Esophageal cancer


Risk Factors

Gender:
Men are affected more frequently than women. Ratio for squamous cell cancer is in the range of 3:1 and for adenocarcinomas 7:1.

Age:
The ages between 45 and 70 are at the greatest risk but patients outside of this age range are occasionally reported to have esophageal cancer.

Barrett's esophagus:
Risk factor for adenocarcinoma of the esophagus, especially when high-grade dysplasia is also present.

Diet:
Diets that are deficient in fruits and vegetables as well as certain minerals and vitamins, particularly vitamins A, C, and riboflavin, may increase the rate of esophageal cancer.

Achalasia:
6% of all achalasia will develop squamous cell esophageal cancer.

 

Tylosis:
Inherited disease that causes excess growth of the top layer of skin on the palms of the hands and soles of the feet. People with this condition also have an extremely high risk (approaching 100%) of getting esophageal cancer and therefore require early and regular screening.

Esophageal webs:
10% of patients will eventually develop squamous cell cancer of the esophagus.

Alcohol & Smoking:
Clear-cut relationship of cancer of the esophagus to the use of tobacco and alcohol.

Strictures:
There are long-term risks associated with chronic inflammation and stasis, as occurs in after caustic injury.

Screening

Individual patients at increased risk for esophageal cancer are candidates for endoscopic surveillance.

Endoscopy with biopsy is the primary method for the diagnosis of esophageal carcinoma.

X-rays are a form of electromagnetic radiation like light, but of higher energy, so they can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray. Barium is very dense and will appear white on the X-ray film.
  • Barium swallow
    An Upper GI and small bowel series is a set of X-rays taken to examine the esophagus, stomach, and small intestine. X-rays are taken after the patient has swallowed a barium suspension (contrast medium). See also barium enema.
  • EGD (esophagogastroduodenoscopy) and biopsy
    Esophagogastroduodenoscopy (EGD) is an examination of the lining of the esophagus, stomach, and upper duodenum with a small camera (flexible endoscope) which is inserted down the throat.
  • Chest MRI or thoracic CT (usually used for helping to determine the stage of the disease)
    A chest MRI uses powerful magnets and radio waves to construct pictures of the body. Unlike conventional radiography and Computed Tomographic (CT) imaging, which make use of potentially harmful radiation (X-rays) that pass through a patient to generate images, magnetic resonance imaging (MRI) is based on the magnetic properties of atoms.
  • PET scan: Sometimes useful for determine stage of disease and whether surgery is possible.
  • Evidence of occult (hidden) blood in stool.

Recommendation

Esophageal cancer is a very difficult disease to treat, but it can be cured in patients whose disease is confined to the esophagus. In circumstances in which surgery can be performed, cure rates are in the range of 25%.

In some circumstances in which the cancer is localized to the esophagus and radiation therapy is used instead of surgery, cure is possible but is less likely than with surgery.

For patients whose cancer has spread outside the esophagus, cure is generally not possible and treatment is directed toward relief of symptoms.