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Esophagus Cancer

Esophagus cancer is a disease that starts in the esophagus when cells change and start to grow out of control. When the cells start growing out of control will result into development of tumor. Tumor can either be benign or malignant. Benign tumor is a tumor that is still enclosed and cannot spread to other parts of the body while malignant tumor is the one that has passed the level of benign and can spread to other parts of the body.Esophagus cancer is also known as esophageal cancer. To understand well about esophagus cancer, one has to at least have knowledge on structure and function of esophagus cancer.

About esophagus
Esophagus is a long hollow muscular organ that connect throat to the stomach. It is part of the digestive system through which food and fluid pass from mouth to the stomach. For an adult person, esophagus is normally 25cm long. The walls of esophagus are made up of layers. These layers help in moving food down the tube to the stomach. The main layers that make up esophageal wall are;

> Mucosa. It is the inner most layer of esophageal wall. It is further subdivided into epithelium, lamina propria and muscularis mucosa.
> Submucosa. It is the layer of the esophageal wall with connective tissues. It is made up of blood vessels and nerves. Submucosa is located under mucosa.
> Muscularis propria. This is a layer that is made up of muscles that help to push food down the esophagus to the stomach. It is located under submucosa.
> Adventitia. It is the outermost layer of esophageal wall. It is made of connective tissues.

The epithelial part of mucosa is made of squamous cell from which most of esophageal cancer cases start. Mucus secreting glands of the esophagus are locates in the submucosa from which some of the cancer cases develop.

Types of esophagus cancer
Esophagus is a long hollow muscular organ that connect throat to the stomach. It is part of the digestive system through which food and fluid pass from mouth to the stomach. For an adult person, esophagus is normally 25cm long. The walls of esophagus are made up of layers. These layers help in moving food down the tube to the stomach. The main layers that make up esophageal wall are;

> Esophageal squamous carcinoma. This starts in the thin, flat cells in the lining of the esophagus, which are called squamous cells. It often begins in the middle and upper part of the esophagus. In Tanzania, this is the most common type of esophagus cancer.
> Esophageal adenocarcinoma. This starts in the glandular part of esophagus. It is normally begin in the lower part of esophagus (near the stomach). In Tanzania adenocarcinoma is less common compared to squamous carcinoma.

If it is not found and treated early, esophageal cancer can spread through the lymphatic system to nearby lymph nodes or through the bloodstream to other parts of the body, most commonly the liver. It can also grow through the esophageal wall and invade the windpipe and lungs

Risk factors of esophagus cancer
When it comes to cancer, anything that increases your probability of developing cancer is called a risk factor. Risk factors only influence development of cancer but it does not directly cause cancer. Sometimes people with risk factors do not develop the disease while those with no risk factors do develop the disease. Knowing risk factors will help you live your life making some better healthy choices to reduce the risk. The risk factors of esophagus cancer include the following.

> Age. Esophagus cancer is more common in older people than in young ones.
>Gender. Statistics indicate that, number of men who develop esophagus cancer is slightly higher than that of women.
>Obesity. Having excess fat in the body will increase someone`s chance of developing esophageal adenocarcinoma.
>Alcohol consumption. Heavy drinking will increase someone`s chance of developing esophagus cancer.
>Tobacco use. The use of tobacco products like cigars, cigarettes, pipes, chewing tobacco and snuff, increases the risk of developing esophageal cancer especially squamous esophagus cancer.
>Esophageal reflux disease. This is the disease where by the stomach contents have the tendency to move into lower part of esophagus. In the stomach gastric acid is produced from the stomach walls. This acid together with enzymes helps digestion of food. But in some people these stomach contents flow back into esophagus. This condition is medically named as gastroesophageal reflux disease. If this disease is left untreated it may result to the condition called barrette`s esophagus which refers to an abnormal change (metaplasia) in the cells of the lower portion of the esophagus. The squamous cells will change into glandular cells which is more resistant to acid from stomach. A person with barrette`s esophagus is prone to esophageal adenocarcinoma.
>Achalasia. It is a failure of smooth muscle fibers at the lower end of esophagus to relax. This will result into failure of esophageal sphincter to open when needed, hence food and liquid will not pass into the stomach which increase the risk of developing cancer due to prolonged contact of mucosa with chemicals within food or produced from food by the action of bacteria.
>Tylosis. It is a rare inherited disease that results into excess growth of top layer of skin on the palms of hand and soles of feet. People with this condition have high chance of developing small growths (papilloma) in the esophagus that may lead to squamous carcinoma.
>Human papilloma virus (HPV) infection. Although researches are still conducted on this, there are some studies indicating possible link between some strains of HPV virus and esophagus cancer. HPV is normally transmitted from one person to another through sexual practices with the infected person.

Prevention of esophagus cancer
To prevent something you need first to know what causes it. Since the specific cause of esophagus cancer is still unknown, currently there is no known way of completely preventing development of esophagus cancer but there are some ways that may help reduce the risk of developing it. These include avoid (quit) tobacco use, avoid excessive use of alcohol, performing physical exercises to help control body weight and seeking treatment for reflux disease.

Early detection and screening of esophagus cancer
When it comes to cancer, early detection normally provide better treatment outcome. When esophagus cancer is found early, chances for better treatment outcome are very high. For most cancers, early detection has been greatly contributed by the presence of screening processes.

Screening is the process of running some tests to someone with no symptoms of the disease with the intention of determining presence or absence of the disease. Unfortunately, currently there is no widely recommended screening tests for esophagus cancer, but for those at higher risk of developing esophagus cancer, most doctors recommend regular endoscopic exams.

An endoscopic examination involves inserting a flexible, lighted tube inside the esophagus to see if everything is okay or there are abnormalities. During the examination, small amount of tissue (biopsy) may be removed for examination under a microscope. This type of screening can help find cancer early or changes that could become cancerous over time.

Signs and symptoms of esophagus cancer
People with esophagus cancer tend to experience some of the following symptoms. Sometimes those signs and symptoms may be as result of other medical conditions that is not cancer. Therefore, going to see a doctor upon experiencing any of the symptoms is advised. The signs and symptoms of esophagus cancer include the following;

> Difficulty swallowing
> Persistent ingestion and heartburn
> Unexplained weight loss
> Choking when swallowing
> Vomiting
> Coughing or hoarseness
> Burning in the chest
> Black coloured or bloody stoo

Diagnosis of esophagus cancer Following suspicion of esophagus cancer, doctors use various tests to locate the disease, learn if the disease has spread to other organs of the body and some tests will help to determine stage of the disease. When running those diagnostic tests, your doctor will consider some of the factors including;

> Results of your previous tests.
> Your general health condition.
> Type of cancer suspected.
> Your age.

The following are some of the diagnostic tests for esophagus cancer although not everyone will need to go through all those tests during diagnosis.

> Medical history. Taking your medical history is a basic procedure when dealing with any disease. Your doctor will ask you some questions so as to try to look for anything that might have put you at the risk of developing esophagus cancer.

> Barium swallow. Barium swallow is the test that involve drinking a liquid containing barium followed by taking series of plain x-ray pictures. Barium will coat on the surface of the esophagus making it possible for the x-ray picture to reveal if there is any abnormality. If anything abnormal is noticed, additional tests will be required to identify it. These tests may involve biopsy and endoscope.

> Endoscope. Endoscope is a thin lighted, flexible tube with a camera at the end which is used for examination inside the body. During the test, you will be sedated (put to sleep using medication), then the tube is inserted into the mouth, down the throat and esophagus, and into the stomach. As the tube pass through the esophagus, the doctor will be able to see any abnormalities. By using an endoscope the doctor may remove a small amount of tissue for examination under a microscope in the laboratory.

> Endoscopic ultrasound. This resemble to that of normal endoscope, but in this the endoscope has an addition of ultrasound probe at the end. The probe releases soundwaves that echo when they bounce off anything solid such as an organ or tumor, which result to production of detailed images of the esophagus. Ultrasound will help to tell if tumor has grown into the wall of the esophagus or not and if it has then how deep into the wall, and whether the disease has spread to the lymph nodes or other nearby structures.

> CT scan. Computed tomography scan is a test that uses x-rays to produce images of several inside parts of the body at the same time. Computer will combine these images to produce three dimensional image that will reveal if there is a tumor or abnormalities in the body. Sometimes a special dye called contrast is given before the scanning process. Contrast will enable images to appear clear.

> MRI scan. Unlike CT scan, magnetic resonance imaging uses strong magnetic field and radio waves to produce images of inside parts of the body. The scanner takes several images of parts of the body. Computer combine these images to form three dimensional image of inside parts of the body. Before the scanning, you may be given a contrast medium so as to produce a clear image.

> PET scan. Positron emission tomography scan is a test that uses special radioactive sugar called tracer and camera to produce picture of inside organs of the body. During the test, radioactive sugar is injected into the body where it will be absorbed by cells. Since cancer cells requires more energy than normal cells, more radioactive sugar will be absorbed by cancer cells. Special camera is used to scan the body. Pictures from the scanner will show areas of the body with more concentration of this sugar which is the indication of cancer cells.

> Biopsy. Biopsy is a test that involve taking small sample of tumor and viewing it under microscope in the laboratory. This test is done by the pathologist (a doctor specialized in evaluating and interpreting cells and tissues under microscope in the laboratory). Biopsy is used as confirmatory test in most types of cancers including esophagus cancer.

Treatment of esophagus cancer

After being diagnosed with esophagus cancer, your doctor will give you the news and most of times it is very difficult for people to accept the news due to the nature of disease itself. After hearing the news, many will start asking themselves different questions like, Will I die?, How am I going to eat?, What should I do?, Is there treatment for this?

Making treatment decision. When helping you with some of your questions that you may have, one of the things that you will talk about with your doctor is availability of any possible solution for your case. So here comes the crucial part that include making treatment decision as there are many treatment options and in order to decide what is the right choice for you, you will need to be careful and get all the help you can get in making decision.

Talk with your doctor. Your doctor will discuss with you about all the treatment options available for your case. During the discussion you will talk about their goals and possible side effects. Among other things that your doctor will consider when presenting to you the options are;

> Your age.
> Any other serious health conditions you have.
> Type and stage your cancer.
> Chances that the treatment option will cure you or help in some any way.
> How do you feel about the possible side effects from treatment options?

After listening to the doctor, do not rush to make the decision but take your time to absorb the information that you have just received and ask questions if there is anything that you have not understood or not sure about. Many people prefer to have a family member or friend with them in order to take part in the discussion making, taking notes or simply listen.

Second opinion After hearing all the options available from your doctor, you may want to get a second opinion from another specialist to confirm or seek more clarification on your doctor’s recommendations or reassurance that you have explored all of your options. Some doctors can even send you together with your initial results to another specialist for more opinions on your case.

Take part in clinical trials Clinical trials are new drugs or modified mode of treatment or new treatment combination for cases like yours that are to be tested if they are effective to be used as standard care treatment options or not. Your doctor or nurse will discuss with you if you want to take part in clinical trial.
Over the years, trials have improved treatments and led to better outcomes to people diagnosed with various diseases including cancer. If you have decided to take part in clinical trial, you can also withdraw at any time.

Treatment options

Treatment of esophagus cancer requires a team of doctors and other health care professionals. This team work together and it is called multidisciplinary team. Team may vary depending on the treatment option for a particular case. But normally multidisciplinary team for treatment of esophagus cancer includes, surgical oncologist, medical oncologist, radiation oncologist, radiation therapist, thoracic surgeon, endoscopist, pathologist and other health care professionals like oncology nurses, physiotherapist and palliative care team. Treatment options include the following;

Surgery Surgery is the removal of tumor and surrounding healthy tissues by an operation. This treatment option is performed by a specialized doctor known as surgical oncologist. Surgery is the treatment option preferred for those cases at an early stage.

The most common surgery to treat esophageal cancer is called an esophagostomy. This involves removing the affected part of the esophagus and connecting the remaining healthy part to the stomach so that the patient can swallow food without problems. The stomach or part of the intestine may sometimes be used to make the connection.

Side effects of surgery Side effects of surgery depend on type and extent of surgery. Some of the possible side effects include the following;

1. Risk of infection.
2. Excess bleeding.
3. Blood clots.
4. Damage to nearby organs or effects of leakage from the connection between the esophagus and stomach or small bowel.

Chemotherapy Chemotherapy is the use of drugs to destroy cancer cells or stop its growth. This treatment is given by a specialized doctor known as medical oncologist. Type of chemotherapy used for treatment of esophagus cancer is known as systemic chemotherapy. In systemic chemotherapy drug gets into the bloodstream to reach cancer cells throughout the body.

Generally chemotherapy is can be given through injection into vein (intravenously) by using a needle or given as a pill or capsule that is swallowed (orally). Chemotherapy can sometimes be given in combination with radiation therapy.

Side effects of chemotherapy Side effects of chemotherapy depend on the dose given, type of drug used and periodic time by which it has been used. Some of the possible side effects include the following;

> Hair loss
> Nausea and/or vomiting.
> Loss of appetite.
> Feeling tired due to low red blood cells count.
> Risk of infection due to decreased white blood cells.
> Easily bruising and bleeding as a result of low blood platelets.
> Changed bowel habits such as constipation or diarrhea.

Radiation therapy Radiation therapy is a treatment of cancer by using high energy x-rays or other radiation particles to destroy cancer cells. Radiation therapy is given by a specialized doctor known as radiation oncologist. There are two main types of radiation therapy, internal radiation therapy (brachytherapy) and external beam radiation therapy. External beam radiation therapy is the one that is normally used when dealing with esophagus cancer.

External beam radiation therapy involve directing beam of radiation to the tumor from the source (machine) which is positioned outside the body. This treatment can either be given alone or in combination with chemotherapy or surgery.

Side effects of radiation therapy Side effects of radiation therapy to esophagus cancer depend on the dose of radiation therapy given. These side effects normally go away soon after completion of treatment but also there are some medications that may help to relieve if they become too severe. Some of the possible side effects include the following;

1. Fatigue
2. Mild skin reactions at the site of irradiation
3. Loose bowel movement
4. Upset stomach
5. Loss of appetite.

TACASO is dedicated to eliminating cancer as a major health problem, and improving the lives of those living with cancer


address: Dar Es Salaam - Tanzania
phone: +255 757 120 337