Cancer of the esophagus is a frequent form of malignant tumors (5-7%), appearing more frequently in men, mainly in mature and old age. Most often, cancer affects the lower and middle esophagus.
Causes
The external factors contributing to the development of esophageal cancer, include unhealthy diet:
Noticed the role of geographical factors. The frequency of carcinoma is much higher in some areas of China, Iran, Central Asia, which is believed to be due to the inclusion in the diet of large quantities of pickled foods, nitrosamines, fungi, very hot food (tea) and a reduced content of selenium in the diet, fresh fruit and vegetables.
Risk of disease rises with a deficit of vitamins, especially A and C.
Smoking increases the risk of disease by 2-4 times. Abuse of alcohol – up to 12 times.
The probability of occurrence of esophageal cancer increases with alkali burns (even many years after exposure).
Precancerous lesions can be considered as diseases such as achalasia of the esophagus, Barrett’s esophagus (risk of subsequent development of carcinoma – 10%).
Clinical picture
Common nonspecific symptoms, and unnerving for malignant disease:
The clinical picture of cancer of the esophagus rather bright. The first complaint the patient – the feeling of difficulty passing the solid food the esophagus. This symptom (dysphagia) are first expressed slightly, so the patients and doctors do not give it due importance, attributing his appearance at the expense of injured esophageal mucosa rough lump of food or bone.
Because of difficulty passing food along the esophagus, patients avoid solid food, resorting to worn-, promolotoy food, then have to be limited only liquid products – tea, milk, broth. Often associated vomiting.Sometimes dysphagia comes to such an extent that the patient can not swallow even saliva. It starts with a progressive weight loss, often reaching up to exhaustion (cachexia).
In the development of the disease, during germination of tumor beyond the esophagus may occur retrosternal pain, sometimes fiery character. Sometimes changes in voice frequency.
In the decay of a tumor may develop complications:
All of the described complications require immediate medical intervention!
Diagnosis
The presence of previously submitted symptoms may come across you or your doctor to conduct the necessary research.
Instrumental
X-rays and EGDS with biopsy – the main methods of diagnosis of cancer of the esophagus. When combined gastroscopy and biopsy of the probability of a correct and timely diagnosis, even at an early stage of esophageal cancer is 95%.
To determine the prevalence of the tumor process, lymph nodes, detection of possible distant metastases applied CT (computed tomography), MRI (magnetic resonance therapy).
To assess the possibility of germination of tumors of the esophagus into the trachea or bronchus in the presence of suspicion performed bronchoscopy.
In complex cases can be applied mediastinoskopii (study periesophageal space by means of an endoscope.
Also in terms of comprehensive examination and to detect metastases shows an overview chest radiograph, liver ultrasound, isotope studies of bones of the skeleton. It should be remembered that the identification of any, even malignant disease at an early stage improves the forecast of the forthcoming treatment.
Treatment
Treatment of cancer of the esophagus is carried out surgically, radiotherapy and combined method (a combination of surgical and radiation treatment method).
Chemotherapy as an independent method of treatment is ineffective. The method of treatment depends on the prevalence of the tumor and its localization.
Any damage to the lower and middle third of the esophagus is used surgical treatment (followed by radiotherapy and chemotherapy if indicated). With the spread of surgical treatment and the inability to use radiation therapy as an independent method.
Any damage to the upper third of the esophagus in the main resort to radiotherapy.
Surgical treatment of esophageal cancer is to remove the esophagus (there are various modifications of surgical treatment) with subsequent grafting of gastric or intestinal (intestinal or colonic) tube.
To improve the results of surgical treatment after the surgery is performed chemotherapy or radiotherapy.
If you can not be degraded in the process of surgical treatment and a high degree of dysphagia, the patient can not eat, in order to impose a gastrostomy feeding – under local anesthesia stomach sutured to the anterior abdominal wall and enter it in the tube for feeding.
Metastasis
Esophageal cancer metastasizing to the mediastinal lymph nodes, with distant metastasis affects the liver (20%), lung (10%), skeletal system, brain.
Forecast
Forecast as of other sites of cancer depends on tumor incidence and presence of metastases, the patient’s age. Each case should be considered separately.
Prevention
The basis of prevention of all forms of cancer (including cancer of the esophagus) is the timely detection and treatment of precancerous lesions (in this case – achalasia of the esophagus, Barrett’s esophagus) as well as identify cancer early, which makes it possible to conduct a successful radical treatment.
All this is achieved in a timely passage of preventive examinations, attentive attitude towards their health.
Also advisable to give up bad habits and to normalize food.
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