Esophageal Cancer : Symptoms, Diagnosis & Treatment

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Esophageal cancer is the cancer of Esophagus (gullet) and are mainly of two types. The Adenocarcinoma which usually occurs in the distal part of esophagus and is associated with long standing Gastroesophagaeal Reflux Disease (GERD) and Barret's Esophagus. The other type of Esophageal cancer is called as Squamous Cell Carcinoma and it is usually limited to proximal two thirds of esophagus. The squamous cell carcinoma of esophagus is directly linked to smoking and alcohol. Alcohol and smoking simultaneously has synergistic effect on development of squamous cell carcinoma of esophagus. While the rate of development of Adenocarcinoma from barret's esophagus is 0.5 to 0.8 percent, it is interesting to now that both squamous cell carcinoma and adenocarcinoma of esophagus occur in almost equal frequency.

Signs and Symptoms of Esophageal Cancer

The most common symptom of esophageal cancer is difficulty in swallowing (dysphagia). Dysphagia is usually progressive first for solids and later on for liquids.

Weight loss is present and is due to cachexic nature of the cancer as well as because of difficulty in eating food. Decrease in appetite, wight loss, and other constitutional symptoms are present. sometimes regurgitation of ingested food, problem of long standing bad breath (halitosis), hoarseness of voice are present.

The physical examination may reveal enlarged mediastinal or supraclavicular lymphnode with long standing history of smoking, alcohol ingestion or problem of gastroesophageal reflux disease. As in all other cancer the blood tests usually reveals hypercalcemia.

Diagnosis of Esophageal Cancer

  • Barium swallow is done to locate the obstruction
  • Endoscopy is done for tissue biopsy as it is mandatory for making diagnosis and type of cancer. 
  • USG is also essential for proper staging of esophageal cancer
  • CT scan is performed for knowing the degree of spread
  • Bronchoscopy might be necessary to find out if the cancer has spread to bronchi

Treatment of Esophageal Cancer

Surgery is the only treatment for the esophageal cancer, but only 20% of the patients are found to be proper candidate for surgical resection. Surgery can only be done if the esophageal cancer is limited to esophagus and has not spread elsewhere.Five year survival rate after surgery is only five to fifteen percent.

If the esophageal cancer has spread to other areas chemotherpay combined with radiation therapy is the only choice for the treatment and it is usually done with 5-Flourouracil.