April celebrates Esophageal Cancer Awareness Month, one of the rarer – but still dangerous – cancers, and the sixth leading cause of cancer deaths globally. But what is esophageal cancer? What are its symptoms, and what can you do to prevent it?
What is it?
Esophageal cancer begins in the esophagus (alternately spelt oesophagus), which is a tube of muscle connecting the mouth to the stomach. It’s the tube in your throat that carries food to your gut for digestion. In esophageal cancer, the cells that line the tube mutate, or start to multiply abnormally, forming tumours and causing cancer.
Adenocarcinoma is the more common form of the cancer, occurring in the mucus-forming cells of the esophagus. These cells are responsible for producing the mucus that traps bacteria, dust, and other infections, and is a part of immune defence.
Squamous cell carcinomas occur in outer cells of the esophagus, which are thinner and flatter. It is a somewhat rarer form of the cancer, and can link to different risk factors.
Like many other cancers, esophageal cancers occurs in stages. There are three main factors that determine the severity: the size of the tumour (T), where the cancer has spread to the lymph nodes (N), and whether the cancer has spread to other organs, or metastasis (M). After diagnostic tests, the doctor assigns a number 0-4 for each category to understand how severe the cancer is. The earliest stage, Stage I, involves a small tumour localised within the esophagus. The latest stage, Stage IV, involves a large tumour that has spread beyond the esophagus to organs such as the liver, and may affect lymph nodes.
Am I at risk?
There are risk factors correlated to esophageal cancer; some of them overlap with other cancers, especially mouth, stomach, and gut cancers. Here are some of the most recognised ones:
- Sex. More men than women develop esophageal cancer, so you may be more at risk as a man.
- Age. The cancer more commonly occurs as you get older. Those under 45 are less likely to develop esophageal cancer, and those above 75 are at a considerably higher risk.
- GERD. Gastroesophageal reflux disease, also known as chronic acid reflux, can also have an impact. GERD is not known to cause hereditary cancer, but it can affect the growth of the esophagal cells.
- Barrett’s esophagus. The condition can affect the cells lining the esophagus, and is caused by acid reflux. GERD and Barrett’s esophagus often go hand in hand.
- Achalasia. A disorder of the esophageal sphincter, it can not only affect your swallowing, but can also increase your risk of cancer.
- Smoking. Quitting can reduce your risk massively, though not smoking at all keeps you at a lower risk overall than those who have smoked before. Second-hand smoke can also increase your chances of developing the cancer.
- Alcohol consumption. Overconsuming alcohol has many health detriments, one of which is an increased risk of esophageal cancer. For women, the recommended daily consumption is 1 glass of red wine per day, while for men, it is 2 glasses.
- Obesity. Being obese, or even overweight, can increase your chances of developing esophageal cancer.
- Lifestyle. A sedentary lifestyle and unhealthy eating can also increase your chances. Too much fat or not enough fruits and vegetables, as well as limited physical activity, are key risks.
What can I do to prevent it?
Target each risk factor individually. Some, like sex and age, are not preventable, but others are.
- Avoid smoking.
- Regulate your alcohol consumption.
- Consume a balanced diet, with enough fruits and vegetables, and limited fats and sugar.
- Maintain your weight and exercise regularly.
- Talk to a doctor about other preexisting conditions you may have.
What are the symptoms?
Symptoms may not be present early on, but the first one recognisable is usually dysphagia. Though it may start small, with a small tumour, it can progress as the tumour grows to a sensation of choking and can affect your ability to drink liquids. If you notice multiple of the following symptoms on a regular basis, it’s a good idea to contact your GP about the possibility of cancer.
- Dysphagia (difficulty swallowing)
- Weight loss
- Pain or discomfort in the chest area
- Hoarse throat/voice
- Chronic coughing
- Chronic pneumonia
- Gastroesophageal pain
How do I get diagnosed?
There are a lot of techniques the doctor may use to complete a thorough evaluation of the esophagus. The diagnostic methods used often depend on your health and symptoms. Some of the common diagnostic methods include:
- Gastroscopy. This is a form of endoscopy where the doctor uses a thin tube with a camera on one end to observe the inside of the esophagus. A sample of cells may be taken to use in a biopsy later.
- Biopsy. The doctor collects cells from the esophagus to observe under a microscope in a lab to check for any mutations or abnormalities. This is the most thorough form of testing and is usually used to draw final conclusions.
- Barium swallow study. You may be asked to ingest a liquid containing barium, which covers the esophagus. Then, in an X-ray, the doctor can examine the esophageal tissue and any abnormalities that may be present.
- Ultrasound, PET, MRI and CT scans. Since the cancer may have spread to the rest of the body, imaging tests can be used to determine its extent. It’s important to detect non-localised cancers before they cause further damage.
How can I get treated?
Since treatments are developing every day, and at the moment, there are many available to treat patients based on their current health conditions and cancer stage. A combination treatment plan will be created and personalised for you by your healthcare team.
Surgery is a common treatment for localised tumours, and can reduce the chances of recurrence. For small tumours, an endoscope can cut away only the cancerous cells. For larger tumours, an esophagectomy is carried out, which cuts away a surrounding area of the esophagus alongside the tumour. If the tumour has spread to the stomach and/or the lymph nodes, but is still localised within the area, an esophagogastrectomy removes parts of the esophagus, surrounding lymph nodes, and upper parts of the stomach as well.
If you have other health conditions that make surgery risky, are an older patient, or your doctor feels surgery is otherwise not a viable option, there are alternatives. Chemotherapy uses chemicals to target the tumour cells, while radiotherapy uses beams of radiation. Both these methods can also be used to treat recurring or non-localised cancer. Supplementary treatments like immunotherapy can support your immune system, which may be weakened by the cancer.
Cancer diagnosis can be difficult, so make sure you have a strong support system of friends, family, and doctors to help you through it. Keep your symptoms monitored and stay on track with your treatments.
Wear a light purple ribbon in solidarity of esophageal cancer patients this month, and spend time learning more about it, sharing reliable information with others, and supporting patients and survivors. You can also donate to cancer charities and funds in India and around the world. More information about esophageal and other cancers is available on www.cancerx.co.in.
Get an expert opinion on your cancer diagnosis now! Visit www.cancerx.co.in/medical_query/.