Esophageal Cancer and Its Treatment

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Introduction

Esophageal cancer is cancer of the trachea (esophagus) (Chabner, 2010, p. 41). The trachea is an elongated, void muscular tube that is about ten meters in length. It connects the throat and the stomach. This condition can also be referred to as malignancy of the esophagus. This esophageal cancer mainly starts affecting the inner layer of the tracheal wall and spreads to the outer parts. There are two major types of cancer: Squamous cell carcinoma and Adenocarcinoma (Jobe, Thomas, & Hunter, 2009). The former starts in the squamous cells found in the esophagus. The squamous cell carcinoma affects the upper, middle and lowers parts of the esophagus. The adenocarcinoma begins affecting the glandular tissue located in the lower part of the esophagus.

Esophageal tumors are characterized by dysphagia or difficulty in swallowing, pain and other signs. These are diagnosed with biopsy where body tissues and fluids are checked to investigate the cause of an ailment (Chabner, 2010, p. 76). Small tumors that are also localized can be readily treated surgically while larger tumors are not operable thus they are treated with palliative care. Their persistence can be delayed by chemotherapy or radiotherapy (Chabner, 2010, p. 77) or a combination of the two. In some instances, the two treatments can call for an operation for larger tumors. Prognosis (determination of the cause of) (Chabner, 2010, p. 9) is dependant on two factors which are the extent of the disease and other health problems.

Discussion

Symptoms

The most common symptoms of esophageal cancer are dysphagia (Chabner, 2010, p. 161) and odynophagia. The former is used to mean difficulty in swallowing while the latter means painful swallowing (Ginex, Hanson & Frazzitta, 2005). Most patients experience dysphagia first but Odynophagia may also be present (Jobe et al., 2009). During this time, fluids and soft food can easily be swallowed while hard foods such as meat are difficult to swallow. Pain or a severe burning sensation in the trachea may be experienced everyday and this is worsened when one shallows food. Hoarse coughs may be experienced as a result of the tumor blocking its way.

Tumor may interfere with normal peristalsis (the rhythmic contraction of the alimentary canal muscles that moves food along the digestive system) (Chabner, 2010, p. 152). This may cause the regurgitation of food and vomiting. Due to the nature of the surface of the tumor, bleeding may easily occur. This is due to the fact that people do not have major symptoms until half of the trachea is blocked. At this point the tumor has spread a great deal. Incase the disease has spread to other parts, there may be other symptoms that are related to this disease, a good example is lung metastasis (the rapid spread of cancer into other parts of the body) which may cause suffocation (Chabner, 2010, p. 115).

Causes

The risk factors that are associated with this condition are age where most patients are over 60 years, sex where it is most common in men, heredity where people with close relatives are more likely to contact it, smoking and heavy drinking, and Plummer-Vinson syndrome among others (Ginex at al., 2005). They increase the chances of suffering from this type of cancer. On the other hand, decreased risk is common in individuals who use aspirin or related drugs, consume coffee moderately, consuming foods rich in cruciferous among others. These are some of the factors that have been associated with decreased cases of this type of cancer. Majority of esophageal tumors are malignant (with fatal effects on health) (Chabner, 2010, p. 115) since those that are benign are about 0.5%. Leiomyoma which refers to the smooth muscle tumor forms less than 10% of the total number of cases.

Treatment

The stage at which the cancer is in at the time of diagnosis (Chabner, 2010, p. 9), the condition of the patient and the degree to which the cancer has spread determines the type of treatment to be applied. In case the cancer has not spread to other organs, surgery (Chabner, 2010, p. 89) may be performed so that the affected portion can be removed. In some instances, surgery may also entail the removal of lymph nodes from the stomach, spleen and the chest (Jobe et al., 2009). After that another section of the lower bowel is attached to the remaining section of the esophagus through medical procedures. After the surgery, patients may receive chemotherapy and radiotherapy treatments. Generally, good nutrition and adequate dental care are important in dealing with this condition.

Patients who cannot swallow at all are treated by the insertion of a stent. These are important since they assist the patient in swallowing food. Further, they help in occluding fistulas. A nasogastric tube serves an important function of enhancing the process of feeding the patient while the tumor treatment is given (Ginex et al., 2005). Some patients call for the insertion of a hole in the skin which gives a direct entry into the stomach. A nasogastric tube and gastronomy are important most especially if the patient tends to aspirate food or saliva into the airways. Another method that can be used in the treatment is Esophagectomy. This is the removal of a section of the esophagus hence shortening the length of the remaining esophagus. Other sections of the digestive system for instance the colon is pulled towards the chest cavity and interjected. The common types of esophagectomy are thoracoabdominal, two stage Ivor Lewis approach and three stage McKeown approach.

The use of Chemotherapy in treatment is dependent on the type of tumor although it seems to be based on cisplatin. Ongoing medical studies attempt to compare the various combinations of chemotherapy. This kind of treatment can be administered after surgery or before or in cases where surgery is not possible. Radiotherapy is also given under the same conditions as the former. This may also be used in patients with localized disease that can not be treated via surgery, where radical radiotherapy may be used to cure.

Generally, the prognosis of this condition is quite poor. This is due to the fact that most of the patients start the treatment at advanced stage. If this cancer is diagnosed in its earliest stages, then the chances of survival for the cancer victim are high (Ginex et al., 2005). This is not possible in most cases since this condition does not have significant symptoms. Most patients go for medical check up because they are experiencing difficulty in swallowing food; this is a sign that is shown at the later stages of cancer growth.

Conclusion

Cancer of the trachea is commonly referred to as esophageal cancer. Dysphasia and odynophagia are the most common symptoms that are associated with this disease. The disease has poor prognosis since majority of the people seek treatment when the cancer is full blown, this is due to the fact that this condition does not have major symptoms. Chemotherapy and Radiotherapy are two major types of treatments that are used to treat this condition.

Reference

Chabner, D. (2010). The language of medicine (9^th ed). Saunders, 1-161.

Ginex, P., Hanson, J. & Frazzitta, B. L. (2005). Esophageal cancer: 100 questions and answers. Jones & Bartlett Learning.

Jobe, B. A., Thomas, C. R., & Hunter, J. G. (2009). Understanding Esophageal Cancer: the principles and practice. Demos Medical Publishing.

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