Oesophageal cancer: Causes, Manifestations And Treatment

Cancer of the esophagus, or esophageal cancer, is a malignant tumour. Globally, its incidence is on the rise.

Men are three times more likely to have it than women. It is the sixth most common cause of death due to cancer.

About the Esophagus

The esophagus, informally known as the food pipe or gullet, is a hollow organ of the digestive system that connects the pharynx and the stomach. Anatomically, it is mostly located in the thoracic cavity, and about a quarter of it is in the abdominal cavity. It is about 20-30 centimetres in length. The lumen of this connecting tube, i.e. the inner diameter, is roughly 1.5 cm at rest and is flat.

Its wall consists of two layers, i.e. muscle fibres and the mucosa. The upper part consists of transverse striated muscle and the lower two thirds of smooth muscle. The muscles create a peristaltic movement, moving the food from the oral cavity to the stomach. The muscle allows it to widen the lumen up to twice its size, which makes it easier for the food to pass to the lower parts of the tract.

The mucosa is the inner layer. It consists of epithelium, which is a multilayered squamous membrane, the lamina propria and muscularis mucosae. In the esophageal wall there is a rich tangle of blood vessels, i.e. arterial supply, venous and lymphatic drainage.

Esophageal Tumours

Oesophageal cancers, like other tumourous diseases, can be benign and malignant. We know several species from both groups. Benign formations do not cause problems in most cases. If they do, they cause difficulty swallowing or occasional bleeding.

In contrast, malignant tumours are a source of bigger and more serious problems, although they may be asymptomatic for a long time. They are invasive and destructive to their immediate environment. The anatomical location of the esophagus complicates the diagnosis.

The advantage is early detection of change and timely treatment.

Even here, preventive check-ups are very important.

The Most Common Esophageal Tumours 

The cause of cancer is most often a genetic abnormality. This is caused by a combination of internal and external factors.

For example, esophageal adenocarcinoma has seen an increasing trend in recent years. Long-term tissue damage due to GERD is reported to be the main cause.

Alcoholism and smoking increase the risk of esophageal cancer by up to five times.

Risk factors that can cause esophageal cancer include:

• being over 45 years of age
• sex, males are three times more susceptible
• alcoholism, especially concentrated and hard alcohol
• smoking and tobacco in any form
• food
  • excessive spicy diet
  • excessive intake of fats, proteins or salt
  • too much caffeine
  • long-term drinking of hot and sour drinks, coffee and tea
  • nitrosamines, marinated food, cold cuts, grilled food
  • vitamin deficiency, especially vitamin A
  • lack of minerals such as zinc or molybdenum
  • low levels of fibre, ballast in the diet
  • toxic substances and chemical additives in food
  • molds and food rot products, aflatoxin, patulin
• being overweight or obese
• environmental resources, heavy metals in nature, such as lead or cadmium
• Barrett's esophagus, a change in the structure of the esophageal epithelium as a result of long-term acidic environment in reflux disease
• caustic injury of the esophagus, in case of accidental or intentional intoxication, or poisoning

Learn more about alcoholism and being overweight or obese.

Other risk factors, so-called precancerous lesions, include hiatal hernia, Barrett's esophagus and, for example, esophageal achalasia. The condition is actually a motility disorder, i.e. the motility of the esophagus with an associated difficulty swallowing. Its cause is unknown.

Another example is Plummer-Vinson syndrome and various types of caustic injury.

Environmental resources, poor lifestyle and a combination of both in the long term are reported as a risk factor for squamous cell carcinoma. In adenocarcinoma, it is mainly Barrett's esophagus.

Barrett's esophagus is a transofrmation of the normal mucosa due to reflux of gastric and duodenal contents on metaplastic cylindrical epithelium. It is located in the lower parts of the digestive tract. The cause is mostly chronic reflux esophagitis.

Risk factors for its occurrence and tissue damage:

• smoking
• alcoholism, binge drinking
• motility disorder
• dysfunction of the esophageal sphincter
• hiatal hernia
• chronic gastroesophageal reflux disease (GERD)

This is one of the reasons why adenocarcinoma occurs mainly in the lower third of the esophagus. This complication, ie precancerous disease, represents a 30-125-fold risk of developing esophageal cancer. Oesophageal cancer is characterized by a long asymptomatic period.

However, the association of problems and issues is a sign of a more advanced stage of cancer.

The symptoms of esophageal cancer can be hidden for a long time. Therefore, this type of cancer is dangerous. It does not manifest itself for a relatively long time, and the tumour grows and metastasizes during this asymptotic period.

The reason is the flexibility of the esophageal muscles. It can double its inner diameter.

This property gives room for tumor growth. And only when he fills the esophagus to two-thirds will cause trouble. Difficulty swallowing, also called dysphagia, is among the initial symptoms.

Dysphagia may be painful. It is also associated with the feeling of food getting stuck in the throat and chest.

Chest pain is characterized by the fact that the person in question can accurately locate it. Pain while swallowing is called odynophagia. It can also result in inability to swallow a bite or drooling, coughing or snoring in a voice.

Similarly, cancer is associated with frequent heartburn. Weight loss is a sign of an advanced stage.

Table: Symptoms occurring in esophageal cancer

TIP: Laryngeal cancer and thyroid cancer are described in a separate article. Learn more about the causes of hoarseness.

Another symptom may be dark black, tarry feces, called melena. It is caused by bleeding from a tumor. The blood passes through the entire digestive tract, where it digests, and this causes it to turn black. The opposite situation is the vomiting of blood, or hematemesis, which is characterized by the vomiting of fresh red blood.

General symptoms include fever, excessive sweating, malaise, increased fatigue, general weakness, and loss of appetite that leads to weight loss.

Due to the good location of the esophagus and its vascular supply, the diagnosis is associated with complications. These are the result of the invasive behavior of the cancer towards its surroundings.

The tumor also grows into other structures, organs and spreads through the blood or lymph to other parts of the body, creating metastases.

These and other symptoms can be a symptom of another disease, so early examination is important for early detection, diagnosis and timely treatment of the disease.

The tumour may be detected by chance.

However, in many cases, esophageal cancer is diagnosed after the initial symptoms appear. This is negatively affected by the location of the esophagus and its hidden location.

That includes the flexibility of the esophageal muscles, too.

At this time, the tumour is in an advanced stage.

The diagnosis itself is simple. The main diagnostic method is an endoscopic examination.

This is supplemented by the histology of the biopsy samples taken. Another imaging method is an X-ray of the esophagus. Optionally, CT, MRI or endosonography are chosen.

Bronchoscopy detects damage to the respiratory system. Laboratory tests determine oncomarkers and basic blood parameters. Cancer staging is important for the diagnosis. This includes evaluation of the tumour itself, lymph node involvement and metastasis, also called the TNM Classification of Malignant Tumours.

Medical history and overall clinical picture are important.

Oesophageal cancer is asymptomatic at first. The fact that the symptoms are hidden is due to the placement of the tumour, which is not visible to the naked eye, but also by the characteristics of the esophageal wall. The muscle of the esophagus is so flexible that it can adapt to swallowed food.

At that moment, it magnifies up to twice its original size.

Subsequent onset of symptoms is a manifestation of a higher and more advanced stage of the disease. The tumor usually affects 2/3 of the esophagus. Dysphagia lasting several months is typical first.

The difficulties are first caused by a solid diet, after several months also mushy food and then also swallowing fluids.

Odynophagia, or pain when swallowing, may be associated. A piece of food gets stuck in the esophagus. One has a sensatin of food or an  obstruction being stuck in the throat or the chest. The patient can point to the precise site. Persistent chest or back pain is a sign of late damage to the surrounding tissues. Invasive behaviour is also due to coughing or difficulty breathing.

When the blood vessels are damaged, there is bleeding. At moderate intensity, there may be some melena, i.e. black tarry stool. Conversely, if the bleeding is intense, fresh blood is vomited.

Likewise, weight loss is a manifestation of advanced cancer.

The affected person loses more than 10 kilograms of weight.

Advanced cancer is characterized by the presence of metastases in the body. These then manifest themselves according to the location and extent of the damage. Esophageal cancer can be treated well, however, if caught early. Therefore, preventive check-ups are essential.