Cancer of Oesophagus- Though India has a relatively low incidence, cancer of the oesophagus is prone to strike those who smoke and drink heavily
Digestive system in human body starts from mouth or oral cavity and ends in anus. In between are the various parts of pharynx, oesophagus, stomach, small intestine, large intestine and rectum. Oesophagus is a muscular tube connecting pharynx to stomach. Its length varies from 23 to 30 cm and it is divided into upper third, middle third and lower third for the convenience of clinicians to modify treatment. The preponderance of the cancer of the oesophagus is very high in some parts of the globe like North China, South America, Western Europe, South Africa, Japan and USSR. India has a relatively low incidence.
A few risk factors are associated with oesophageal cancer. It is very often found in people of low socio economical status. The correlation between this factor and cancer is unknown. People who drink alcohol moderately or heavily (more than 35 drinks per week) suffer from this type of cancer more. Smokers are also prone to develop oesophageal cancer. Low intake of fruits and vegetables is associated with oesophageal and colon cancer.
The most common complaint is difficulty in swallowing which often becomes painful. The onset is gradual with difficulty in swallowing solid food, which when ignored progresses to liquid food too. A man came to my clinic with a history of eight months of swallowing difficulty which he did not reveal to his family members fearing that his daily alcohol intake will be stopped. Ultimately when he developed severe vomiting and gross weight loss, his wife forcibly got all the tests done and it was found that he had incurable cancer of oesophagus.
Hematemesis or blood vomiting occurs during the later stage of the disease. Sometimes the wall of the oesophagus gets eroded and a passage is created between the oesophagus and trachea or the wind pipe. This leads to cough while eating since the food passes into the trachea which in turn leads to lung infection.
Swallowing difficulty and weight loss are highly indicative of cancer of oesophagus. 80 per cent of the oesophageal tumours are malignant. Anybody with these complaints should be tested with an endoscopy followed by biopsy if any ulceration or growth is visualized. Endoscopy is a simple procedure wherein a tube-like structure, fibre optic in nature is inlioduced through the mouth and negotiated through oesophagus into the stomach. This can guide us regarding the site, extent and nature of the disease, and tissue for biopsy can be obtained.
CT scan of chest and abdomen determines the spread of the disease beyond oesophagus to the surrounding structures or distant organs like liver and lymph glands in chest and abdomen. Intraluminal oesophageal ultrasound examination (EUS) can pick up lymph nodes surrounding oesophagus and a fair idea of the depth of cancer in the wall can be obtained.\ Barium swallow (a thin solution of barium sulphate is given to the patient to swallow and X- rays are taken) is a very informative investigation, which is losing out to endoscopy as it is more informative.
Types of carcinoma
There are commonly two types of carcinomas, namely squamous carcinoma and adenocarcinoma. Squamous carcinoma occurs in upper and middle third, and adenocarcinoma is mostly limited to lower third. Oesophageal carcinomas are usually diagnosed late since obstructive features like swallowing difficulty occur when a part of the oesophagus is blocked by a big tumour which has already become advanced.
The treatment, like all other malignancies, comprises of surgery, chemotherapy and radiotherapy. Early disease can be treated well with surgery which is followed up with chemotherapy or radiotherapy, or both, depending upon the final histopathology report. This mode of treatment gives the best result. Other stages of disease are treated with a combination of chemotherapy and radiotherapy. Newer techniques of radiotherapy and novel chemotherapeutic agents have improved the outcome with fewer side effects.
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