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Causes and Symptoms of Cancer of the Esophagus
( Esophageal Cancer)

Author:   Peter Sedesse MD

Types and Prevalence of Cancer of the Esophagus

Cancer of the Esophagus ranks in the top 15 type of cancers in the world and is much more common in men than in women.  The vast majority, more than 90% of cases, affect individuals over the age of 50.  There are many types of Esophageal cancer, but the two most common are Adenocarcinoma and Squamous Cell Carcinoma. 
Adenocarcinma affects the mucus-secreting cells of the esophagus, while Squamous Cell Carcinoma affects that outermost layer of cells that line the esophagus. There are also a few other, very rare types cancer of the esophagus..

Causes of Esophageal Cancer

There are a few things that are known to be major causes of Esophageal Cancer.  Smoking is by far the most widely known and researched and is the likely cause in the majority of cases of cancer of the esophagus.  Obesity is also a leading cause, with individuals who have a body mass index (BMI) over 30 having a 50% increased risk of developing cancer of the esophagus.  There is also research that links other things to increasing the risks of Esophageal Cancer, these include eating high amounts of meat cooked at high temperatures such as grilling.  When meat is cooked at high temperatures, a type of chemical is formed called hetero-cyclic amines which have been shown to cause cancer. There is also a small amount of research that suggests that frequently drinking very hot fluids can increase the risk of developing cancer of the esophagus.  Excessive alcohol consumption has also been linked to Esophageal Cancer.  However, smoking is by far the leading cause.

There are medical conditions that greatly increase the risk of developing Esophageal Cancer.  The first is a condition called Barrett´s Esophagus.  In this condition, the cells of the esophagus change because of repeated and frequent cases of acid reflux.  It is believed that the change forced upon the cells of the esophagus by the frequent assault of acid can turn normal cells into cancerous cells.  Individual´s with Barrett´s Esophagus are 10 times more likely to develop Esophageal Cancer.  The other medical condition with is linked to cancer of the esophagus is Achalasia.  Achalasia is when the valve that separates the esophagus from the stomach does not relax properly and traps food in the esophagus, above the stomach.  This stretches the esophagus and individuals with this condition have a much higher chance to develop cancer of the esophagus.

Signs and Symptoms of Cancer of the Esophagus

The signs and symptoms of Esophageal Cancer change and worsen depending on the stage of the cancer.  Also, because this type of cancer is so closely linked with Barrett´s Esophagus, it is practical to consider heartburn and gastroesophageal reflux disease (GERD) as a precursor symptom. Individuals who suffer from heartburn or GERD more than once a week are very likely to develop Barrett´s Esophagus, and therefore at much higher risk of developing cancer of the esophagus.  Indigestion and heartburn also continue to be a major symptom during all stages of Esophageal Cancer.

Other symptoms include difficulty swallowing, pain in the chest and unexplained weight-loss.  In some cases, the cancer cells will bleed into the stomach which could induce vomiting.  Another sign of cancer of the esophagus is coughing and hoarseness, which could result in a noticeable change in voice.

Prevention of Esophageal Cancer

As mentioned under the causes of this type of cancer, smoking is by far the leading cause of Esophageal Cancer and so quitting smoking  should be a high priority.  Obesity is closely linked to both cancer of the esophagus as well as heartburn and GERD that leads to Barrett´s Esophagus.  For this reason, weight management, including dieting and exercising are recommended for those with a BMI approaching 30.

Antioxidants found in fresh fruits and vegetables have also been shown to prevent many types of cancer including Esophageal Cancer and research has shown individuals who eat 4-5 servings of fruits and vegetables per day have a significant reduced chance of developing cancer.  Although the research isn´t strong, for individuals who are at risk of developing this type of cancer, it might also be wise to limit consumption of hot liquids, meats cooked at high temperatures as well as alcohol..

Treatment Options for Cancer of the Esophagus

There are four stages of cancer of the esophagus and treatment options will be different depending on the stage.   Esophageal Cancer is normally detected during endoscopy and confirmed by a biopsy.  In stage 1, the cancer is limited to the lining of the esophagus and is normally treated by the surgical removal of the tumor along with a small amount of tissue surrounding the tumor.  In stage 2, the tumor has penetrated deeper into the tissue of the esophagus and may have spread to nearby lymph nodes. In stage 3 of Esophageal Cancer, all layers of the esophagus have been invaded and the lymph nodes are involved.  There is also a chance the cancer has spread to other organs or tissues.  In stage 4, the cancer has spread to other areas of the body. Once the cancer reaches stages 2-4, the surgery is more invasive and more tissue is removed.  In some cases the upper portion of the stomach is removed. Also in stages 2-4, radiotherapy, chemotherapy or both are used.

Survival Rates and Prognosis following treatment for Esophageal Cancer

Survival rates of Esophageal Cancer are low, with even cancer detected during Stage 1 having prognosis of less than 40% 5 year survival rate.  With Stage 3 and Stage 4, the survival rate of cancer of the esophagus drops below 10%.  For this reason, smokers and obese individuals need to be very vigilant for frequent heartburn and GERD.

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