Esophageal Cancer

Esophageal cancer develops in the esophagus, the long hollow tube in the digestive tract that carries food from the mouth to the stomach. Cancer cells may form and develop into growths or tumors in the walls of the esophagus. There are several different types, classified by the kinds of cells involved, of esophageal cancer. The most common types are adenocarcinoma and squamous cell carcinoma. Adenocarcinoma develops in the mucous-secreting glands; squamous cell carcinoma develops in the cells that line the surface of the esophagus. If left untreated, malignant tumors can spread to other parts of the body and cause serious complications, such as an obstructed esophagus, bleeding or severe weight loss.

Causes and Risk Factors of Esophageal Cancer

Although the specific causes of esophageal cancer are unknown, there are certain factors that can increase the risk of developing it:

  • Excessive alcohol consumption
  • Use of chewing tobacco
  • Obesity
  • Smoking
  • Being over the age of 65
  • Barrett‘s esophagus
  • Gastroesophageal reflux disease (GERD)
  • Radiation treatment to chest or upper abdomen

Symptoms of Esophageal Cancer

Esophageal cancer in its early stages may not cause any symptoms, but as the disease progresses, patients may experience:

  • Difficulty swallowing
  • Weight loss
  • Chest pain
  • Fatigue
  • Heartburn
  • Hoarse voice
  • Cough

Although these symptoms may be caused by another, less severe condition, a physician should be consulted if symptoms persist.

Diagnosis of Esophageal Cancer

To diagnose esophageal cancer, a doctor performs a physical examination and reviews symptoms. If esophageal cancer is suspected, a series of tests is performed. They may include:

  • X-ray
  • Biopsy
  • Endoscopy (to examine the lining of the esophagus)
  • Barium swallow
  • CT or PET scans

If esophageal cancer is diagnosed, its stage must be determined before an appropriate course of treatment can be decided upon.

Treatment of Esophageal Cancer

Treatment for esophageal cancer varies depending on the stage and severity of the condition, as well as the patient‘s overall health. Treatment often includes surgery, chemotherapy, radiation therapy or a combination of these treatments. Surgery is often successful in removing the cancerous tumors, as well as any other nearby affected tissue. Surgery for esophageal cancer may remove just the tumor, or part or all of the esophagus and stomach, in order to ensure that the disease has been thoroughly eradicated.

Types of Esophagectomy

Surgery for esophageal cancer is called esophagectomy; it can be performed as open abdominal surgery or laparoscopically. Laparoscopy is less invasive and involves smaller incisions. Laparoscopic surgery is usually performed to remove cancerous tissue when the cancer has not metastasized. If open surgery is required, it may take one of three forms:

Transhiatal esophagectomy

In a transhiatal esophagectomy, the surgeon makes two large incisions, one in the patient‘s neck and one in the upper belly. After removing the diseased tissue, the surgeon rejoins the rebuilt esophagus and the stomach.

Transthoracic esophagectomy

In a transthoracic procedure, the surgeon makes one incision in the patient‘s chest and one in the upper belly. The esophagus is removed, and the stomach is used to form a tube to replace it.

En bloc sophagectomy

The en bloc procedure is the most invasive type of esophagectomy. In this procedure, the surgeon makes cuts in the neck, chest and belly. All of the esophagus and part of the stomach is removed. The remaining piece of the stomach is formed into a tube, and attached to the remnants of the esophagus.

In all three procedures, nearby lymph nodes are removed to ascertain whether the existing cancer has spread.

During early recovery, the patient has a feeding tube in place to allow the digestive tract to heal. When appropriate, the patient may begin or resume cancer treatments such as chemotherapy or radiation therapy.

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