What happens and what forms it comes in
The tumor begins with altered cells of the mucous membrane and gradually grows into the wall of the esophagus, narrowing its lumen and spreading to the lymph nodes. Squamous cell carcinoma most often occurs in the upper and middle third, adenocarcinoma - in the lower third, closer to the stomach. Dysplasia and Barrett's esophagus are distinguished separately: this is not cancer yet, but precancerous changes that can be identified and monitored with regular endoscopy. The growth rate and choice of treatment depend on the type of tumor and the depth of germination.
- Squamous cell carcinoma - upper and middle third of the esophagus
- Adenocarcinoma - lower third, associated with Barrett's esophagus
- Mucosal dysplasia is a precancerous condition
- Early cancer within the mucosa - removed endoscopically
- Locally advanced forms with lymph node involvement
Causes and risk factors
The main contribution is made by substances and influences that constantly damage the mucous membrane. Smoking and alcohol act together and reinforce each other. The habit of drinking very hot tea burns the mucous membrane, and chronic injury supports inflammation and cell restructuring. For adenocarcinoma, long-term gastroesophageal reflux disease plays a key role: acid changes the epithelium of the lower third of the esophagus. The risk is also increased by obesity, achalasia, chemical burns and a lack of vegetables and fruits in the diet.
- Smoking and chewing tobacco
- Strong alcohol
- Very hot drinks and food
- Gastroesophageal reflux disease and Barrett's esophagus
- Obesity
- Achalasia cardia, scars after a chemical burn
- Age over 55 years, male
Symptoms
The first and most characteristic symptom is dysphagia - difficulty passing food. First, a person notes that dry meat or bread does not go well, then he has to drink food, later difficulties arise with soft food, and in severe cases - with liquid. At the same time, weight decreases and weakness appears. Chest pain, regurgitation, bad breath and hoarseness occur when the tumor spreads. Sometimes the first manifestation is anemia due to hidden blood loss.
- Increasing difficulty swallowing
- Pain or discomfort in the chest when eating
- Vomiting food, drooling
- Weight loss and weakness
- Hoarseness of voice
- Anemia and dark stools
Diagnostics
The main method is endoscopy of the upper digestive tract with a biopsy: the doctor examines the mucous membrane and takes pieces of tissue, from which the pathologist makes a final diagnosis. To assess the spread, MSCT of the chest and abdominal cavity with contrast is prescribed, endoscopic ultrasound to determine the depth of invasion and the condition of the lymph nodes, and, if necessary, PET-CT. General and biochemical blood tests complete the picture. Barium X-ray is used less frequently and does not replace endoscopy.
- Videoesophagogastroduodenoscopy with biopsy
- Histological examination of the material
- MSCT of the chest and esophagus with contrast
- Endoscopic ultrasound
- PET-CT according to indications
- General blood test
Treatment and prevention
The treatment plan is drawn up by a consultation with the participation of an oncologist, a surgeon and a radiotherapist. Early tumors within the mucosa are removed endoscopically, preserving the esophagus. For deeper germination, surgery is used, often in combination with chemotherapy and radiation therapy before and after the intervention. If radical treatment is not possible, esophageal stenting and other measures are performed to restore nutrition and relieve pain. Prevention boils down to quitting smoking and alcohol, weight control, treatment of reflux and monitoring for Barrett's esophagus.
- Endoscopic mucosal resection for early cancer
- Surgical removal of the esophagus with plastic surgery
- Chemotherapy and radiation therapy
- Stenting for severe narrowing
- Nutritional support and pain relief
- Quitting smoking and alcohol, treating reflux
