The esophagus is the channel through which swallowed food and liquid enter the stomach. The esophageal wall is primarily made up of muscle tissue which contracts forming peristaltic waves that transport food to the stomach.
Esophageal tumors usually originate in the epithelial cells that form the lining of the esophagus. They undergo alterations in their DNA that cause changes in appearance and function, in addition to uncontrolled growth. This type of tumor usually grows invading surrounding tissues, but can also spread to other parts of the body.
The different types of esophageal cancer are classified according to the type of cells involved:
- Adenocarcinoma usually originates in the mucus-secreting glands that replace normal esophageal epithelium. It customarily affects the inferior part nearest to the stomach.
- Epidermoid carcinoma originates from the cells forming the normal lining of the esophagus. It tends to affect mainly the middle and upper third parts of the esophagus.
If diagnosed early on, it is a type of cancer that can be prevented and cured in a high percentage of cases.
iTAcC has a highly specialized medical team in the diagnosis and treatment of esophageal tumors. Treatment decisions are carried out in a multidisciplinary manner, involving specialists in the digestive system (endoscopists), general surgeons, otolaryngologists, thoracic surgeons, pulmonologists, radiologists, pathologists, radiation oncologists and medical oncologists. Nutritionists and physiotherapists at iTAcC provide rehabilitative support to the patient during and after treatment. All of the aforementioned provides the best guarantee in the prevention, diagnosis and treatment of cancer.
A state of chronic inflammation in the esophagus has been shown to contribute to altered cell DNA and cause the growth of a tumor.
The principal factors which can contribute to tumor development in the esophagus are:
- Alcohol abuse.
- Gastroesophageal reflux disease: it is an alteration of the esophageal mucosa due to the presence of stomach acid caused by inadequacy of the lower esophageal sphincter.
- Barrett’s esophagus: precancerous cells in the mucosa of the esophagus due to chronic gastro-oesophageal reflux.
- Achalasia: it is a disease that affects the muscles of the esophagus producing a pathological contraction in the lower part which makes swallowing food difficult.
- Eating very hot food.
- Diet low in fruits and vegetables.
- Age: most cases are found between 55 and 70 years of age.
- Gender: more common in men than in women (the ratio is 3 to 1).
A good prevention is based on:
- Drink alcohol in moderation.
- Quit smoking.
- Weight control.
- A diet rich in fruits and vegetables.
- Reduce the risk of gastroesophageal reflux by avoiding foods like coffee and fats.
Early diagnosis and treatment of preneoplastic lesions such as Barrett’s esophagus is also extremely important in the prevention of esophageal cancer.
Diagnosis begins with a complete medical history and examination. Dysphagia (difficulty swallowing solids and liquids) is the most common clinical manifestation that we see in esophageal cancer. Bleeding may also be present in some cases.
Several additional tests are performed when an esophageal tumor is suspected:
- Esophagoscopy: the doctor passes a flexible tube called an endoscope through the mouth. It permits seeing the entire distance from the esophagus and stomach as well as extracting tissue samples (biopsy) for their analysis.
- Barium X-ray: a thick contrast is administered orally. It is adheres to the walls of the esophagus and improves the visualization of any abnormality at this level.
Various imaging tests are performed in order to diagnosis the extent of the disease: the level of involvement of the esophageal wall and regional lymph nodes. These tests are:
- The computed tomography (CT) is usually the first step in staging esophageal cancer. It is an imaging technique that uses X-rays to obtain sharp images so that the thoracic and abdominal cavity can be studied in great detail. A radiopaque contrast is injected in many cases in order to obtain better visualization of lesions and affected lymph nodes.
- Positron Emission Tomography (PET) is a test that requires the use of a small amount of radioactive glucose in order to detect growing tumor cells.
- Endoscopic ultrasound (EUS): The doctor passes a flexible endoscope through the oral cavity which emits ultrasounds that allow an examination of the esophageal lesion” in direct contact” with it. It is the best diagnostic test to evaluate the depth of the lesion within the wall of the esophagus.
The medical team at iTAcC is in direct contact with specialists in the digestive system (endoscopists), general surgeons, otolaryngologists, thoracic surgeons, pulmonologists, radiologists, pathologists, radiation oncologists and medical oncologists, who are involved in designing the best treatment for the patient diagnosed with esophageal cancer.
The main objective at iTAcC is to carry out a personalized treatment in order to obtain the highest success rate in each patient.
The early stages of esophageal cancer on occasion can be treated by endoscopic procedures conserving the anatomical integrity of the organ and reducing complications simultaneously. The endoscopic mucosal resection technique allows for the complete elimination of the part of the mucosa and submucosa of the esophagus affected by the more superficial lesions. This technique is often associated with radiofrequency ablation for the specific treatment of Barrett’s esophagus.
The endoscopy plays an important role in the opening of the esophageal light channel using esophageal stenting. This improves the feeding of patients in selected cases.
Surgical removal of the esophagus (esophagectomy) is the cornerstone in the treatment of esophageal tumors. Sometimes it can be done as a single treatment according to the stage of the disease. Quite often it is associated with radiotherapy and chemotherapy as part of an integrated, multidisciplinary treatment.
The surgeon may remove all or part of the esophagus in addition to the upper region of the stomach together with the surrounding lymph nodes in a surgical procedure. The continuity of the digestive system is then reconstructed and joined with the remaining portion of the stomach or intestinal tract.
These surgical procedures can be performed in select cases by the minimally invasive thoracoscopy and laparoscopy. They require a shorter hospital stay; have less postoperative pain and a faster recovery. The minimally invasive esophagectomy has excellent clinical and oncologic results when performed by experienced surgeons.
iTAcC physicians may recommend radiation therapy in combination with chemotherapy. This depends on the clinical and pathological stage of the tumor, the size of the lesion and the involvement of the regional lymph nodes. Treatment can be administered before (neoadjuvant) or after (adjuvant) the surgery in order to eliminate possible microscopic disease and improve the results obtained only by surgery.
Radiotherapy and chemotherapy may be used alone or in combined as a definitive treatment for the patient in more advanced stages of the disease when response to surgical treatment has been null.
At iTAcC we have the most advanced technology for administering precise radiotherapy treatments. With the TrueBeam STx system the following techniques can be carried out:
- Stereotactic body radiotherapy (SBRT)
- Intensity Modulated Radiation Therapy (IMRT)
- Image-guided radiotherapy (IGRT)
We are able to deliver high doses of radiation to the tumor with sub-millimeter precision. This system detects respiratory movements of the patient which decreases the maximum side effects in organs and peripheral tissues such as the heart and lungs during short term session treatment of the tumor.
At iTAcC we foster a strong interest in research and in-depth clinical protocols. This allows for the development of new therapies and improves existing ones with the goal of increasing survival rate as well as improving the quality of life of patients diagnosed with esophageal cancer.
It is necessary after treatment to begin the follow-up protocol which is based on a thorough control of patient progress by specific imaging tests.