Question: Did you know that there are two main types of esophageal cancer?
The esophagus is the muscular tube that connects the throat to the stomach. When we swallow, the muscles push the food down the esophagus into the stomach. There is a valve (sphincter) at the junction of the esophagus and stomach that opens to let food through, then closes to prevent stomach acid and food from flowing back into the esophagus (reflux ).
Esophageal cancer is a malignant tumor of the esophagus. It is rare in the United States and accounts for 1% of all cancers. Worldwide, it is the 8th most common cancer, frequently seen in East Asia. Smoking is a risk factor and likely explains the high incidence in China and some populations in the United States.
Other factors include excessive alcohol consumption, chronic acid reflux, obesity, and diets high in processed meats and low in vegetables. Men are more at risk (4x that of women), as are people over 55. With chronic reflux, there may be a change in the lining of the esophagus, Barrett’s esophagus which is associated with an increased risk of esophageal cancer.
Early detection has proven difficult. Worrisome symptoms include difficulty swallowing, painful swallowing, and unintentional weight loss. The first symptoms are frequent and non-specific: cough, hoarseness, chest pain. There are no routine screening recommendations for the general population. Screening is recommended for people with a strong family history, genetic predisposition, or Barrett’s disease.
There are two main types of esophageal cancer (determined by their microscopic appearance): squamous cell carcinoma and esophageal adenocarcinoma.
Squamous cell carcinoma is associated with smoking and/or excessive alcohol consumption. Its frequency has declined in the United States over the past 30 years. It begins in the squamous cells of the esophagus.
Adenocarcinoma of the esophagus is associated with smoking, reflux, and Barrett’s disease. Over the past 30 years it has become more common. It begins in the glandular tissue of the lower part of the esophagus, where the esophagus and the stomach join.
The body is constantly replacing tissue cells. In general, cancer begins when healthy cells develop changes (mutations) in their DNA. Healthy cells grow and divide in an orderly fashion for your body to function normally. But when a cell’s DNA is damaged, the cells can continue to divide, forming a mass called a tumour. Cancerous tumors can spread to other parts of the body.
Esophageal cancer is diagnosed by endoscopy, with the patient sedated, a fiberoptic tube is inserted through the mouth into the esophagus. Biopsies are obtained. Further studies focus on the extent of the disease. Treatment is determined by staging and includes: surgery, chemotherapy, and radiation therapy.
Gastroesophageal reflux (heartburn, regurgitation) is very common and can increase the risk of esophageal cancer. Treating reflux with dietary changes and lifestyle changes can be effective, but medications are usually needed, such as H2 blockers (eg, famotidine). Some patients require proton pump inhibitors (PPl) such as omeprazole to control symptoms, PPLs are much more potent than H2 blockers.
We screen for Barrett’s esophagus in patients with: hiatus hernia, over the age of 50, male, chronic gastroesophageal reflux disease (GERD), Caucasians, centrally obese , smoking or a history of Barrett’s esophagus or esophageal adenocarcinoma in the first instance. relative degree.
In patients with Barrett’s disease, the risk of developing cancer is 30 times higher than in the general population, but the absolute risk of developing cancer in patients with Barrett’s metaplasia is also low. We treat virtually all patients with Barrett’s esophagus indefinitely with a proton pump inhibitor (PPI) based on studies that suggest aggressive anti-reflux therapy was associated with a decreased risk of esophageal adenocarcinoma.
We invite you to a special presentation on esophageal cancer, hosted by Dr. Shah, on Thursday, April 28 at 5:00 p.m. at the Mission Hope Cancer Center. Please call 805-219-4673 to reserve your spot.
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