WORLD CANCER DAY: ESOPHAGEAL CANCER

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It had started with increasing difficulty in swallowing food. At first Kyoto, who was a chronic smoker thought it was due to the recent diagnosis of GERD with the increasing acid reflux he suffered over time. However, when the chest pains began, further tests were carried out and he was diagnosed with esophageal cancer.

Esophageal cancer is the abnormal growth of cells in the esophagus, which tend to proliferate in an uncontrolled way and metastasize. It is simply cancer occuring in the esophagus. The esophagus is a long, hollow tube that runs from your throat to your stomach, and helps move the food you swallow from the back of your throat to your stomach to be digested. Esophageal cancer usually begins in the cells that line inside the esophagus. It can occur anywhere along the esophagus. More men than women get esophageal cancer.

Incidence Rates in Africa

 

The overall trend of the esophageal cancer in Sub-Saharan Africa, show a steady increase in the population based age-gender standardized incidence rates, ranging from 0.6 cases to 76.6 cases per 100,000 males and 0.8 cases to 36.5 cases per 100,000 females.

 

Types

Esophageal cancer is classified according to the type of cells that are involved:

  1. Adenocarcinoma: They begin in the cells of mucus-secreting glands in the esophagus, and occur most often in the lower portion of the esophagus.
  2. Squamous cell carcinoma: They occur most often in the upper and middle portions of the esophagus, and are the most prevalent esophageal cancer worldwide.
  3. Other rare types include small cell carcinoma, sarcoma, lymphoma, melanoma and choriocarcinoma.

Signs and symptoms

Cancers of the esophagus are usually found because of the symptoms they cause. Diagnosis in people without symptoms is rare and usually accidental (because of tests done for other medical problems). Unfortunately, most esophageal cancers do not cause symptoms until they have reached an advanced stage, when they are harder to treat.

  • Trouble swallowing

The most common symptom of esophageal cancer is a problem swallowing, with a feeling like the food is stuck in the throat or chest, or even choking on food. The medical term for trouble swallowing is dysphagia. This is often mild when it starts, and then gets worse over time as the opening inside the esophagus gets smaller.

When swallowing becomes harder, people often change their diet and eating habits without realizing it. They take smaller bites and chew their food more carefully and slowly. As the cancer grows larger, the problem can get worse. People then might start eating softer foods that can pass through the esophagus more easily. They might avoid bread and meat, since these foods typically get stuck. The swallowing problem may even get bad enough that some people stop eating solid food completely and switch to a liquid diet. If the cancer keeps growing, at some point even liquids might be hard to swallow.

To help pass food through the esophagus, the body makes more saliva. This causes some people to complain of bringing up lots of thick mucus or saliva.

  • Chest pain

Sometimes, people have pain or discomfort in the middle part of their chest. Some people get a feeling of pressure or burning in the chest. These symptoms are more often caused by problems other than cancer, such as heartburn, so they are rarely seen as a signal that a person might have cancer.

Swallowing may become painful if the cancer is large enough to limit the passage of food through the esophagus. Pain may be felt a few seconds after swallowing, as food or liquid reaches the tumor and has trouble getting past it.

  • Weight loss

About half of people with esophageal cancer lose weight (without trying to). This happens because their swallowing problems keep them from eating enough to maintain their weight. Other factors include a decreased appetite and an increase in metabolism from the cancer.

  • Other symptoms

Other possible symptoms of cancer of the esophagus can include:

  • Hoarseness
  • Chronic cough
  • Vomiting
  • Hiccups
  • Bone pain
  • Bleeding into the esophagus. This blood then passes through the digestive tract, which may turn the stool black. Over time, this blood loss can lead to anemia (low red blood cell levels), which can make a person feel tired.

Having one or more of the symptoms above does not mean you have esophageal cancer. In fact, many of these symptoms are more likely to be caused by other conditions. Still, if you have any of these symptoms, especially trouble swallowing, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed.

Risk factors

Factors that cause irritation in the cells of your esophagus, increase your risk of esophageal cancer. They include:

  • Smoking
  • Having precancerous changes in the cells of the esophagus (Barrett’s esophagus)
  • Being obese
  • Consistent alcohol abuse
  • Having bile reflux
  • Having difficulty swallowing because of an esophageal sphincter that won’t relax (achalasia)
  • Having a steady habit of drinking very hot liquids
  • Not eating enough fruits and vegetables
  • Undergoing radiation treatment to the chest or upper abdomen
  • Gastroesophegeal Reflux Disease (GERD).

 

 

 

Staging systems for esophageal cancer

Since esophageal cancer can be treated in different ways, different staging systems have been created for each situation:

  • Pathological stage (also called the surgical stage): If surgery is done first, the pathological stage is determined by examining tissue removed during an operation. This is the most common system used.
  • Clinical stage: If surgery might not be possible or will be done after other treatment is given, then the clinical stage is determined based on the results of a physical exam, biopsy, and imaging tests. The clinical stage will be used to help plan treatment, but it might not predict outlook as accurately as the pathologic stage. This is because sometimes the cancer has spread further than the clinical stage estimates.
  • Post neoadjuvant stage: If surgery is done after other treatments such as chemotherpay or radiation have been given (this is called neoadjuvant therapy), then a separate post neoadjuvant stage will be determined after surgery.

Since most cancers are staged with the pathological stage, we have included that staging system in the tables below. If your cancer has been clinically staged or if you have had neoadjuvant therapy, it is best to talk to your doctor about your specific stage for those situations.

Grade

Another factor that can affect your treatment and your outlook is the grade of your cancer. The grade describes how closely the cancer looks like normal tissue when seen under a microscope.

The scale used for grading esophagus cancers is from 1 to 3.

  • GX: The grade cannot be assessed.(The grade is unknown).
  • Grade 1 (G1: well differentiated) means the cancer cells look more like normal esophagus tissue.
  • Grade 3 (G3: poorly differentiated, undifferentiated) means the cancer cells look very abnormal.
  • Grades 2 (G2: moderately differentiated) falls somewhere in between G1 and G3.

The grade is often simplified as either low grade (G1) or high grade (G3).

Low-grade cancers tend to grow and spread more slowly than high-grade cancers. Most of the time, the outlook is better for low-grade cancers than it is for high-grade cancers of the same stage.

Location

Some stages of early squamous cell carcinoma also take into account where the tumor is in the esophagus. The location is assigned as either uppermiddle, or lower based on where the middle of the tumor is.

 

Tests and diagnosis

  1. Early detection of oesophageal cancer is extremely important as it improves the chance of successful treatment.
  2. Endoscopy to examine the oesophagus.
  • CT scan, may be recommended to determine whether the cancer has spread.

Complications

  1. Obstruction of the esophagus. Cancer may make it difficult or impossible for food and liquid to pass through your esophagus.
  2. Pain. Esophageal cancer causes severe frontal neck pain.
  3. Bleeding in the esophagus. Esophageal cancer can cause bleeding. Though bleeding is usually gradual, it can be sudden and severe.
  4. Metastasis: Radical spread of cancerous cells to the neck, chest and head of an inflicted individual

 

Prevention

What steps can be taken to reduce your risk of esophageal cancer?

  1. I) Quit smoking. If you smoke, talk to your doctor about strategies for quitting.
  2. II) Drink alcohol in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
  3. Eat more fruits and vegetables. Add a variety of colorful fruits and vegetables to your diet.
  4. Maintain a healthy weight. If you are overweight or obese, talk to your health provider about strategies to help you lose weight.
  5. Avoid taking extreme hot temperatures of food or drinks.

 

Treatment

This depends on the size of the cancer, whether it has spread, your age and general state of health. Esophageal cancer is best treated if found in its earliest stages, before it has spread to other parts of the body.Unfortunately, esophageal cancer is a serious condition and the long-term survival rate is often not good, even with treatment.

1) Surgery: Esophagectomy – a portion of the esophagus is removed and the stomach is pulled up and joined to the remaining esophagus

2) Radiotherapy (high energy X-rays): can be used alone or in combination with surgery or chemotherapy.

3) Chemotherapy: May be used with radiotherapy (chemoradiotherapy) or without radiotherapy.

 

REFERENCES:

https://www.mayoclinic.org/diseases-conditions/esophageal-cancer/symptoms-causes/syc-20356084

https://www.cancer.org/cancer/esophagus-cancer/detection-diagnosis-staging/signs-and-symptoms.html

 

TOGETHER WE CAN FIGHT CANCER

Stay Safe. Stay Healthy.

Chidimma Chukukere.

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Lead Nurse Africa is a Pan-African nursing organization dedicated to public health promotion and professional development.

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