Do you have questions about esophageal cancer? Let's talk!

You may have heard about Esophageal Cancer. This is a serious condition, but it is very important to be aware of it. Because sometimes the cancer may be quite advanced by the time symptoms appear. But don't worry, let's talk about everything in simple terms.

What is esophageal cancer? How does it develop?

Simply put, the esophagus is a long tube made of muscles that carries food from the throat to the stomach when we swallow. So, cancer occurs when the cells in this esophagus start to divide abnormally and uncontrollably. The cells that form in this way gather together and form a tumor.

Esophageal cancer is the tenth most common cancer in the world. It can be a bit serious, because as I said before, this cancer can grow for a while without showing any symptoms . The reason for this is that our esophagus can stretch a little, like when we swallow a large mouthful of food. So until the cancer gets a little bigger, we may not feel any discomfort. But when the tumor gets bigger and starts to block the opening of the esophagus, it becomes difficult to swallow food, and it hurts when we swallow.

There are two main types of esophageal cancer, right?

Yes, there are mainly two types:

1. Adenocarcinoma: This is the most common type, especially in Western countries. It develops in the cells of the glands in the esophagus that produce mucus that helps with swallowing. This type usually develops in the lower part of the esophagus.

2. Squamous cell carcinoma: This type starts in the squamous cells that line the inside of the esophagus. It usually develops most often in the upper and middle parts of the esophagus.

Can this cancer be completely cured?

This really depends on how early the cancer is detected. If it is detected early, that is, when the cancer is small, it can be surgically removed and sometimes completely cured. But, unfortunately, only 25% of people with this cancer are diagnosed before the cancer has spread. That is why we say, if you have even the slightest symptom, be concerned about it.

Who is at higher risk of developing this cancer?

In general, statistics show that this disease is most common in men over the age of 60. Also, there are some differences between some races. For example, squamous cell carcinoma is more common in black and Asian people, while adenocarcinoma is more common in white people. However, these are just general observations, and anyone can develop this condition.

What are the symptoms of esophageal cancer? How to recognize it?

The first symptom that many people experience is difficulty swallowing (dysphagia) . It can feel like something is stuck in the throat. In addition, there may be symptoms such as:

• Pain in the throat or back of the chest, meaning behind the breastbone or between the shoulder blades.
• Vomiting, possibly vomiting blood.
• Coughing up blood.
• Frequent heartburn.
• A hoarse voice, or a persistent cough.
• Unintentional weight loss .

If you have one or more of these symptoms, it doesn't necessarily mean you have esophageal cancer. However, if these symptoms persist, it's best to see a doctor for a checkup.

How quickly does this cancer spread?

Esophageal cancer is usually a type of cancer that can grow very quickly . As I mentioned before, because our esophagus is quite flexible, as the cancer grows, it tends to wrap around it. This is why symptoms often appear after the cancer has spread a little.

What are the main causes of this cancer? What are the risk factors?

It's hard to say for sure what the exact cause is. However, doctors have identified several factors that increase the risk of developing this cancer. Let's take a look at what they are:

• Tobacco use: This includes both smoking and smokeless tobacco (e.g. chewing tobacco with chewing gum, chewing gum with chewing gum). These can damage the cells of the esophagus and greatly increase the risk of cancer.
• Alcohol use: Drinking alcohol for a long time or in excess is also a major risk factor.
• Obesity: Being overweight or obese can cause inflammation in the esophagus. This inflammation can eventually lead to cancer.
• Barrett's esophagus and chronic acid reflux: Long-term acid reflux, which is the backflow of stomach acid into the esophagus, can cause changes in the cells in the lower part of the esophagus if not treated properly. This condition is called Barrett's esophagus. It is not cancer, but it is a condition that has an increased risk of developing into cancer. People who do not have Barrett's esophagus but have long-term heartburn are also at increased risk of developing esophageal cancer.
• Human Papillomavirus (HPV): HPV is a very common virus. It can cause changes in the tissues of the vocal cords, mouth, hands, feet, and genitals. Some types of HPV increase the risk of esophageal cancer.
• If you have had cancer before: People who have had head or neck cancer are at higher risk of developing esophageal cancer.
• Other conditions: This cancer is also associated with some rare and hereditary conditions. An example is achalasia , a rare condition that makes it difficult to swallow. Another is tylosis , a rare, hereditary condition that causes thickening of the skin on the palms and soles of the feet.
• Exposure to certain chemicals: People who are exposed to chemicals like dry cleaning solvents for a long time are also at higher risk of this cancer.

How do doctors diagnose this cancer? (Diagnosis)

If you have the symptoms mentioned above, your doctor will first ask you about your symptoms and your medical history. Then, they may do some tests, such as:

• Barium swallow test: This involves having you drink a liquid containing a substance called barium and taking a series of X-rays. The barium makes the esophagus clearly visible on the X-ray images. This can then be used to see if there are any abnormalities in the esophagus.
• CT scan (Computed Tomography scan): This test allows doctors to see if cancer has spread to other parts of the chest and abdomen (belly).
• Esophagogastroduodenoscopy (EGD): In this, a thin, flexible tube called an endoscope (equipped with a camera) is inserted through the mouth and looked directly into the esophagus. This can clearly see any changes or tumors in the wall of the esophagus.
• Esophageal endoscopic ultrasound: This can also be done at the same time as an EGD. It uses sound waves to take pictures of the inside of the esophagus. This can help determine how deep the cancer has grown into the esophagus wall and whether it has spread to nearby lymph nodes.
• Biopsy: If the doctor sees a suspicious area during the EGD, they will take a small piece of tissue and examine it under a microscope. This is how they can confirm whether or not cancer cells are present.

Doctors use the information from these tests to determine the stage and grade of the cancer. The stage of the cancer is how far the cancer has spread (e.g., the size of the tumor, whether it has spread to lymph nodes, or to distant organs). The tumor grade is how similar the cancer cells are to healthy cells and how quickly they divide. Treatment is planned based on this stage and grade.

What are the treatments for this?

The treatment for esophageal cancer depends on the stage and grade of the cancer, as mentioned above, and the patient's overall health. There are several main treatment options:

• Surgery: The most common treatment for early-stage esophageal cancer is an operation called an esophagectomy . This involves removing part or all of the esophagus, along with surrounding tissue. Then, a portion of the stomach is pulled up and connected to the chest and neck, creating a new esophagus.
• Radiation therapy: This involves targeting a high-energy beam of radiation to the tumor to kill cancer cells. It is also used as an adjuvant treatment before or after surgery.
• Chemotherapy: This involves giving drugs that kill cancer cells or stop them from growing. This can be given before, after surgery, or in combination with radiation therapy.
• Endoscopic Submucosal Dissection (ESD): This procedure is used to remove very early stage cancers that are confined to the superficial layers of the esophageal wall.
• Endoscopic Mucosal Resection (EMR): This is a procedure similar to ESD, used to remove cancerous tumors in the mucous lining of the esophagus.
• Endoscopic laser therapy: When a cancerous tumor blocks the esophagus and makes it difficult to swallow, a laser beam is used to remove part of the tumor to reduce the discomfort.
• Photodynamic therapy (PDT): In this, special drugs called photosensitizers are given to the body, and then a special light is directed at the cancer site. When this light hits, the drug is activated and causes a chemical reaction that destroys the cancer cells.
• Targeted therapy: Some esophageal cancer cells have an abnormal amount of a protein called HER2 protein . This protein helps the cancer cells grow. Targeted therapy involves giving drugs that target this HER2 protein.
• Immunotherapy: This involves stimulating our body's own immune system to fight cancer cells. Drugs called immune checkpoint inhibitors are used for this purpose.

Remember, not all of these treatments are suitable for every patient. Your medical team will determine which treatments are best suited to your condition.

What can someone with esophageal cancer expect?

This really depends on a lot of factors, like your overall health and how far the cancer has spread when it's diagnosed. If it's caught early, doctors can often treat it successfully. About 46% of people who are treated early are still alive five years after diagnosis.

However, if the cancer has already spread, it may not be possible to completely destroy it. In such cases, doctors focus on providing treatments that help the patient live as long as possible, maintain quality of life, and relieve symptoms. This is also called palliative care . It helps the patient live comfortably and without pain.

How can I reduce my risk of developing this cancer?

Although it cannot be completely prevented, there are several things we can do to reduce the risk:

• Follow a good diet: Eat a balanced diet, eat more fruits and vegetables, and maintain a healthy weight that suits you.
• Staying away from tobacco and alcohol: These are two of the main risk factors.
• Avoid exposure to certain chemicals (depending on the job).
• HPV infection is a risk factor for esophageal cancer. Ask your doctor about the HPV vaccine.
• If you have a condition like Barrett's esophagus , your doctor will recommend regular screening tests. Follow those instructions.

There is currently no recommended screening test for esophageal cancer for the general population, but doctors may recommend tests such as an EGD for people with high risk factors.

How do I take care of myself after treatment?

Some side effects may occur after surgery for esophageal cancer. For example, nausea, vomiting, and heartburn. You may need help managing these. Many people may experience problems like:

• Difficulty eating: Cancer and its treatments can make it difficult and painful to swallow food. This can also cause weight loss. If so, seek advice from your doctor. They may recommend things like eating small, frequent meals and taking nutritional supplements.
• Dumping syndrome: This occurs when the stomach replaces the esophagus after surgery. The stomach cannot hold and digest food, and the food passes quickly into the small intestine. This can cause symptoms such as nausea, vomiting, stomach pain, sweating, and flushing.

Talk to your medical team about these things and get advice on how to deal with them.

Can this cancer come back?

Yes, sometimes cancer can come back (recurrence). You can do these things to reduce that risk:

• Limit alcohol: Excessive alcohol consumption increases the risk of cancer coming back.
• Avoid tobacco use: If you smoke, try to quit. Seek medical advice if necessary.

When should I see the doctor?

This will vary depending on your situation. The follow-up schedule for someone who has had early stage cancer surgically removed is different from the schedule for someone whose cancer has spread.

If your treatment is successful, your doctor will usually ask you to come in for check-ups every three to six months for the first two years, and every six to twelve months for the next three years. These check-ups may include a physical exam, blood tests, imaging tests, and endoscopy.

What questions should I ask my doctor?

Esophageal cancer is a potentially life-threatening disease. If you have this condition, you may want to ask your doctor questions like these:

• What type of esophageal cancer do I have?
• What stage is my cancer in?
• What treatments do you recommend?
• Can this be cured completely?
• If I can't be cured completely, what can you do to help me?
• How long can I live with this cancer?
• Do I need to do genetic testing or biomarker testing?

Don't be afraid to ask these questions. It's very important that you have a clear understanding of your situation.

Finally, things to remember (Take-Home Message)

Esophageal cancer is the tenth most common cancer in the world, and it is also a challenging cancer to treat. This is because symptoms usually appear after the cancer has spread. It can often be difficult to find a complete cure. In such cases, doctors focus on providing patients with treatments that help them live as long as possible and with the best possible quality of life.

There is probably nothing more difficult in life than being told, "You have an incurable disease." At a time like that, you may need time and help to process the situation. Doctors understand this and will do everything they can to help you. If necessary, they will also refer you to a mental health specialist.

The most important thing is to be aware of changes in your body and seek medical advice as soon as possible if you have any concerns. The earlier you detect it, the more likely it is that treatment will be successful.

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