ESOPHAGEAL (FOOD PIPE) CANCER
Esophageal cancer is rare, but its mortality rate is one of the highest. Its incidence is changeable according to regions.
The Squamous cell carcinoma (SCC) and adenocarcinoma (ADC) are the most common types of esophageal cancer. The incidence rate of melanoma, carcinoid tumors and leimyosarcoma is much lower. Esophageal carcinoma occurs 5 to 10 times more common in man than in woman. The incidence rate increases with age. SCC is generally diagnosed at the age of fifty, ADC at sixty.
Variation in occurring SCC in different geographical regions depends on nutrition features, smoking and alcohol use.
Etiology of esophageal cancer is considered to be multifactorial and it is changing according to culture, lifestyle and eating habits. While in the USA and in Europe tobacco and alcohol use is the most important factor in developing countries nutritional factors are most common.
Etiological factors of esophageal cancer can be divided into 5 groups:
a-Cigarettes and alcohol
The first stage of esophageal cancer is asymptomatic. Physical examination is usually normal. During this period cancer is diagnosed generally by incidentally performed endoscopy.
Symptoms of disease change according to tumors placement, progress of disease and regional and distant metastases.
The main signal of esophageal cancer is dysphagia (swallowing disorders). Dysphagia is variable and occasionally repeats itself. However, dysphagia is a sign of late stage.
At first stage patient can experience problems swallowing solid food, than also liquids can cause trouble. Level of dysphagia depends on tumors location.
The second signal is the occurrence of chest pain during swallowing (odynophagia). Friction caused by food in the narrowed place leads to feeling of burning. Eventually ulcers develop on the tumor’s surface and severity of pain increases.
Other symptoms are: excessive production of saliva (hypersalivation),smelly burps, hiccups and rarely hematemesis (vomiting of blood) melena (passage of black, tarry stools). We can observe also weight loss. Weight loss in esophageal cancer patients is more advanced than in patient with other malignant diseases.
Perforation of the ulcers, formed on the tumors surface cause fistulas development on the surrounding tissue. Cancer cells can spread to structures surrounding the esophagus, including the large blood vessel that can cause severe bleeding and even death.
Esophageal cancer is a difficult to treat. Deciding about surgical treatment of esophageal cancer we have to pay attention on certain factors: the aim of surgery (curative, palliative), tumor location (upper, middle, lower esophagus), the organ, which will be used for reconstruction (stomach, jejunum, colon), applying surgery alone or combined with radiotherapy +/- chemotherapy.