Esophageal Cancer

The esophagus is a long, hollow tube that connects your throat to your stomach. Esophageal cancer is a type of cancer that develops there. The food you swallow is moved through your esophagus from the back of your throat to your stomach so it may be digested.

Usually, the cells that line the inside of the esophagus are where esophageal cancer develops. Everywhere along the esophagus is susceptible to esophageal cancer. Esophageal cancer affects more males than women.

The sixth most frequent cause of cancer-related fatalities globally is esophageal cancer. Different geographic regions have varying incidence rates. The use of alcohol and tobacco products, as well as certain dietary practices and obesity, may all contribute to a greater prevalence of esophageal cancer in specific areas.

Esophageal Cancer: Causes

The specific causation of esophageal cancer is unclear.

Esophageal cells can become cancerous when changes (mutations) arise in their DNA. Cells expand and divide out of control as a result of the alterations. The esophagus develops a tumor from the accumulating aberrant cells, which has the potential to spread to other organs and adjacent tissues.

Esophageal Cancer: Types

The sort of cells involved determines how esophageal cancer is categorized. Your treatment options are influenced by the type of esophageal cancer you have. Esophageal cancer comes in a variety of forms.

• Adenocarcinoma. The cells of the mucus-secreting glands in the esophagus are where adenocarcinoma develops. The lower part of the esophagus is where adenocarcinoma most frequently develops. The most prevalent kind of esophageal cancer, adenocarcinoma, mostly affects Caucasian men.

• Carcinoma of the squamous cell. The lining of the esophagus is covered in flat, thin cells called squamous cells. Most frequently, squamous cell carcinoma develops in the upper and middle esophagus. Globally, squamous cell carcinoma is the most common esophageal cancer.

• Other uncommon kinds. Small cell carcinoma, sarcoma, lymphoma, melanoma, and choriocarcinoma are a few examples of uncommon esophageal cancers.

Esophageal Cancer: Symptoms

The patient with esophageal cancer mainly presents with the following symptoms −

Progressive solid food dysphagia caused by locally advanced cancer-producing blockage and dysphagia to liquid appears in advanced stages are the most common clinical presentations of both esophageal adenocarcinoma and squamous cell carcinoma.

Dysphagia, which may signify severe illness and cause many patients to be incapacitated at the time of the diagnosis, can lead to cachexia and significant weight loss. It's possible that there were mild, non-specific symptoms first, such as burning or soreness in the retrosternal.

At the time of the initial diagnosis, hematemesis, melena, and anemia symptoms may be present as a result of visible or undetected gastrointestinal bleeding. Although aspiration pneumonia is uncommon, regurgitation can occasionally happen. Laryngeal nerve paralysis, cough, and/or post-obstructive pneumonia are common clinical manifestations in patients with tracheobronchial wall invasion-generating fistulas.

Esophageal Cancer: Risk Factors

Esophageal cancer is hypothesized to develop as a result of alterations brought on by prolonged esophageal irritation. The following things can irritate the cells in your esophagus and raise your chance of developing esophageal cancer −

• Being affected by gastroesophageal reflux disease (GERD)

• Smoking

• Having Barrett's esophagus, which has precancerous alterations in its cells

• Becoming fat

• Consuming alcohol

• Experience bile reflux

• Due to a rigid esophageal sphincter, having trouble swallowing (achalasia)

• A consistent practice of consuming hot beverages

• Inadequate consumption of fruits and vegetables

• Receiving radiation therapy to the upper abdomen or chest

Esophageal Cancer: Diagnosis

The diagnosis of esophageal cancer is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes −

• Swallowing barium study. You consume a barium-containing drink during this investigation, and then you are subjected to X-rays. Your esophagus' inside is coated with barium, which causes any alterations to the tissue to be visible on the X-ray.

• Inspect your esophagus using a scope (endoscopy). A flexible tube with a video lens is passed down your neck and into your esophagus by your doctor during endoscopy. Your doctor checks your esophagus using an endoscope to check for inflammation or cancer.

• Obtaining a tissue sample for analysis (biopsy). Your doctor could take a sample of the questionable tissue using an endoscope, a special scope that is sent down your mouth and into your esophagus (biopsy). A laboratory examines the tissue sample to check for cancer cells.

Estimating Cancer's Severity

If esophageal cancer has been identified, your doctor could advise further testing to find out if the disease has progressed to your lymph nodes or other parts of your body.

Testing could involve −

• Bronchoscopy

• Ultrasound with endoscopy (EUS)

• Computer-aided imaging (CT)

• CT with positron emission (PET)

Your cancer is given a stage by your doctor using the data from these procedures. Roman numerals from 0 to IV are used to denote the stages of esophageal cancer, with the lowest stages signifying tiny cancer that has only affected the outermost layers of your esophagus.

Stage IV signifies cancer's advanced stage and the extent to which it has spread throughout the body. As medical professionals develop cancer diagnosis and therapy, the cancer staging system keeps changing and becoming more sophisticated. Your doctor chooses the best therapies for you based on the stage of your cancer.

Esophageal Cancer: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Conservative Treatment

Chemotherapy is a medication that destroys cancer cells using chemicals. In patients with esophageal cancer, chemotherapy medications are frequently administered either before (neoadjuvant) or after (adjuvant) surgery. Radiation treatment can be used in conjunction with chemotherapy.

Surgical Treatment

Surgical treatment may be required in severe cases which include −

• Tiny tumors are surgically removed.

• Esophagus surgery to remove a piece of it (esophagectomy).

• Surgery to remove the upper stomach and a segment of the esophagus (esophagogastrectomy)

Esophageal Cancer: Prevention

The main preventative step that nurses should stress is quitting smoking and drinking alcohol. Patients should also obtain GERD treatment and keep a healthy body weight.

Conclusion

Even with therapy, esophageal cancer has a relatively poor overall survival rate. Squamous cell cancer rates have decreased over the past few decades, whereas adenocarcinoma rates have gradually risen, primarily due to GERD. Esophageal cancer patients get multidisciplinary care. Every organ in the body is impacted by not being able to eat. The majority of individuals are very underweight when they appear. It is impossible to overstate the importance of the nurse's involvement in caring for these patients following surgery and providing preventative instruction.

The nurse is in charge of starting J-tube feeds, weighing the patient, and keeping an eye out for any adverse effects throughout the recovery period. Many patients experience a wide range of problems, which over time affect their quality of life. These individuals should receive treatment from a dietician to make sure they are getting enough calories.