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Treatment of esophageal cancer abroad

Esophageal cancer is a malignant formation from epithelial cells of the corresponding organ. It is characterized by the late diagnostics and negative prognosis. Incidence of esophageal cancer mainly depends on the eating habits of the different nationalities representatives.

 

High frequency of this pathology is registered in Japan, France, Brazil, Kazakhstan and accounts from 10 to 30 cases per 100,000 persons a year. Meanwhile, this number is just 2 cases per 100,000 persons a year in Mexico, Israel, and Armenia.

 

Esophageal cancer

 

Causes of esophageal cancer

Various countries and regions significantly differ for the incidence of esophageal cancer. This says about high influence of the external factors on the probability of this pathology.

 

Key risk factors of esophageal cancer are:

  • Thermal influence (too hot or, rarely, too cold food)
  • Chemical influence (alcohol, spices, salt)
  • Mechanical impact (hard and dry food)
  • Male sex
  • Smoking
  • Gastroesophageal reflux (regurgitation of stomach contents in to the esophagus) that is caused not only by digestive tract illnesses, but also by constant over eating at night. Late overeating makes intra-abdominal pressure go higher

 

Chronic esophagitis is considered a basis for the precancerous condition. It is detected among the majority of patients with esophageal cancer.

 

Other precancerous illnesses are:

  • Leukokeratosis
  • Cardiac sphincter failure
  • Ulcers and scarring of the esophagus after thermal burns
  • Benign tumors (adenoma, papilloma)
  • Esophagus diverticula
  • Esophagus achalasia

 

Esophageal cancer symptoms

 

Symptoms of esophageal cancer

Early signs of esophageal cancer are non-specific. Besides, they are weakly expressed, therefore don’t force a patient to have a doctor’s appointment.

 

Symptoms are:

  • Apathy, decreased ability to work, increasing weakness
  • Sensation of burning or scraping in the esophagus
  • Bolus sticks to the organ’s walls

 

A number of patients don’t have any symptoms at the beginning stage. Further, 80% of patients have dysphagy (swallowing disorders), but mostly it is a late sign of esophageal cancer.

 

Dysphagy stages are:

  • Stage 1 is when a patient experiences difficulties while swallowing hard food
  • Stage 2 comes when it is hard to swallow mushy food
  • Stage 3 is means it is hard to swallow liquids
  • Stage 4 is when a complete esophageal obstruction occures

 

Other possible symptoms of the esophageal cancer are:

  • Odynophagia, pain while eating (if tumor has ulcers or existence of the inflammatory process)
  • Esophagus spasms while eating
  • Constant pain not associated with eating, that irradiates between shoulder blades or into the neck
  • Hoarseness, if tumor has invaded into the recurrent nerve
  • Saliva regurgitation (with a significant narrowing of the esophagus)
  • Bad breath (because of breakdown of the food stuck in the esophagus)
  • Nausea and vomiting (if tumor has spread into the stomach)
  • Cough and choking while swallowing (if cancer is located in the upper third of the esophagus)

 

A patient might lose weight at the beginning stage as a result of discomfort while eating as well as at the advanced stages because of cancer cachexia (wasting).

 

Esophageal cancer diagnostics

 

Diagnostics of esophageal cancer

Esophageal cancer is hard to identify on the basis of symptoms only, as it doesn’t have pathognomonic symptoms. Instrumental and laboratory methods are:

  • Chromoesophagoscopy is used for the early diagnostics of esophageal cancer. Its mucous coat is stained with Lugol's iodine solution or methylene blue. Healthy cells accumulate the coloring material and those pathologically changed (cancer, scars, anabrosis) remain the same.
  • Exfoliative cytodiagnosis is assigned to the patients in some regions with high incidence of esophageal cancer. Mucous membrane scraping is taken with the help of special brush for cytological test.
  • Radiography is the first method of the research which is indicated if esophageal cancer is suspected. Radiography is an X-ray with contrasting agent (barium sulfate). It helps to evaluate the esophagus patency.
  • Fibroesophagoscopy is a basic diagnostics techniqueand performed after the X-ray. This is an endoscopic test which presupposes the instrumental intervention into the esophagus. It helps to not only evaluate the tumor location and character of its growth. This way, they also take biological material for the morphological examination.
  • Visualization methods are CT, MRI, transesophageal ultrasound. These techniques are used to assess the spread of the pathological process.
  • Laparoscopy is indicated if tumor process has spread. The procedure helps to detect metastases and to identify tumor foci in the abdomen. Laparoscopy is necessary to identify the desirable volume of surgical intervention and to choose the therapeutic tactics.

 

Esophageal cancer treament abroad

 

Treatment of esophageal cancer abroad

Basic treatment methods of esophageal cancer are surgery and radiation therapy. If cancer is resectable, treatment is started with a surgery. Volume of the intervention is identified by the prevalence of the pathological process.

 

They can use:

  • Subtotal esophageal resection (removal of the organ’s large part)
  • Extirpation of esophagus with lymph nodes

 

Sometimes, specialists perform expanded operations meaning the removal of other organs’ fragments (e.g. stomach). At the same time the esophagus plastic repair is held. To restore an esophagus they use small or large intestine fragments.

 

Esophageal cancer radiation therapy

 

Radiation therapy is indicated in combination with the surgery as well as an independent treatment technique (for weak patients, if tumor is irresectable, a patient refuses to undergo a surgery). Radiation can be distant or contact (brachytherapy).

 

Chemotherapy doesn’t have significant impact of the patients’ survival, if it is used by itself. That’s why it’s only applied as an addition to the basic treatment methods.

 

Targeted therapy is rarely used. It is effective only for acinic cell carcinoma treatment while esophageal cancer is squamous cell cancer in 95% of cases. Targeted therapy effects the cancerous cells but doesn’t touch healthy tissues. The “Herceptin” medicine is applied for acinic cell carcinoma of esophagus treatment.

 

Esophageal cancer prognosis

 

Esophageal cancer - Prognosis

Unfortunately, prognosis is negative for esophageal cancer. Partly it’s associated with the late diagnostics of the pathology (on stage 3 or 4). That’s why only 15% of patients are able to undergo radical surgical treatment.

 

Others are indicated radiation therapy, chemotherapy and also palliative care that improve patients’ life quality, but don’t lengthen it.

 

Five-year survival depending on the prevalence of esophageal cancer is:

  • Tumor doesn’t go out the organ limits – 40%
  • There are regional metastases – 21%
  • Distant metastases are present – 4%

 

Majority of the patients with unresectable tumor die within 12 months if radiation therapy and chemotherapy are applied. If no treatment is applied, then average life expectancy of the patients after diagnosis establishment is 5-6 months.

 

Esophageal cancer treatment

 

Prognosis depends not only on the cancer prevalence, but also on the location of the oncological process. Cancer in the upper third of the esophagus has a least favourable perspective. General five-year survival of the patients doesn’t go over 1%. If cancer is located in the medium or lower third of the esophagus then its number varies from 5 to 15% of patients.

 

Histological type of tumor influences the prognosis. Squamous cell cancer is characterized by the least favourable prognosis than acinic cell carcinoma. One more negative factor is endophytic nature of the tumor when it is growing towards the esophagus wall not into its lumen.

 


 

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