surrounding lymph nodes. To replace the esophagus, parts of the stomach are formed into a tubular shape and connected to the upper stump of the esophagus. Intestinal parts can also be used to restore the passage of food.

Radiation therapy is used both for healing and palliative care to improve food intake in the event of swallowing difficulties. In Barrett's esophageal cancer, a cancer that developed as a result of Barrett's syndrome, radiation therapy was unsuccessful.

Palliative measures such as the placement of a self-expanding stent in the esophagus can counteract a narrowing of the digestive tract and ensure that food intake is as normal as possible until death. Tumor ablation, in which constricting cancerous tissue is removed with laser or heat (usually argon plasma coagulation), has the same goal. If it is no longer possible to get through the esophagus, a gastric tube (PEG tube) can be used for nutrition.

With chemotherapy it is possible that an initially inoperable cancer becomes smaller (down-sizing) and thus becomes operable. At the moment, modern combination chemotherapies can improve the disease in 15-20%.

Prospect for healing and life expectancy

The difficulty of esophageal cancer is that it usually shows symptoms late, which is why 90% of tumors are only discovered in the advanced stages. The earlier esophageal cancer is diagnosed, the more favorable the prognosis. Esophageal cancer tends to metastasize mainly to the lymph nodes. It only spreads late in the bloodstream (hematogenous). Then mainly in the lungs, liver and bones, but this is usually no longer experienced by the person affected.

Therapy with the prospect of a cure is only possible as long as no metastases (daughter tumors) can be found in lymph nodes or foreign organs. The tumor must be limited, i.e. it must not grow into the surrounding tissue and should not be located in the upper third of the esophagus (then it is usually inoperable). Barrett's esophageal cancer is 95% found in the lower third of the esophagus. Squamous cell carcinoma can occur in any part of the esophagus.

Without surgery, the average survival time is less than a year. About 40% of esophageal tumors are assessed as operable and treated with the aim of healing. The 5-year survival rate for these patients is 10-20%. The operation is risky and around 10% of operations are not survived. With palliative therapy, the 5-year survival rate is 4%.

Alternatively, it can be used for inoperable tumors or tumors in the upper third of the esophagus a chemo-chemotherapy lead to a 3-year survival rate of 30%.

Which doctors and clinics are specialists in esophageal cancer?

Anyone who needs a doctor wants the best medical care for themselves. This is why the patient asks himself, where can I find the best clinic for me? Since this question cannot be answered objectively and a serious doctor would never claim that he is the best doctor, one can only rely on the experience of a doctor.

We help you to find an expert for your illness. All listed doctors and clinics have been checked by us for their outstanding specialization in the area of ‚Äč‚Äčesophageal cancer and are awaiting your inquiry or your treatment request.

swell :

Herold - Internal Medicine 2016

Heiner Greten - Internal Medicine 12th Edition

Dual Series - Internal Medicine 2009