Peter was just 48, in April 2013 when he was diagnosed with Esophageal Cancer. He had trouble swallowing food and after two weeks of antibiotics, the symptoms persisted so he was referred for a barium swallow test. The test revealed a throat hernia.
A follow-up endoscopy and biopsies took it to a surprise where the result showed to be Esophageal Cancer. He was shocked and felt like he had been served a death sentence. He was detected with stage 3-4 esophageal cancer. It affects more men than women, and usually with people in their 60s or above.
The treatment was quickly scheduled and after two cycles of intense chemotherapy, Peter was booked for a 10-hour operation in July 2013. Thankfully the operation went well, and the cancer was removed along with 52 lymph nodes.
Peter is in good health eight years on. He returned to work a year later but lost around six stone in weight and despite remarkable progress, he still has struggled with his food, but Peter is strong and positive and living a full life again.
Now Peter has chosen a charity to support parents & their families and raise awareness of this cancer. Though Peter was diagnosed at a later stage, he fought back and won the battle of life.
Likewise, in this article, you will be guided through types, stages, symptoms, causes, diagnosis, and treatment of esophageal cancer which will help you to detect cancer at an early stage and prevent it before it gets delayed. So, let’s get started.
The esophagus is a muscular tube that is responsible for moving food from the throat to the stomach and Esophageal Cancer occurs when a malignant tumor forms in the lining of the esophagus.
Cancer starts when cells in the inner lining of the esophagus grow out of control. A tumor can occur anywhere along the length of the esophagus, including the place where the esophagus and stomach meet.
Types of Esophageal Cancer
Esophageal Cancer is classified into two types according to the type of cells involved:
Squamous Cell Carcinoma – This cancer begins in the thin cells that make up the lining of the esophagus. This occurs most often in the upper and middle portions of the esophagus. This is the most common esophageal cancer worldwide.
Adenocarcinoma – These cancers start in the glandular cells that are responsible for the production of fluid such as mucus. It is most common in the lower part of the esophagus, near the stomach.
Other types include small carcinoma, lymphoma, melanoma, and choriocarcinoma.
During the early stages of Esophageal Cancer, you will not experience any symptoms but as cancer progresses, you may experience:
- Difficulty swallowing
- Weight loss
- Food coming back through the esophagus
- Chest pain
- Chronic cough
There are different stages for different types of cancer. Doctors use a tool called as TNM system to describe the stage of cancer:
Tumor (T) – It indicates how intensely the primary tumor has grown into the wall of the esophagus and the surrounding tissue.
Node(N) – It shows if the tumor has spread to lymph nodes, where and how many?
Metastasis (M) – It shows if cancer has spread to other parts of the body, where and how much?
These results are combined to determine the stage of esophageal cancer for everyone. There are 5 stages and doctors often describe the type of cancer by its grade. The grade describes how much cancer cells look like healthy cells when viewed under the microscope. If esophageal cancer looks like healthy tissue and contains different cell grouping, then it is called “differentiated”. If the esophageal cancer cells look different from healthy tissue, it is called “poorly differentiated”.
The cancer is found in the top lining of the esophagus. It has not spread to deep layers and has not spread to any lymph nodes or distant organs.
The cancer grade does not apply and can be located anywhere in the esophagus.
Stage IA – The cancer is in the top layers of the esophagus. Cancer has not spread to any lymph nodes or distant organs.
The cancer is in grade 1 or in an unknown grade and located anywhere in the esophagus.
Stage IB – Cancer can be in either condition:
- The cancer is in the top layers of the esophagus, but the cancer cells are less differentiated.
- The cancer is in the third layer of the esophagus but has not spread to the lymph nodes or other parts of the body.
Cancer can be in any grade or an unknown grade and located anywhere in the esophagus.
Stage IIA – It can be any of these conditions:
- The cancer is in the third layer of the esophagus and has spread into the thick muscle layer of the esophagus.
- The cancer is in the outer layer of the middle or upper part of the esophagus.
- The cancer is in the outer layer of the lower part of the esophagus.
Cancer might be in grade 2 or 3 and located anywhere in the esophagus.
Stage IIB – It can be any of the below conditions:
- The cancer cells are in the outer layer of the upper or middle part of the esophagus. The cancer cells are less differentiated.
- The cancer cells are in the outer layer of any part of the esophagus.
- The cancer cells have spread into the lining of the esophagus and below layers.
Cancer can be in grades 2-3 or any grade and located anywhere in the esophagus.
Stage IIIA – It can be any of the below conditions:
- Cancer has spread into the lining of the esophagus and below layers. Cancer has spread to 3 to 6 lymph nodes near the tumor.
- The tumor has developed into the third layer of the esophagus and has spread to 1 or 2 lymph nodes.
- Cancer has scattered outside the esophagus to nearby tissues and but has not spread to lymph nodes or any other parts of the body.
Cancer can be in any grade and located anywhere in the esophagus.
Stage IIIB – It can be any of these conditions:
- Cancer has grown into the third layer of the esophagus and has spread to 3 to 6 lymph nodes.
- Cancer has developed into the outer layer of the esophagus and has spread to either 1 to 2 or 3 to 6 lymph nodes.
- Cancer has spread to structures surrounding the esophagus and has spread to either no nodes or 1 to 2 lymph nodes.
Cancer can be of any grade and located anywhere in the esophagus. It has not scattered to distant organs.
Stage IVA – It can be either of these conditions:
- Cancer has spread to nearby structures and may have spread to 3 to 6 lymph nodes.
- Cancer has stretched to 7 or more lymph nodes.
It can be located anywhere in the esophagus.
Stage IVB – Cancer has scattered to other parts of the body such as the liver and lungs.
Cancer can be of any grade and located anywhere in the esophagus.
The cancer is found in the top lining of the esophagus. It has not started to grow in the deep layers. The cancer grade does not apply.
Stage IA – The tumor has spread into the lining of the esophagus and underneath layers.
It has not scattered to distant organs or lymph nodes.
Stage IB – Cancer can meet either of the below conditions:
- Cancer has spread below the lining of the esophagus. The cancer cells are moderately differentiated.
- The tumor has grown into the layers of the esophagus called the submucosa.
Cancer can be of grade 1 or 2 or an unknown grade.
Stage IC – Cancer can meet either of the below conditions:
- The tumor has grown below the lining of the esophagus or the submucosa. The cancer cells are poorly differentiated here.
- Cancer has expanded into the third layer of the esophagus and is well or moderately differentiated.
Cancer can be grade 1, 2 or 3.
Stage IIA – cancer cells are in the third layer of the esophagus. They can be grade 3 or unknown grade.
Stage IIB – It can be either of these conditions:
- The tumor has spread to the outer layer of the esophagus.
- Cancer is in the inner layer or esophagus and has spread to 1 or 2 lymph nodes.
Stage IIIA – It can be either of these conditions:
- Cancer is in the inner layers of the esophagus and has stretched to 3 to 6 lymph nodes.
- Cancer is in the third layer of the esophagus and has stretched to 1 or 2 lymph nodes.
Stage IIIB – It can be any of these conditions:
- Cancer is in the third layer of the esophagus and has stretched to 3 to 6 lymph nodes.
- Cancer is in the surface layer of the esophagus and has spread to either 1 to 2 or 3 to 6 lymph nodes.
- Cancer has scattered to structures near the esophagus and either no lymph nodes or 1 or 2 lymph nodes.
Stage IVA -It can be either of the below conditions:
- Cancer has scattered to structures near the esophagus and either no lymph nodes or 3 to 6 lymph nodes.
- Cancer has stretched to 7 or more lymph nodes.
Stage IVB – Tumor has spread to other parts of the body such as the liver and lungs. Cancer can be any grade.
Doctors consider that irritation in the esophageal cells develop cancer and some habits that can cause irritation include:
- Alcohol consumption
- Being overweight
- Not having enough fruits and vegetables
- Having achalasia, where the muscle at the bottom of the esophagus does not relax properly
This is the first test done when people have trouble swallowing. Series of X-rays are taken after you swallow barium, a thick liquid that shows up on X-rays. It helps doctors to identify a certain problem in your esophagus.
In this test, the doctor passes an endoscope, a thin light tube, puts it in your mouth, and passes it down into your esophagus and stomach. Endoscopy ultrasound helps to provide more information about the extent of the tumor in nearby tissues.
In this test, the doctor takes out a small piece of tissue from the esophagus. The cells are examined under a microscope for any cancer cells. It is more often done during endoscopy.
It is an X-ray in which pictures show where the cancer cells are in the esophagus and if it has spread.
It uses radio waves and magnets instead of X-rays to take more detailed pictures. It may be used to check if nearby lymph nodes are swollen, which might mean that it is cancer.
It uses sugar that can be seen inside your body with the help of a special camera. If there occurs to be cancer, then the sugar will show up as hot spots where the cancer is found. It can help to find if cancer has spread.
There are many ways to treat Esophageal Cancer that include:
Esophageal Cancer surgery is used to remove all the cancer cells when the cancer is small and hasn’t spread. Your doctor can remove the cancer cells using an invasive approach, using an endoscope and several small incisions.
The side effects of surgery include pain, bleeding, lung complications, problem swallowing, nausea, heartburn, and infection.
It uses radiation beams to kill cancer cells. It can be administered externally (with the help of a machine) or internally (with the help of a device placed near the tumor called brachytherapy).
It can also be used to help with symptoms like pain, bleeding, trouble swallowing that happen if cancer has grown very large and has spread to other parts of the body. It is often combined with chemotherapy.
Side effects are severe with combined treatment that include fatigue, nausea, vomiting, painful sores in the mouth and throat.
Chemotherapy for Esophageal Cancer involves the use of drugs to kill cancer cells. It may be used before or after surgery. The drugs can be given in vein or taken as pills.
It is given in cycles and each cycle is followed by a break that gives the body time to recover. Treatment often lasts for many months. It is often given with radiation therapy.
Side effects can include hair loss, nausea, vomiting, fatigue, pain but the problem will go away after the treatment ends.
It is a treatment that boosts your immune system to attack the cancer cells. These drugs may be given into the vein.
Side effects may include fatigue, rashes, stomach sickness and these will go away after the treatment ends.
This therapy targets specific proteins on cancer cells to treat cancer. These affect mainly the cancer cells and not the normal cells in the body.
The Esophageal Cancer treatment cost in India can range anywhere between $3000-$5000 depending upon the quality of treatment and hospitals.
Esophageal Cancer is aggressive cancer with a low survival rate worldwide. Hence chances of successful treatment are better when caught at an early stage. Therefore, it is important to see a doctor when a person suspects esophageal cancer.
Frequently Asked Questions and patient concerns:
Is Esophageal Cancer curable?
Esophageal cancer is aggressive cancer and in most cases is a treatable disease though cure rates are low. It depends on several factors like the stage of cancer and the overall health of the patient. People with early-stage disease have a better chance of survival.
Is Esophageal cancer hereditary?
It happens in a person’s lifetime and is not passed on to their children. Hence it is not inherited but acquired during a person’s life.
Do you feel ill with esophageal cancer?
It might be hard to spot at an early stage but once cancer progresses, it affects your digestion such as having a problem swallowing.
What age does esophageal cancer occur?
It is most often diagnosed at the age of 50 and above and is more common in men than women.
How fast does esophageal cancer progress?
It grows slowly for many years and once the symptoms develop can progress rapidly.
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