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