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Oesophagus Cancer

What is Oesophagus Cancer?

Anatomy The oesophagus is a hollow, muscular tube connecting the throat and the stomach and lies right behind the trachea and in front of the spine. Usually 10 to 13 inches long, food and liquids consumed travel through the oesophagus (lumen) to go to the stomach.

Oesophagus cancer or oesophageal cancer or cancer of the oesophagus occurs in three portions: cervical area, thoracic area and the LE/GE Junction (lower oesophageal / gastroesophageal junction). Invariably high thoracic and cervical tumours are squamous cell carcinomas while the distal LE / GE junction tumours are adenocarcinomas. SCC or Squamous cell carcinomas account for more than 90% of the cancers worldwide. Adenocarcinomas are a more common occurrence in the developed countries.

Causes

  • The oesophageal mucosa can come in contact with noxious stimuli leading to dysplasia and subsequent carcinoma
  • The most common contributing factor to oesophagus cancer is the over-exposure to smoking and alcohol, which promotes squamous cell carcinoma
  • Nutritional and vitamin (riboflavin) deficiencies are also factors causing oesophageal cancer
  • Caustic injuries
  • Nitrosamines in the soil can be environmental contributors to oesophageal cancer
  • Consumption of foodstuffs such as betel nut
  • Scalding liquids
  • Fungi and yeasts
  • Acquired achalasia
  • Multiple gene loci
  • Genetic disorder tylosis Palmaris et plantaris
  • Plummer-Vinson syndrome increases the risk of oesophageal cancer
  • Biphosphonate causes oesophagitis linking it to the formation of cancer
  • HPV or human papillomavirus infections
  • Adenocarcinoma
  • GERD

Signs and Symptoms

  • Dysphagia or difficulty in swallowing graduating from solids to liquids
  • Epigastric pain
  • Pain in the bone in case of metastatic disease
  • Cough
  • Weight loss (a very common symptom)
  • Hoarseness
  • Bleeding

Diagnosis

  • Primary method of diagnosis is flexible endoscopy with biopsy
  • CT of chest and abdomen for early-stage oesophageal cancer – this is predominantly done for staging the cancer
  • PET (positron emission tomography) scan is done for staging locoregionalized cancer
  • Endoscopic ultrasonography for accuracy of staging; for patients where the cancer is limited to the mucosa and the submucosa with small nodules
  • Laparoscopy and thoracoscopy for patients with advanced T3-T4 adenocarcinoma
  • Bronchoscopy for middle and upper thoracic oesophagus
  • Barium swallow is done to detect strictures and intraluminal masses
  • On physical examination, hepatomegaly and lymphadenopathy in the supraclavicular area is noticed

Treatment and Medication

It is essential to stage oesophageal cancer before assessing the treatment modality. A stage-IV oesophageal cancer is treated with supportive and symptomatic care. Chemotherapy for squamous cell carcinoma will include cisplatin. Other regimens used are:

  • antimetabolite agents such as Adrucil and Xeloda
  • alkylating agents Cisplatin, Carboplatin, and Eloxatin
  • antimicrotubular agents Docefrez, Taxotere, and Paclitaxel
  • Topoisomerase inhibitors like Camptosar
  • Miscellaneous antineoplastics such as Photofrin

Dr. Deepak can effectively diagnose and stage oesophageal cancer to provide the right treatment at the right time.

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