Esophageal cancer - Causes, symptoms and treatment. MF.

Causes of esophageal cancer

The causes of esophageal cancer include some peculiarities of nutrition: the abuse of excessively hot and spicy food, including drinks, the use of smoked and jerky meat and fish, products containing small bones( stroganina), traumatizing the esophagus mucosa, chewing tobacco and nasal, drinking alcohol. A major role in the development of esophageal cancer is played by smoking, as the smoker swallows not only cigarette smoke, but also harmful substances settling on the oral mucosa. At the smokers abusing alcohol, the risk of development of a cancer of an esophagus increases in 100 times.

In the development of tumors of the esophagus an important role is played by a lack of food vitamins A, B, C, and E, as well as some trace elements( molybdenum, selenium, folic acid).

Among other factors: chronic esophageal diseases, such as chronic esophagitis( inflammation), erosion and ulcers of the esophagus, associated with a throw into the lumen of the esophagus of irritating gastric contents( reflux-esophagitis) and prolonged exposure to a carcinogenic factor on the mucosa of the esophagus( gastric juice, bile), which increases the risk of cancer.

Damage to the esophagus: chemical and thermal burns, exposure to metallic dust( arsenic, chromium, nickel), asbestos, combustion products, as well as scarring in the organ;polyps( benign tumors);some other chronic and hereditary diseases of the esophagus( Barrett, achalasia and tylosis).With the development of esophageal cancer, there is often a genetic predisposition.

Symptoms of esophageal cancer are divided:

1. Nonspecific: weakness, sweating, body temperature rises, decreased or no appetite, weight loss.

2. esophageal cancer specific:
- difficulty swallowing( dysphagia) - initial - from the violation of the passage of solid and coarse food to a violation of the passage of fluid and up to complete obstruction( even water);
- pain behind the sternum or back, between the shoulder blades as a result of inflammation and ulceration of the mucous membrane, at the last stage of the disease the pain is caused by the germination of the tumor into adjacent organs or large nerve trunks of the chest;
- excessive salivation, accumulation of saliva above the tumor( with the involvement of the major nerves of the chest cavity);
- hoarseness of the voice is associated with the paresis( immobility) of the vocal folds as a result of the germination of large plexus nerve plexuses;
- cough, supernumerary, dry, sometimes can be with purulent or bloody sputum, as a result of tumor germination of bronchi or trachea.

The last groups of symptoms are characteristic of advanced stages of the disease.
By structure, squamous cell carcinoma of the esophagus and adenocarcinoma( from glandular cells) are isolated. According to the growth form, tumors are divided into: a cancer growing in the lumen of the organ( exophytic), growing along the organ wall( endophytic) and mixed growth forms.

The location is distinguished:

- Cancer of the upper esophagus - cervical, upper thoracic and middle;
is a cancer of the lower parts of the esophagus - the lower thoracic and esophageal-gastric junction.

Stages of esophageal cancer:

Stage 1: swelling of up to 3 cm and affects only the mucosa of the esophagus;
Stage 2: tumor size 3-5 cm and presence of metastases in nearby lymph nodes;
Stage 3: the size of 5 to 8 cm and the entire thickness of the body wall, as well as the presence of metastases in the nearby lymph nodes;
Stage 4: the extent or size of the tumor more than 8 cm, its transition to nearby organs( growth in the lung, bronchi or trachea, large vessels), as well as the presence of metastases in other organs.
Esophageal cancer metastasizes, primarily, to nearby lymph nodes, metastases most often affect the lungs, liver and bones, as well as tumors can be given by intra-walled screenings( into the esophagus wall).

Complications of esophageal cancer:

Hemoptysis - secretion of blood clots with sputum( with tumor germination of the bronchi and trachea).Danger of bleeding from the tumor until the intense, leading to the death of the patient. For large tumors that germinate nearby organs, fistulas can develop( their holes that are not present in normal organs), such as between the esophagus and trachea, esophagus and mediastinal tissue, leading to the development of severe inflammatory processes that drain the patient and lead to his death. Dysphagia - a violation of the passage of food, is dangerous without timely treatment, as the patient "dies of hunger".

Examination of patients with esophageal cancer should include:

X-ray examination of the esophagus with contrast: allows to determine the extent of the tumor, the degree of occlusion of the esophagus lumen, the presence of fistulas( flow of contrast mass in the respiratory tract or soft tissues), the nature of tumor growth.

X-ray of the esophagus with contrast. The arrow indicates a tumor that causes a constriction of the esophagus.

Esophagogastroscopy( FGDS) - examination "from within" through a special device with a large increase, this research method allows you to examine in detail the mucous membrane of the esophagus, stomach and duodenum and detect the tumor, determine its boundaries and take a piece for examination under a microscope. The method is safe and well tolerated by patients. When small tumors are detected in the initial stage, it is possible to remove them through the same apparatus using short-acting intravenous anesthesia.

Fibrofronchoscopy( FBS) - examination through the endoscope of the trachea and bronchial tree, allows to reveal the germination of the tumor in these organs, the degree of compression by it and the presence of fistulas between the esophagus and the trachea.

Endoscopic picture of squamous cell carcinoma of the esophagus. The degeneration of papilloma into squamous cell carcinoma.

Computed tomography: allows to determine the boundaries of the esophagus, the presence of growth in the surrounding organs and separated metastases.

Ultrasound examination of the abdominal cavity is performed to exclude metastatic lesion. Ultrasound through the esophagus is used to clarify the depth of tumor germination, as well as in the planning of low-traumatic( endoscopic) surgeries.

Ultrasonic picture of esophagus tumor, view through gastroscope.
1-ultrasound sensor, 2-tumor
The arrow indicates tumor growth in the muscular layer of the esophageal wall.

Laparoscopy, thoracoscopy - low-traumatic operations - used to determine the prevalence of the tumor along the thoracic and abdominal cavity.

Treatment of esophageal cancer

Treatment of esophageal cancer is a rather difficult task. The difficulty lies in the large amount of surgical intervention: the removal of the entire esophagus, replacing it with another organ( part of the stomach or large intestine), is performed by cutting two cavities( thoracic and abdominal), is severely tolerated by patients, especially given that patients suffering from esophageal cancer areextremely exhausted( as a result of dysphagia and hunger).

The leading method of treatment of esophageal cancer is undoubtedly surgical, only surgery gives hope for recovery of the patient. The operation can be performed only on 1-2, rarely on 3 stages of the disease, due to the close arrangement of organs in the thoracic cavity and tumor germination of vital structures that can not be removed.

At 3-4 stages of the disease, when a tumor can not be removed or the patient is severely depleted, gastrostomy is performed: holes in the stomach on the stomach through which the patient is fed.

At present, radiation therapy is often used: radiation of the esophagus by a radioactive source( especially at stage 1); in patients with a higher stage, irradiation is used with a symptomatic purpose: temporarily relieve pain, dysphagia. It is possible to use both external( remote) and internal( through the esophagus) irradiation or their combination.

Prognosis for esophageal cancer can be favorable only at stage 1-2, provided adequate treatment( operation, irradiation).At stage 3-4 the prognosis is extremely unfavorable, patients quickly die from exhaustion.