What Are the Types of Esophageal Cancer?
Cancer of the esophagus is a rare type of cancer, but the frequency has been increasing over the past twenty years. In many cases, because early symptoms are slight or resemble other causes, diagnosis is delayed. By the time the disease has spread, survival rates are low. However, new treatments are being developed to try to abort the worst before it is too late. Proper treatment of a main factor, reflux disease and medical consultation is important.
Types
Two types of cancer that arise in the esophageal are squamous cell carcinoma, which grows in the flat cells lining the esophagus, and adenocarcinoma which starts in the lower portion of the esophagus near the stomach. Additionally, some other rare types of esophageal cancer exist. These are leiomyosarcoma, lymphoma, small cell carcinoma and spindle cell carcinoma. Breast or lung cancer can metastasize to the esophagus. Squamous cell cancer is the more common of the two main kinds. There are also noncancerous esophageal tumors.
Features
A condition called Barrett's Esophagus may precede the development of adenocarcinoma. In Barrett's, the lining of the esophagus nearest the stomach changes from a protective type of cell to cells resembling those in the stomach itself. This frequently happens as a result of long-standing Gastroesophageal Reflux Disease (GERD). In GERD, if the lower esophageal sphincter, which normally prevents stomach acid from backing up the esophagus, is weakened, corrosive acids backup into the esophagus. In self defense, the cells lining that part change. This is called metaplasia. In about one percent (estimates vary) of cases of Barrett's, the cells continue to change, first to low-grade dysplasia and then high-grade dysplasia. If not stopped before this point, the process may lead to cancer.
Identification
Early esophageal cancer may be suspected on the basis of symptoms, which are difficulty in swallowing solid foods and weight loss. Undetected cancer of the esophagus that has progressed will cause problems swallowing even liquids. Additionally, a growing tumor can compress the vocal cord nerves causing hoarseness. Diagnosis of cancer and the type is made from a biopsy taken with an endoscopy, a narrow tube that is inserted in the throat down through the esophagus at least to the stomach and possibly into the duodenum.
Warning
Known risk factors for esophageal cancer include smoking and alcohol, which plays a primary role in development of squamous cell carcinoma but is less significant in adenocarcinoma. Human papillomavirus infections and radiation to the esophagus may be risk factors as well. Age and gender are risk factors. Half of the people contracting it are over seventy. Men are affected three times as often as women. African Americans develop esophageal cancer twice as often as Caucasians. While those with Barrett's esophagus are more likely to get cancer, the actual risk of cancer developing is estimated between 0.5 and one percent per year.
Prevention/Solution
Controlling GERD is a primary goal in preventing cancer development. This is done medically through acid-suppressing drugs---either H2-blockers such as Zantac, Pepcid or their generic equivalents, or Proton Pump Inhibitors (Prevacid, Protonix, Zegerid and the like. If medical control is insufficient, surgery is an alternative. Two types of operations exist. Fundoplication, where the upper part of the stomach is wrapped around the esophagus and sewn into place, has been performed for many years on patients. New methods using laparoscopic gastric diversions are also used. However, a recent large retrospective study found no significant benefit of fundoplication over medical treatment in preventing the development of esophageal cancer (Tran, T., et al., Fundoplication and the risk of esophageal cancer in Gastroesophageal reflux disease, "American Journal of Gastroenterology," 2005 May; 100(5):1002-8).
Tags: cell carcinoma, esophageal cancer, risk factors, cells lining, esophageal cancer, lining esophagus, squamous cell
