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Pharyngeal-Esophageal Cancer

Esophageal cancer is a serious type of cancer characterized by the uncontrolled proliferation of cells within the muscular tube that carries food from the mouth to the stomach.

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ℹWhat is Pharyngeal-Esophageal Cancer?

The esophageal wall consists of several tissue layers that work together to push food toward the stomach during swallowing. The inner surface of most of the esophagus is lined with thin, flat squamous cells. In the portion near the stomach, the inner surface is composed of glandular epithelial cells. Beneath this lining lies the submucosal tissue, which keeps the esophagus moist. Beneath the submucosa, thick muscle layers contract in wave-like motions to push food down the esophagus.

Most esophageal cancers are tumoral lesions of the mucosa originating from the epithelial cells lining the esophagus. There are two main histological types: Squamous Cell Carcinoma, arising from squamous cells, and Adenocarcinoma, arising from glandular cells that secrete mucus and other fluids.

Squamous cell carcinoma most commonly occurs in the upper and middle sections of the esophagus. Adenocarcinoma usually begins in the glandular epithelial cells in the lower part of the esophagus, near where it joins the stomach. These tumors often develop in individuals with Barrett’s esophagus.

Common Symptoms

Difficulty Swallowing
The most prominent symptom. Initially, there is difficulty with solid foods; as the disease progresses, even swallowing liquids becomes difficult.
Weight Loss
Involuntary and rapid weight loss is observed.
Chest Pain
A burning or squeezing sensation behind the breastbone.
Regurgitation
The backflow of undigested food into the mouth.
Hoarseness and Chronic Cough
May occur due to the tumor pressing on surrounding nerves.
Melena (Black Stool)
Stools appear tarry black due to blood from the esophagus being digested and mixing with the stool.

Diagnosis Methods

Endoscopy (Gastroscopy)
The interior of the esophagus is examined with a lighted camera. A definitive diagnosis is made by taking a biopsy from suspicious areas.
Barium Esophagography
An X-ray of the esophagus is taken after the patient drinks a contrast agent; the status of the obstruction can be detected via this method.
Endoscopic Ultrasonography (EUS)
Currently the most sensitive method for determining how deep the tumor has penetrated the esophageal wall and whether there is enlargement in surrounding lymph nodes.
Computed Tomography (CT)
Used to determine the extent of the mass's expansion around the esophagus and whether it has spread to other organs (liver, lungs, etc.).
Positron Emission Tomography (PET-CT)
Used to detect metabolically active tumor foci and distant metastases.

Causes

Tobacco and Alcohol Use
The most significant risk factors for squamous cell carcinoma. The risk increases exponentially when used together.
Barrett's Esophagus
Developed due to chronic Gastroesophageal Reflux Disease (GERD), this condition is the most important risk factor for adenocarcinoma.
Obesity
Particularly increases the risk of adenocarcinoma. Increased intra-abdominal pressure can trigger reflux, leading to Barrett’s esophagus.
Hot Beverage and Food Consumption
Regular consumption of very hot beverages can damage the esophageal mucosa and increase cancer risk.
Dietary Habits
A diet poor in fresh fruits and vegetables and rich in nitrosamines may increase risk.

Treatments

Endoscopic Treatments
Endoscopic Mucosal Resection (EMR), submucosal dissection, and tumor ablation (photodynamic therapy, argon plasma coagulation, radiofrequency ablation) can provide curative options for superficial tumors while preserving the integrity of the esophagus.
Surgery (Esophagectomy)
The most effective method in early stages. The cancerous part of the esophagus and surrounding lymph nodes are removed. The remaining portion is usually joined with a tube made from the stomach. Today, this can be successfully performed via laparoscopic or robotic surgery.
Radiotherapy
Can be applied before surgery to shrink the tumor (neoadjuvant) or after surgery to clear residual cells (adjuvant).
Chemotherapy
Generally applied in combination with radiotherapy (chemoradiotherapy). For Squamous Cell Cancer, Paclitaxel and Carboplatin are used; for Adenocarcinoma, the FLOT combination (Fluorouracil, Leucovorin, Oxaliplatin, Docetaxel) is utilized.
Immunotherapy and Targeted Therapy
In advanced-stage adenocarcinomas, targeted therapies suited to the tumor's genetic structure or immunotherapies that strengthen the immune system are used. In squamous cell cancers, Nivolumab can provide significant benefits as an adjuvant after surgery.
Palliative Care
If the tumor cannot be removed surgically, a stent may be placed in the esophagus or the canal may be opened with laser treatment to ensure the patient's nutrition.

Prevention

Avoiding Tobacco and Alcohol
Significant reduction of risk, especially for squamous cell carcinoma.
Treatment of Reflux Disease
Effective treatment of chronic GERD and regular endoscopic follow-up for patients with Barrett’s esophagus is vital.
Healthy Diet and Weight Control
A diet rich in fresh fruits and vegetables, maintaining an ideal weight, and avoiding very hot food/beverage consumption is recommended.
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