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General Surgery
Esophageal Cancer
Esophageal cancer is a serious type of cancer characterized by the uncontrolled proliferation of cells in the muscular tube structure that carries food from the mouth to the stomach.
ℹWhat is Esophageal Cancer?
The wall of the esophagus consists of several layers of tissue that work together to push food toward the stomach during swallowing. Most esophageal cancers are tumoral lesions in the mucosa originating from the epithelial cells lining the esophagus.
There are two main histological types: Squamous Cell Carcinoma, which is more common in the upper and middle parts of the esophagus, and Adenocarcinoma, which usually develops in the lower part, in the area where it joins the stomach. Adenocarcinoma often develops in people with Barrett's esophagus.
Common Symptoms
Dysphagia (Difficulty Swallowing)
The most prominent symptom. Initially presents with difficulty swallowing solids, progressing to liquids as the disease advances.
Weight Loss
Involuntary and rapid weight loss.
Chest Pain
Burning or squeezing sensation behind the sternum.
Regurgitation
Backflow of ingested food into the mouth.
Hoarseness and Chronic Cough
Caused by tumor pressing on surrounding nerves.
Melena (Black Stool)
Tarry black stool resulting from digested blood originating from esophageal bleeding.
Diagnosis Methods
Endoscopy (Gastroscopy)
The inside of the esophagus is examined with a lighted camera; biopsies from suspicious areas provide definitive diagnosis.
Barium Esophagography
The patient swallows a contrast agent and X-rays reveal the degree of obstruction.
Endoscopic Ultrasonography (EUS)
Demonstrates the depth of tumor invasion into the esophageal wall and lymph node enlargement.
Computed Tomography (CT)
Evaluates local extent and distant metastasis.
PET-CT
Used to determine whether cancer has spread to distant organs.
Treatments
Endoscopic Treatments
Endoscopic Mucosal Resection (EMR), submucosal dissection, and tumor ablation may offer curative potential for superficial tumors.
Surgery (Esophagectomy)
The most effective method in early stages. The cancerous portion and surrounding lymph nodes are removed. Successfully performed via laparoscopic or robotic surgery.
Radiotherapy
Applied as neoadjuvant (tumor downsizing) or adjuvant (eliminating residual cells) therapy.
Chemotherapy
Usually combined with radiotherapy (chemoradiotherapy). Paclitaxel/Carboplatin for squamous cell carcinoma, FLOT regimen for adenocarcinoma.
Immunotherapy and Targeted Therapy
Used in advanced adenocarcinoma. Adjuvant Nivolumab provides significant benefit in squamous cell carcinoma post-surgery.
Palliative Treatments
When surgical resection is not feasible, esophageal stenting or laser treatment may be used to maintain nutritional intake.