Esophageal Cancer

Esophageal Cancer

Esophageal cancer is malignancy of the esophagus. There are various subtypes, primarily squamous cell cancer and adenocarcinoma. Squamous cell cancer arises from the cells that line the upper part of the esophagus. Adenocarcinoma arises from glandular cells that are present at the junction of the esophagus and stomach.[1] Esophageal tumors usually lead to dysphagia (difficulty swallowing), pain and other symptoms, and are diagnosed with biopsy. Small and localized tumors are treated surgically with curative intent. Larger tumors tend not to be operable and hence cannot be cured; their growth can still be delayed with chemotherapy, radiotherapy or a combination of the two. In some cases chemo- and radiotherapy can render these larger tumors operable. Prognosis depends on the extent of the disease and other medical problems, but is fairly poor.[2]

Signs andi symptoms
Dysphagia (difficulty swallowing) is the first symptom in most patients. Odynophagia (painful swallowing) may be present. Fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty. Substantial weight loss is characteristic as a result of poor nutrition and the active cancer. Pain, often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character. An early sign may be an unusually husky or raspy voice.

The presence of the tumor may disrupt normal peristalsis (the organised swallowing reflex), leading to nausea and vomiting, regurgitation of food, coughing and an increased risk of aspiration pneumonia. The tumor surface may be fragile and bleed, causing hematemesis (vomiting up blood). Compression of local structures occurs in advanced disease, leading to such problems as upper airway obstruction and superior vena cava syndrome. Fistulas may develop between the esophagus and the trachea, increasing the pneumonia risk; this condition is usually heralded by cough, fever or aspiration.[2]

If the disease has spread elsewhere, this may lead to symptoms related to this: liver metastasis could cause jaundice and ascites, lung metastasis could cause shortness of breath, pleural effusions, etc.

Causes and risk factors

Increased risk
There are a number of risk factors for esophageal cancer.[2] Some subtypes of cancer are linked to particular risk factors:

Age. Most patients are over 60, and the median in US patients is 67.[2]
Sex. It is more common in men.
Heredity. It is more likely in people who have close relatives with cancer.
Tobacco smoking and heavy alcohol use increase the risk, and together appear to increase the risk more than either individually.
Gastroesophageal reflux disease (GERD) and its resultant Barrett's esophagus increase esophageal cancer risk due to the chronic irritation of the mucosal lining (adenocarcinoma is more common in this condition, while all other risk factors predispose more for squamous cell carcinoma).[3]
Human papillomavirus (HPV)[4]
Corrosive injury to esophagus by swallowing strong alkalines (lye) or acids.
Particular dietary substances, such as nitrosamine.
A medical history of other head and neck cancers increases the chance of developing a second cancer in the head and neck area, including esophageal cancer.
Plummer-Vinson syndrome (anemia and esophageal webbing)
Tylosis and Howel-Evans syndrome (hereditary thickening of the skin of the palms and soles).
Radiation therapy for other conditions in the mediastinum.[2]
Celiac disease predisposes towards squamous cell carcinoma.[5]
Obesity increases the risk of adenocarcinoma fourfold.[6] It is suspected that increased risk of reflux may be behind this association.[3][7]
Drinking large quantities of hot beverages, especially hot brewed teas
Alcohol consumption in individuals predisposed to alcohol flush reaction[8]
Achalasia

Decreased risk

Risk appears to be less in patients using aspirin or related drugs (NSAIDs).[9]
The role of Helicobacter pylori in progression to esophageal adenocarcinoma is still uncertain, but, on the basis of population data, it may carry a protective effect.[10][11] It is postulated that H. pylori prevents chronic gastritis, which is a risk factor for reflux, which in turn is a risk factor for esophageal adenocarcinoma.[12]
According to the National Cancer Institute, "diets high in cruciferous (cabbage, broccoli, cauliflower) and green and yellow vegetables and fruits are associated with a decreased risk of esophageal cancer."[13]
Moderate coffee consumption is associated with a decreased risk.[14]
According to one Italian study of "diet surveys completed by 5,500 Italians"—a study which has raised debates questioning its claims among cancer researchers cited in news reports about it—eating pizza more than once a week appears "to be a favorable indicator of risk for digestive tract neoplasms in this population."[15]

Esophageal Cancer
Onchocerciasis / River Blindness Obsessive-Compulsive Disorder (OCD) Eye Cancer Extensively Drug-Resistant Tuberculosis Esophageal Cancer Epstein-Barr Virus Electrocardiogram Echocardiography Ebola Hemorrhagic Fever Head Lice (Pediculosis) Human Parainfluenza Viruses How the Heart Works Hookworm Infection Holter Monitor and Event Monitors Holes in the Heart Histoplasmosis High Blood Cholesterol (Hyperlipidemia) Hendra Virus Disease and Nipah Virus Encephalitis Hemorrhagic Fever with Renal Syndrome Heart Valve Disease Heart Transplant Heart Palpitations Heart Disease Heart Defects Prostate Cancer - Treatment	Esophageal Cancer Esophageal cancer is malignancy of the esophagus. There are various subtypes, primarily squamous cell cancer and adenocarcinoma. Squamous cell cancer arises from the cells that line the upper part of the esophagus. Adenocarcinoma arises from glandular cells that are present at the junction of the esophagus and stomach.[1] Esophageal tumors usually lead to dysphagia (difficulty swallowing), pain and other symptoms, and are diagnosed with biopsy. Small and localized tumors are treated surgically with curative intent. Larger tumors tend not to be operable and hence cannot be cured; their growth can still be delayed with chemotherapy, radiotherapy or a combination of the two. In some cases chemo- and radiotherapy can render these larger tumors operable. Prognosis depends on the extent of the disease and other medical problems, but is fairly poor.[2] Signs andi symptoms Dysphagia (difficulty swallowing) is the first symptom in most patients. Odynophagia (painful swallowing) may be present. Fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty. Substantial weight loss is characteristic as a result of poor nutrition and the active cancer. Pain, often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character. An early sign may be an unusually husky or raspy voice. The presence of the tumor may disrupt normal peristalsis (the organised swallowing reflex), leading to nausea and vomiting, regurgitation of food, coughing and an increased risk of aspiration pneumonia. The tumor surface may be fragile and bleed, causing hematemesis (vomiting up blood). Compression of local structures occurs in advanced disease, leading to such problems as upper airway obstruction and superior vena cava syndrome. Fistulas may develop between the esophagus and the trachea, increasing the pneumonia risk; this condition is usually heralded by cough, fever or aspiration.[2] If the disease has spread elsewhere, this may lead to symptoms related to this: liver metastasis could cause jaundice and ascites, lung metastasis could cause shortness of breath, pleural effusions, etc. Causes and risk factors Increased risk There are a number of risk factors for esophageal cancer.[2] Some subtypes of cancer are linked to particular risk factors: Age. Most patients are over 60, and the median in US patients is 67.[2] Sex. It is more common in men. Heredity. It is more likely in people who have close relatives with cancer. Tobacco smoking and heavy alcohol use increase the risk, and together appear to increase the risk more than either individually. Gastroesophageal reflux disease (GERD) and its resultant Barrett's esophagus increase esophageal cancer risk due to the chronic irritation of the mucosal lining (adenocarcinoma is more common in this condition, while all other risk factors predispose more for squamous cell carcinoma).[3] Human papillomavirus (HPV)[4] Corrosive injury to esophagus by swallowing strong alkalines (lye) or acids. Particular dietary substances, such as nitrosamine. A medical history of other head and neck cancers increases the chance of developing a second cancer in the head and neck area, including esophageal cancer. Plummer-Vinson syndrome (anemia and esophageal webbing) Tylosis and Howel-Evans syndrome (hereditary thickening of the skin of the palms and soles). Radiation therapy for other conditions in the mediastinum.[2] Celiac disease predisposes towards squamous cell carcinoma.[5] Obesity increases the risk of adenocarcinoma fourfold.[6] It is suspected that increased risk of reflux may be behind this association.[3][7] Drinking large quantities of hot beverages, especially hot brewed teas Alcohol consumption in individuals predisposed to alcohol flush reaction[8] Achalasia Decreased risk Risk appears to be less in patients using aspirin or related drugs (NSAIDs).[9] The role of Helicobacter pylori in progression to esophageal adenocarcinoma is still uncertain, but, on the basis of population data, it may carry a protective effect.[10][11] It is postulated that H. pylori prevents chronic gastritis, which is a risk factor for reflux, which in turn is a risk factor for esophageal adenocarcinoma.[12] According to the National Cancer Institute, "diets high in cruciferous (cabbage, broccoli, cauliflower) and green and yellow vegetables and fruits are associated with a decreased risk of esophageal cancer."[13] Moderate coffee consumption is associated with a decreased risk.[14] According to one Italian study of "diet surveys completed by 5,500 Italians"—a study which has raised debates questioning its claims among cancer researchers cited in news reports about it—eating pizza more than once a week appears "to be a favorable indicator of risk for digestive tract neoplasms in this population."[15]
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