esophagus is a muscular tube connecting the oral cavity
to the stomach. It is made up of muscle tissue of various
types, and actively propels food to the stomach when functioning
properly. It is about 10 inches (25cm) in length and lies
in the chest cavity between the trachea (windpipe) and
spinal column. The muscular layers of the esophagus are
covered by specialized protective cells known as epithelial
cells that are replenished, when necessary, to keep the
body and digestive tract healthy.
there are many types of cancer, they all share common
characteristics that allow doctors to group them together
when discussing general characteristics. Generally, normal
cells become abnormal, dividing too often and are unable
to regulate their growth the way normal cells can. As
these abnormal cells build up, they begin to form a mass
known as a tumor. Tumors can be classified as benign or
malignant based on their ability to spread and their potential
to be life threatening.
esophageal cancer, while much more common in some parts
of the world, accounts for only about one percent of all
cancers in the United States. This particular type of
cancer tends to be found in patients over 55 years of
age and is twice as likely to be diagnosed in a man than
in a woman. In addition, it is more common in African-Americans
than in white people. While the exact cause of cancer
of the esophagus is not yet known, doctors and researchers
have identified several risk factors which can significantly
increase the risk of developing esophageal cancer. In
the United States, smoking tobacco and excessive use of
alcohol can put one at increased risk for developing esophageal
cancer. Heavy smokers who drink alcohol excessively are
much more likely than the general population to be diagnosed
with esophageal cancer. Reduction or cessation of these
harmful activities reduces the risk of getting esophageal
cancer and can also decrease your chance of developing
other cancers and problems of the respiratory and digestive
Chronic irritation of the lower esophagus is also a risk
factor for the development of cancer of the esophagus.
When the lower esophagus is repeatedly exposed to the
harmful acidic contents of the stomach (gastroesophageal
reflux), the cells are transformed to better withstand
these harsh conditions. A change in the esophageal lining
known as Barrett's esophagus puts a person at risk for
developing a cancer in this area. Diagnosis and control
of reflux, medically and surgically, can reduce the chances
that Barrett's esophagus will eventually lead to cancer
in this area. Also, irritation from the ingestion of caustic
substances can place patients at increased risk of developing
esophageal cancer for several years after the time of
Many times, esophageal cancer develops in patients with
no clear cut risk factors. When this happens, it is likely
a combination of known and unknown factors which contributes
to the formation of a malignancy. Avoiding known risk
factors, and the maintenance of a well balanced diet and
exercise program is the best means of prevention currently
available. Patients who consider themselves at risk for
the development of cancer of the esophagus should visit
their physician for recommendations regarding evaluation
symptoms of esophageal cancer may be caused by less
serious health problems and only a physician, after
appropriate evaluation, can tell for sure. Early esophageal
tumors which are small in size are not usually symptomatic.
However, as the tumor increases in size, patients begin
to experience difficulty swallowing.
Difficulty swallowing, the most common symptom, worsens
as the tumor enlarges and begins to obstruct the normal
flow of swallowed food. At first, one notices difficulties
with meats, breads and fresh vegetables but as the cancer
progresses, even liquids can become difficult to handle.
problems associated with esophageal cancer are pain
behind the breastbone and frequent, painful bouts of
coughing or hiccups. In addition, weight loss and breath
odor can be signs of an advancing esophageal malignancy.
It should be noted that quite often, people are able
to compensate for early symptoms of esophageal cancer.
For example, avoiding foods that tend to stick may give
patients a way to deal with some of the early problems
associated with a tumor in the esophagus. In addition,
chewing food more completely or drinking more liquids
with meals may be ways of compensating for early symptoms
ofesophageal cancer. Although
symptoms may come and go at first, a patient with recurrent
symptoms such as those described above should consult
with a physician who can suggest appropriate evaluation
help make a diagnosis when symptoms are present, regardless
of the disease, the doctor will take a detailed history
and perform a complete physical exam. In addition to the
basic history and physical examination, the physician
will most likely order a battery of blood tests and radiologic
studies, i.e. x-rays. The tests that are most useful to
doctors are a barium swallow (esophagram) and esophagoscopy.
To perform a barium swallow, patients must drink a liquid
that shows up well on x-ray examinations. By looking at
these films, doctors can determine if the shape of the
esophagus is suspicious for a mass of some kind. Esophagoscopy
is a procedure performed with the patient under intravenous
sedation. A long thin camera is used to view the lining
of the esophagus and take samples (biopsies) of anything
abnormal or suspicious. These biopsies are then studied
carefully by a pathologist who specializes in determining
whether small samples of tissue are normal or abnormal.
Once a diagnosis of cancer is made, the extent of the
disease will help to determine appropriate therapy. This
is known as "stage".
Staging the cancer is an attempt to find out if any other
parts of the body are involved with the cancer and help
guide treatment and also play a role in predicting prognosis.
Often, a CT (CAT) scan is performed to help identify the
extent of the cancer and is very helpful in determining
stage. Occasionally, biopsies of nearby lymph nodes that
look suspicious on x-ray are taken to help stage disease
and allows doctors to administer the most appropriate
cancer is difficult to cure unless it is discovered in
the earlier stages, before it has begun to spread. Unfortunately,
early esophageal cancers are seldom symptomatic and the
disease is usually advanced at the time of diagnosis.
Esophageal cancer is treated with surgery, radiation therapy
or chemotherapy. Doctors may choose different combinations
of these treatments based on the specifics of each case.
Most of the time, surgical treatment involves removal
of the tumor with a portion of the esophagus. There are
several types of incisions that may be used and, usually,
the stomach is used to reconnect the upper esophagus to
the rest of the gastrointestinal tract. Surgeons choose
the type of incision and reconstruction based on what
will offer the patient the best chance for cure. Often,
patients with esophageal cancer have a poor nutritional
status and other medical problems that may limit the procedure
that they will be able to tolerate. All of these factors
are taken into consideration when decisions about surgical
procedures are made by doctors and their patients.
varies with the overall fitness of the patient and is
difficult to predict precisely. However, a minimum of
10-14 days in the hospital should be expected. Patients
typically have tubes placed into their small intestine
with which tube feedings can be given postoperatively
before oral intake is resumed. The anastomosis (hook-up)
at the site of tumor resection is protected by inserting
a tube that travels through the nose and into the stomach
for at least the first week after surgery. In addition,
nothing will be permitted by mouth until after an x-ray
study is performed to be certain that the anastomosis
is intact and water tight. A substantial amount of pain
is present in the immediate postoperative period and is
controlled with narcotic analgesics in most cases. Early
mobilization is critical to an optimal recovery and patients
are pushed to ambulate and sit upright as much as possible
starting 24-48 hours after surgery. Discharge is anticipated
after patients tolerate a soft diet and have demonstrated
the strength necessary to function well enough at home.
Specific discharge instructions are provided by the department
of cardiothoracic surgery.
prognosis is related to how advanced the cancer is at
the time of the diagnosis. Early detection is critical,
and may improve a patient's chances of a favorable outcome.
Do not ignore swallowing difficulties and have any and
all swallowing related problems evaluated by a doctor
ESOPHAGEAL MYOTOMY FOR ACHALASIA
Compares thoracoscopic and laparoscopic myotomy for achalasia.
THERAPY FOR ESOPHAGEAL CANCER
Studies a minimally invasive method of shrinking obstructing
cancers of the esophagus.