Esophageal Cancer: Treatment, Procedure, Cost and Side Effects

The esophagus is a muscular tube connecting the throat with the stomach. It is a connecting tube placed behind the windpipe. It helps to swallow the food from the throat to stomach. Cancer in this esophagus or pharynx is known as Esophageal cancer. This cancer emerges basically in the cells inside the esophagus.

It is a disease where the tissues of the tube-like structure that connects the throat to the stomach become malignant . It may be generally termed ""esophagus cancer"" or more specifically termed in relation to their location and type such as ""gastroesophageal junction adenocarcinoma"" . Depending upon the type of cancerous cell formed, this cancer is classified as mentioned below:

• Adenocarcinoma – In this cancer, the lower third region of esophagus is affected which is made up of glandular cells.
• Squamous Cell Carcinoma – In this cancer, a thin, inner layer made up of squamous cells of esophagus are affected by cancerous cells found commonly in middle third of the esophagus.

There are stages of esophagus starting from 0 and ending at IV described as invasive to most aggressive

A person suffering from Esophageal Cancer has numerous symptoms and signs. Though there are some common set of symptoms that the majority of people diagnosed with Esophageal Cancer have. Such as the sense of pain in throat while eating or drinking due to swelling in the tube, Chest & heart burning, Coughing, Indigestion, weight loss and Vomiting.

Very common signs of esophagus cancer are difficulty in swallowing food by person. In some cases, the tumors of this cancer spread across the nearby surrounding parts before its detection. A term used as dysphagia that means abnormal condition for swallowing solid foods and at higher stages of such cancer types, person found difficulty in swallowing liquids or other forms of liquids.

People experiences heartburn, indigestion like gastrointestinal problems related to gastroesophageal reflux in the upper abdomen region. As person is not able to swallow food, there are symptoms of unexplained weight loss and iron-deficiency anemia.

Patients are also passing black tarry stool and blood in vomiting which is not visible with naked eyes. At primary stages, medical professionals cannot detect the formation of tumors in esophagus region because of presence of esophagus is in chest cavity not easily viewable through physical examinations. Hoarseness and cough are also considered as noticeable signs as the vocal cords are also damaged due to reflux of acid in the throat region.

There are basically two types of Esophageal Cancers, Adenocarcinoma and squamous cell carcinoma.

• Adenocarcinoma occurs by the formation of granular cells, which grow in the lower part of the esophagus. It happens due to a condition known as Barrett’s esophagus.
• In squamous cell carcinoma, the cells inside the esophagus start growing disorderly. This growth occurs mainly due to frequent drinking and smoking.

It arises due to some mutations in the DNA. these mutations cause uncontrollable cell growth and disordered cell divisions. Then by there accumulation, a tumour forms that grow in a manner to chock out the throat.

Any form of esophagus carcinoma having a common cause smoking behind their occurrences. Squamous cell carcinoma is caused when alcohol and tobacco products are used together because these agents are damaging the DNA of cells present in line of esophagus. Adenocarcinoma is occurring in people suffering from gastroesophageal reflux condition because stomach acid is coming back to lower esophagus and damaging the cells and causing inflammation.

Some chromosomal or gene abnormalities and motility disease like Achalasia are also considered as factors behind the occurrence of esophageal cancer. Barrett’s esophagus is a condition containing presence of precancerous cells in esophagus is also a cause behind this type of cancer. Repeated radiation treatment for chest or upper abdomen, bile reflux, obesity, habit of consuming hot fluids and not fruits and vegetables are factors for such conditions.

It mainly has 3 stages depending on the 3 major pieces of information:

• Stage 1: The expansion of the tumour: In this stage, the maximum growth of the tumour reaches to nearby organs.
• Stage 2: lymph nodes get affected: In this stage, the growth extends to the nearest lymph nodes.
• Stage 3: Growth spreads to distant sites: In this stage, the tumour reaches distant organs such as the liver or lungs.

In screening of esophagus cancer, no specific tests or procedures are defined but some routine screening tests such as esophagoscopy, biopsy, brush cytology, balloon cytology, chromo endoscopy, fluorescence spectroscopy are performed. Some other testing methods are used in identification of esophagus cancer are endoscopic ultrasound, an X-ray imaging test , a CT scan and Positron emission tomography scan or MRI. These tests and scans works as detection tools for esophagus cancer and information collected from them can give idea to doctor in assigning proper treatment plans as per stage of cancer.

• Endoscopy: In this esophagus gets examined by using the scope. The doctor inserts a flexible tube containing a video lens in the throat and looks for the area of irritation.
• Biopsy: In this test also a scope is inserted in the throat to collect a sample of tissues that the doctor founds questionable. The sample is then forwarded to the laboratory to identify the cancer cells.

The approach of treating patient suffering from esophagus cancer varies because it depends on the type of cancer as well as the level or stage of cancer and health of patient. The diagnosis of cancer generally happened after the tumor has grown in bigger size and spreaded potentially. Many cases have followed treatment of removal of tumor as it has not expanded to other parts of body while other treatments shrink the tumor in esophagus. Following are some treatment recommended to this type of cancers:

• Surgery- In this method, removal or tumor or removal of affected portion of esophagus along with lymph nodes is done and the tube is reconstructed with tissue of stomach or small intestine.
• Chemotherapy and radiation – In this method, the tumor gets shrunken by exposure to drugs or external beam radiation. Some healthy cells surrounded by the affected portion also get damaged or shrunken and patient may feel certain side effects like hair loss, nausea, vomiting, pain, neuropathy etc.
• Targeted therapy- This treatment plan carries cancer-fighting medications that are targeted towards inhibiting tumor growth.
• Other treatments - Photo-dynamic therapy and endoscopic therapy are other treatments worked towards the esophagus cancer.

It is a treatable disease though in most of the cases it is rarely curable. It was found that only 5% to 30% of patient survive up to 5 years after diagnosing Esophageal Cancer that too if they are responsive to the treatments. The patients diagnosed in a very early stage has much more chance to survive.

The treatment also comes with some side effects, though the chances of having these side effects are less. Some of them are listed as:

• Surgeries performed for treating Esophageal Cancer may cause a blood clot in the brain or the lungs and a heart attack during or after their procedure.
• There is a risk of infection in the surgery can cause complications in the lung.
• Radiation therapy involves side effects such as painful sores in the throat and mouth, diarrhoea, vomiting, skin changes, nausea, dry mouth or thick saliva and fatigue.

There are majorly 4 sessions of treatment process segregated according to the severity of the disease.

• Session I: Chemoradiation therapy is performed before the surgery
• Session II: Chemoradiation and Chemotherapy therapy is performed before the surgery
• Session III: Chemoradiation and Chemotherapy therapy is performed before the surgery and Chemoradiation therapy is performed alone as well.
• Session IV: Chemoradiation & Chemotherapy therapy is performed before laser surgery and Stent insertion along with Clinical trials of the chemotherapy.

For curing it naturally, one should follow some steps mentioned below:

• Maintain a healthy weight- diet with high calories should be consumed and a small or frequent meals in short time period can also help to maintain healthy weight
• Selection of food – Swelling in esophagus area forms difficulties in chewing and passing food from throat to stomach. So it is advised to select such form or types of food that are easy to swallow and chewable.
• Intake of protein rich food and whole grains
• Selection of good source of healthy fat and variety of fruits and vegetables daily.
• Drink plenty of water and care about mouth.
• Avoid sugary or sweet items.

Cancer and its various treatments often have various side effects that need monitoring and relieving the person of the side effects. This type of support is termed as palliative care where patient’s emotional, social and physical needs are taken care of. It includes betterment of life and providing support to patients and their families. It may be started as early as the cancerous cells are detected or after the surgical removal of the tumor. The palliative care includes medication, nutritional changes, relaxation methods and other therapies. Therefore, palliative care is a very important part of the overall recovery of a cancer patient.

Recovery time depends upon various factors including- type of esophageal cancer, a person's health conditions, the stage at which cancer is at and the type of treatment the person is undergoing. The treatment may last up to four to six weeks but the palliative care may extend for many years.

Cancer is a costly affair. People suffering from it can incur costs between Rs. 305,922 to Rs.5 or 6,00,000. The treatment cost can go on increasing depending upon the hospital you are admitted to and the type of treatment you are going for.

The treatment of cancer does not have a permanent solution. If the cancer is detected early, then there are chances of it not returning. However, cancer might recur even after the surgery and the associated chemotherapy and radiation therapy.

Gastroesophageal reflux disease leads to occurrence of Barrett’s esophagus and esophagus cancer. Chances of GERD can be avoided to prevent heartburn that is possible by avoiding common culprits like tomatoes, citrus fruits, chocolate, onions, spicy foods, fried and fatty items, alcohol and carbonated drink etc. Some natural foods that help in prevention of esophagus cancer are known as cancer-fighting foods described as follow:

• Colourful fruits and vegetables – Cruciferous group of vegetables like cauliflower, broccoli, cabbage, all green and yellow fruits intake of at least five serving in daily diet can minimise chances of such cancer.
• Tea – With property of full of antioxidants, a cup of green tea or black tea daily can prevent cancer.

• Black raspberries – A content as ellagic acid is present in black raspberries and it protects against inflammation, a cause of it.