Esophageal cancer is a rare tumor, mainly in women, but with a high mortality rate. It is currently the eighth most common cancer worldwide. The incidence varies significantly depending on the geographical area, being higher in certain regions of Asia and Central and Southern Africa.
Only 10% of men with esophageal cancer survive more than 5 years, although fortunately survival is improving in most European countries.
There are currently two types of esophageal cancer: squamous esophageal cancer and adenocarcinoma. Adenocarcinoma is progressively increasing in incidence in the developed world and already exceeds squamous esophageal cancer. The factors that cause esophageal cancer vary between the two types. Barrett’s esophagus and obesity are associated with esophageal adenocarcinomas, while tobacco and alcohol consumption are risk factors for squamous cell carcinoma.
Through what signs or tests can we detect esophageal cancer?
Currently there is no useful test for the diagnosis of esophageal cancer in the general population. Its study includes the performance of a detailed and complete clinical history, with physical examination, blood tests (with CEA and SCC markers) and upper endoscopy along with biopsies of suspicious lesions. For the study of the disease at the regional level, echoendoscopy with FNA biopsies of suspicious lymph nodes is used. And for the possible dissemination of the disease at a general or systemic level: thoracic-abdomino-pelvic CT, bronchoscopy (depending on the location of the tumor), and PET-CT.
Individuals diagnosed with potentially malignant or premalignant lesions may benefit from periodic endoscopies that involve exploration of the esophagus using a flexible tube, called an endoscope.
The patients in whom this test is most frequently used are those diagnosed with Barrett’s esophagus. Endoscopies with biopsy, removal of a small piece of tissue from the area for microscopic study, can detect premalignant stages (called dysplasia) and thus enable a therapeutic decision to be made. This diagnostic endoscopy approach may also be advisable in those affected by gastroesophageal reflux esophagitis that does not respond well to medical treatment.
In case the dysplasia is considered high grade (stage prior to malignant transformation), surgery to remove the area of Barrett’s esophagus or treatment by endoscopic means (depending on each case) is advised. It is also possible that in the removed tissue, a small carcinoma is detected that was not visualized with the endoscope. The prognosis in these cases is excellent.
With all the necessary diagnostic tests, the extent of the disease and its corresponding staging (TNM stage) is established. Thus an initial prognosis is made and a personalized therapeutic plan can be made for each patient. All this, as well as the treatment, is done by a multidisciplinary team of various specialists. Thus, staging (identification of the characteristics) of esophageal cancer is an essential step in order to adequately plan its treatment.
Symptoms of esophageal cancer
In the earliest stage of the disease there are usually no symptoms, so in these conditions the diagnosis is usually made accidentally and as an unexpected finding for other reasons. However, most cases are diagnosed when certain symptoms are present.
The most frequent symptoms are the following:
- Dysphagia: this is the most frequent symptom of esophageal cancer. It consists of difficulty in swallowing together with a sensation of stopping in the throat or chest. It usually begins with solid foods, especially meat and bread, and progressively increases. This causes a feeding based mainly on liquids, and finally it evolves to the impossibility to swallow even saliva.
– Weight loss: occurs in a high percentage of cases as the disease progresses. It is largely due to difficulty in feeding, as well as loss of appetite and metabolic changes.
– Retrosternal pain: it is a rare symptom that can appear in both benign and malignant processes. If it appears in a case of esophageal cancer it denotes that it is advanced.
– Other symptoms: If the tumor invades structures neighboring the esophagus, cough, hiccups or dysphonia (hoarseness) may appear.
If a patient presents any of these symptoms, he/she should see a specialist in General Surgery to perform the necessary tests and make a diagnosis. As these symptoms sometimes appear in benign diseases, it is necessary to wait for the results of the tests to establish a diagnosis.
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