Esophageal Cancer: Types, Stages, Symptoms, Causes, Diagnosis And Treatment

Each and every organ of the body plays a vital role in performing several essential functions. As, the oesophagus helps in transporting saliva, liquids, and foods from the mouth to the stomach. There can be growths or tumours in the oesophagus that might be cancerous or non cancerous. So, what is Esophageal Cancer? Esophageal cancer occurs in the oesophagus (a long, hollow tube that runs from the throat to the stomach). The oesophagus helps move the food swallowed from the back of the throat to the stomach for digestion. Esophageal cancer usually begins in the cells that line the inside of the oesophagus. Onlymyhealth editorial team spoke to Dr. Surinder Dabbas, Senior Director & HOD, Surgical Oncology & Robotic Surgery, BLK Hospital, about the types, stages, signs, causes, diagnosis and treatment of Esophageal cancer. 

Types of Esophageal Cancer

Different types of cancer start in varying cells of the oesophagus. Every cancer develops in various unique ways in individuals. In fact, each type of cancer requires a different treatment method. Esophageal cancer is generally of two types, one is adenocarcinoma and the other one is squamous cell carcinoma. Moreover, there is also a third type of rare esophageal cancer that is called small cell carcinoma. As per Dr. Surinder Dabbas, here are the main two types of Esophageal cancer: 

1. Adenocarcinoma

The first type is referred to as adenocarcinoma, which occurs in the lower part of the oesophagus. It is the most common form of cancer and begins in glandular cells. Adenocarcinoma is usually related to acid reflux, caused due to an incompetent valve at the gastroesophageal junction. This type of cancer is usually seen in middle aged and obese people. 

2. Squamous cell carcinoma

The other type of oesophagal cancer is referred to as the squamous cell carcinoma, which is usually found in the upper and middle part of the oesophagus. It is the kind of cancer that forms in the thin, flat cells lining the inside of the oesophagus. This type of cancer is mostly related to drinking alcohol and smoking. 

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Esophageal Cancer Stages

Like every type of cancer, oesophagal cancer also has stages, where stage 1 to 3 are curable, and stage 4 is incurable. In the first and second stage of oesophagal cancer, the tumour is localized to the food pipe in the oesophagus. In the third stage, it spreads beyond the oesophagus, to the lymph nodes. In the fourth stage, it starts spreading to other organs such as lungs and liver. It is usually difficult to detect esopheagal cancer at an early stage. Here are the 4 stages of Esophageal cancer: 

• Stage 1: In the first stage, the cancer cells are found only in the lining of the esophagus.
• Stage 2: In this stage, cancer spreads upto the muscles and outer wall of the  esophagus. It may even develop in the surrounding lymph nodes.
• Stage 3: Cancer spreads more deep into the inner muscles and reaches the connective tissue wall. It may spread into surrounding organs or more nearby lymph nodes. 
• Stage 4: At this stage, the cancer is incurable and spreads to all the other organs of the body. 

Symptoms of Esophageal Cancer

Amongst the many symptoms of oesophagal cancer, the most common one is Dysphagia, or difficulty in swallowing food, which at first happens with solid foods, with semi-solid foods, then the patient even develops difficulty in swallowing liquids, depending on the severity of the disease. Many patients have pain in the throat or oesophagus more specifically. Patients may also notice bleeding while vomiting, which is a rare symptom. At an advanced stage, Esophageal cancer can even cause complications like pain and bleeding in the oesophagus. Below mentioned are the main symptoms of esophageal cancer: 

• Swallowing difficulty 
• Chest pain
• Heartburn
• Sudden weight loss
• Persistent coughing 
• Esophageal bleeding 

Causes of Esophageal Cancer

Esophageal cancer can occur anywhere in the lining of the esophagus. And, this type of cancer is more common in men than women. According to Dr. Surinder, Smoking is the most common cause of oesophagal cancer. People who have suffered from reflux disease for a long time are at a risk for cancer. Chronic gastroesophageal reflux disease, if left untreated, can eventually lead to cancer of the oesophagus. Consumption of alcohol may also lead to oesophagal cancer. The role of family history is a very rare thing in this type of cancer usually does not play a prevalent role in the development of oesophagal cancer in one's body. These are not definite causes but can be risk factors or triggers for Esophageal cancer. Having very hot liquids regularly can also be an addition to the factors. 

Diagnosis Esophageal Cancer

Dr. Dabbas said, "When a patient complains that he is suffering from dysphagia, they are always advised by doctors to have a CT scan of the chest and endoscopy. If something relevant is disclosed with the endoscopy, a biopsy of the cells in the oesophagus is performed, with which the cancer is detected and identified as either adenocarcinoma or squamous cell carcinoma. Majorly, endoscopy and biopsy are done for an accurate diagnosis." Swallow studies are also done for the diagnosis of esophageal cancer. Sometimes, to know the advancement of the cancer, other tests are done like bronchoscopy, endoscopic ultrasound and positron emission tomography. On this basis, the cancer stage is determined and further medical treatment is provided by the oncologist. 

Treatment of Esophageal Cancer

The treatment of oesophagal cancer is dependent on the stage of cancer. Surgery is usually common in the first stage. In the second and third stage, chemotherapy and radiation therapy is given before the surgery. In the fourth stage, only chemotherapy is given to the patient. Preventive measures can be taken to avoid the development of oesophagal cancer in the body, early screening is the key in this. Yearly endoscopy for people above age 50 is recommended. Heavy smokers are advised to get screened regularly. Quitting smoking and avoiding or cutting back on consumption of alcohol is advised, along with regular exercise and avoiding becoming overweight. In the case of persistent heartburn, a doctor must be consulted regularly. For preventive and coping up measures, here are some lifestyle moderations that an esophageal cancer patient should make:

1. Quit smoking 

Smoking may increase the risk of squamous cell carcinoma, which is also a type of esophageal cancer. It can have an adverse affect on the oesophagus. You can even talk to your doctor about techniques for quitting smoking. 

2. Avoid alcohol

Alcohol consumption also triggers the development and advancement of Esophageal cancer. Avoiding and minimalising alcohol intake is a good way to prevent and avoid the spread of cancer. You can set a specific level of alcohol consumption for yourself.

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3. Weight management

Obesity is one of the minor triggers of adenocarcinoma Esophageal cancer. It is important to include fruits and vegetables in your diet for a balanced nutritious meal. Losing weight is also a useful lifestyle modification that helps you in preventing other health problems too. 

These were the types, stages, symptoms, causes, diagnosis and treatment for Esophageal cancer by Dr. Surinder Dabbas. Besides radiation therapy and chemotherapy, immunotherapy can also be beneficial in making the immune system stronger to fight cancer. If you experience the above mentioned esophageal cancer signs, you should visit the doctor for diagnosis. 

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