Esophageal cancer is cancer that develops in the esophagus, where food goes down. The cause of esophageal cancer is not yet clear, but it is presumed to be the cause of continuous inflammation in the esophagus. Alcohol and tobacco are the main factors that cause esophageal inflammation. The habit of drinking hot food and beverages also increases the risk of esophageal cancer. The World Health Organization (WHO) has also designated beverages hot above 65 degrees Celsius as carcinogens.
Definition of esophageal cancer
Esophageal cancer is cancer that develops in the esophagus. It can be divided into squamous cell carcinoma, adenocarcinoma, leiomyosarcoma, rhabdomyosarcoma, lymphoma, and melanoma depending on the tissue type. In Asia, squamous cell carcinoma accounts for more than 90%, and adenocarcinoma accounts for 2.5%. In the West, on the other hand, the rate of adenocarcinoma is higher.
Causes of esophageal cancer
The cause of esophageal cancer is still not clearly known. However, like other digestive cancers, genetic and environmental factors are thought to act in a complex way. Among esophageal cancers, squamous cell carcinoma is closely related to smoking and alcohol consumption. Smoking increases your risk of developing esophageal cancer by 5-6 times. It is known that drinking and smoking at the same time have a much greater effect. It is known that adenocarcinoma, which occurs mainly in the West, is closely related to gastroesophageal reflux. The habit of drinking hot drinks frequently is also known to increase the risk of esophageal cancer.
Symptoms of esophageal cancer
Just as most digestive cancers have no symptoms by themselves, esophageal cancer is often asymptomatic in its early stages. Because the esophagus is a passageway through which food passes, if esophageal cancer progresses, pain or difficulty swallowing may occur when swallowing food. In addition, as esophageal cancer progresses, food cannot go down and reflux causes coughing and aspiration pneumonia. In addition to the symptoms of the esophagus itself, hoarseness and aspiration of food can occur when cancer invades the nerve endings around the esophagus to the vocal cords. Involvement of the spine can cause back pain. If the respiratory system is invaded, symptoms such as coughing and hemoptysis may occur.
Esophageal cancer screening methods
The most basic and accurate examination is gastroesophageal endoscopy. By inserting an endoscope into the esophagus through the mouth, the lesion of the esophagus can be directly observed and a biopsy can be performed. They can also examine the stomach down to the esophagus to help guide treatment. In addition to endoscopy, esophageal ultrasound endoscopy uses ultrasound on the wall of the esophagus to determine the depth of invasion of esophageal cancer and whether it has invaded the surrounding lymph nodes.
A bronchoscopy helps determine whether esophageal cancer has invaded the trachea or bronchi by inserting the endoscope through the breathing airway rather than the esophagus.
Computed tomography (CT) of the chest and abdomen helps to determine the location of the esophageal cancer, whether it has invaded nearby organs, whether it has metastasized to lymph nodes, and whether it has spread to other organs, thereby establishing a treatment plan. Positron emission tomography (PET CT) is useful for detecting lymph node or distant metastases that have not been identified by other tests.
Esophageal cancer treatment methods
Treatment for esophageal cancer includes surgery, radiation therapy, and chemotherapy.
For most gastrointestinal cancers, if complete resection is possible, surgical removal is the standard treatment. However, due to the nature of the esophagus located within the ribcage, intra-abdominal and intra-thoracic surgery are required at the same time as the digestive organs in the abdominal cavity are mainly used as an alternative tissue. Middle and upper esophageal cancer require surgery through an incision in the neck. Since the scope of surgery is large, various side effects may occur after surgery, and there are mainly elderly patients, surgery for esophageal cancer should be carefully decided.
In the case of esophageal cancer in its early stages, it can be treated through surgery if complete resection through surgery is possible because it does not invade surrounding tissues and metastases to the lymph nodes are not severe. If complete resection by surgery is impossible due to invasion of surrounding organs, esophageal cancer can be treated with chemotherapy, radiation therapy, or chemotherapy. After these treatments, esophageal cancer may be re-evaluated and surgery may be considered. Even esophageal cancer that cannot be completely resected before these treatments can be completely resected if its size decreases after treatment.
Esophageal cancer post-surgery management
The most uncomfortable thing for patients after esophageal cancer surgery is eating. Among them, most patients complain of discomfort about the amount of food and reflux. Esophageal cancer surgery uses the stomach as a replacement for the esophagus, so the stomach loses its ability to store food. It also lacks an esophageal sphincter to prevent reflux, which makes reflux more likely. In order to prevent this, it is important to eat small, slow, frequent meals. It is also recommended not to lie down immediately after eating, nor to eat or drink before going to bed.
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