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Oesophageal Cancer - Overview
Oesophagal cancer occurs when cells in the oesophagus begin to multiply, eventually creating a tumour. Oesophagus is the long, hollow, muscular tube that connects your throat to your stomach. It helps to move the food swallowed from the back of your throat to your stomach for digestion.
This type of cancer usually begins in the cells that line the inside of the oesophagus. It can occur anywhere along the oesophagus. More men are diagnosed with oesophagal cancer than women. Some common causes of oesophageal tumours include tobacco and/or alcohol use, obesity, and poor nutrition. There are two types of oesophagal cancer:
Adenocarcinoma: This type develops in the tissue that secretes mucus, which helps you swallow. It usually affects the lower part of your oesophagus.
Squamous cell carcinoma: This type usually starts in squamous cells that line the oesophagus. It commonly affects the upper and middle parts of your oesophagus.
Oesophageal Cancer Symptoms
Oesophageal cancer symptoms, typically, are not readily recognizable in the early stages. However, some of the signs and symptoms of oesophagal cancer to watch out for include:
- Painful or difficult swallowing (dysphagia)
- Weight loss without trying
- Pain or pressure in the chest
- Coughing or hoarseness
- Worsening indigestion and heartburn
- A lump under the skin
Importance of Screening for Oesophagal Cancer
Globally, oesophagal cancer is the eighth most common type of cancer and the sixth most common cause of cancer-related deaths. Its incidence is the most rapidly rising cancer in developed countries. However, its incidence varies within different geographic locations.
Oesophageal cancer is aggressive in nature but may not cause noticeable symptoms in the early stages. This is one of the biggest challenges associated with oesophagal tumour. Most patients seek medical care only when they have trouble swallowing; this symptom appears when the cancer is advanced and may have spread to different organs. This is because the oesophagus, being a muscular organ, stretches to make room for large bites of food and other big things. But as the tumour grows, it can block your oesophagal opening, which may cause pain or difficulty in swallowing. Hence, with screening, oesophagal cancer can be detected at an early stage, which can provide better treatment outcomes.
For any cancer type, the five-year survival rate is considerably better for people diagnosed with early asymptomatic cancers than for those diagnosed with symptomatic disease. In the case of oesophagal tumour, the five-year survival rate is less than 20 per cent after the onset of symptoms. Thus, early detection is associated with improved survival rates.
The Challenge of Screening
Currently, there are no guidelines that recommend screening for oesophagal cancers, except for those individuals who are at high risk of developing it. No low-cost, non-invasive screening tools are employed. There is a need for accurate, non-endoscopic screening tools and to define a well-characterised screening population.
Testing people at high risk
For now, doctors recommend regular endoscopic screening for oesophagal adenocarcinoma if you are at high risk, particularly if you have the following conditions:
Barrett's oesophagus:
Barrett's oesophagus is a condition in which the lining of the oesophagus becomes damaged by acid reflux, thickening the lining, which becomes red. This condition can be caused by gastroesophageal reflux disease (GERD).
Factors increasing your risk for Barrett's oesophagus include:
- Experiencing chronic GERD
- Being a man
- Being 50+
- Being obese
- Being Caucasian
- Smoking
- Having a family history of Barrett’s
Some experts recommend that patients with Barrett’s oesophagus should get screened for oesophagal cancer every three years. Individuals who have family members with inherited Barrett’s oesophagus should consider screening with an upper endoscopy after turning 40 years old.
Inherited syndromes:
Inherited syndromes or hereditary syndromes can also increase the risk of developing oesophagal cancer, which commands regular endoscopies to look for cancers or pre-cancers. Some examples include tylosis or Bloom syndrome. Individuals with these syndromes should consider undergoing upper endoscopy after turning 20 years old for oesophagal tumour screening.
Available Tools for Oesophageal Cancer Diagnosis
The initiation and success of oesophageal cancer treatment measures and oesophageal cancer survival rate depend on how early the oesophageal cancer symptoms are recognized, the current stage of oesophageal cancer, the speed of cancer progression, the patient's mental health and physical well-being, etc. Some of the following tests are used or studied for screening oesophagal cancers.
Esophagoscopy: In this procedure, a thin, tube-like instrument with a light and a lens (oesophagoscope) is inserted through the mouth or nose and down the throat into the oesophagus to check for any abnormal areas. Sometimes, tissue samples may be removed using a tool in the oesophagoscope, which is evaluated under a microscope (in the laboratory) for signs of cancer.
Biopsy: In this test, cells or tissues are removed from several different areas in the lining of the lower part of the oesophagus to be viewed under a microscope and to check for oesophageal cancer diagnosis.
Brush cytology: This procedure involves brushing the cells from the lining of the oesophagus and viewing them under a microscope. It can be done during an esophagoscopy.
Balloon cytology: In this procedure, the patient swallows a deflated balloon, which is then inflated to collect the cells from the lining of the oesophagus and pulled out. The cells on the balloon are then examined under a microscope.
Chromoendoscopy: This procedure involves spaying a dye onto the lining of the oesophagus during esophagoscopy. If there is increased staining of certain areas of the oesophagal lining, it may indicate an early sign of Barrett’s oesophagus.
Fluorescence spectroscopy: In the procedure, a light probe that emits a special light is passed through an endoscope, which shines on the lining of the oesophagus. The light given off by the cells lining the oesophagus is then measured. If certain areas of the oesophagal lining emit less light, it may be a sign of malignancy.
Conclusion
Oesophageal cancers and associated deaths can be prevented by careful monitoring and treatment (if needed). This type of cancer can be treated successfully when detected early. Thus, screening for oesophagal cancer is important, especially in populations that are at high risk.
Dr. T Raja Director - Medical Oncology Apollo Cancer Centre, Chennai
