The esophagus is an anatomic and functional structure of the digestive tract. It is basically a contractile muscular tube that joins the throat to the stomach, situated immediately behind the trachea or the windpipe. Its job is to transfer the food and liquids that have moved from the throat down to the stomach. The esophagus length is normally about 10 to 13 inches.
The esophagus consists of multiple layers, basically divided into the Mucosa, Submucosa, Muscularis propria and the Adventitia.
1. Mucosa: The layer that lines the interior of the esophagus is called the mucosa. The mucosa in turn has three layers-
- The Epithelium- It is the first layer of the mucosa of the esophagus. It is made up of either squamous cells (flattened epithelial cells) or columnar cells (slightly taller epithelial cells). The epithelium is the starting point for most esophageal cancers.
- The Lamina Propria- It lies just below the epithelium. It is made up of a thin layer of connective tissue.
- The Muscularis Mucosa- It is an extremely thin layer of muscle located just under the lamina propria.
2. The Submucosa: This is again a layer of deeper connective tissue located below the mucosa (hence called submucosa). It contains mucous glands for lubrication of the esophagus
3. The Muscularis Propria: It is a very thick layer of muscle under the submucosa. Its job is to contract in a synchronized, rhythmic way to propel food along the esophagus, starting from the throat and going to the stomach.
4. The Adventitia: The outermost esophageal layer, again made up of connective tissue.
What is cancer of the esophagus ?
Cancer of the esophagus (esophageal cancers) are cancers that occur in the esophagus.
What are the causes of esophageal cancers ?
- Mostly the causes of esophagus tumours are environmental, rather than genetic.
- The environmental factors that are known to contribute to esophageal cancers are alcohol consumption, cigarette smoking, deficiencies of Iron, riboflavin, and vitamin A, poor diet and increased food temperatures while eating.
- Certain medical conditions like Celiac disease and Barrett’s Esophagus have been particularly associated with esophageal cancer.
Barrett’s Esophagus
- Barrett’s esophagus is a condition of the esophagus where the normal mucosa or lining changes to resemble that of intestinal mucosa.
- It is a known risk factor for adenocarcinoma of the esophagus. In fact, the risk of developing adenocarcinoma in Barrett’s esophagus is likely to be 30–45 times higher than that of the general population.
What are the types of esophageal cancers ?
There are two basic types of Esophagus Tumours-
- Squamous Cell Carcinomas- Malignant Cancers that initiate in the squamous epithelial lining of the esophagus.
- Adenocarcinomas- Malignant Cancers that initiate in the gland cells that produce mucous.
What are the clinical features of esophageal cancers ?
The symptoms can include difficulty in swallowing or dysphagia, hiccups, or food regurgitation (food coming back up the esophagus into the mouth). If there is pain or discomfort in the throat, hoarseness, persistent cough or vomiting, it is important to see a doctor immediately.
How are esophageal cancers diagnosed ?
- A complete physical examination of the body is mandatory.
- Endoscopy – An endoscopic examination is to be done for the investigative line-up. During an endoscopic examination of the upper digestive tract (also called as esophagogastroscopy), a thin, flexible, lighted tube called an endoscope is passed down the patient’s throat. This enables the doctor to check and examine the lining of the esophagus, stomach, and the inner organs. An ultrasound can also be done along with the endocopiy (endoscopic ultrasound).
- Radiology- A CT scan of the chest and abdomen is usually performed. A barium swallow is done to indicate the exact location of the tumor in the esophagus. A barium swallow basically consists of taking radiographic or x-ray pictures after the person drinks a special liquid. Because this liquid is bright and clear on the X-ray picture, we can visualize the esophagus clearly.
- Biopsy/Histopathologic Examination- If abnormal areas are noted on endoscopy, biopsies or tissue samples can be obtained with instruments passed through the endoscope. These tissue samples are examined by a pathologist and the diagnosis will be arrived at.
How are esophageal cancers treated ?
The chief types of treatment that can be used for esophageal tumours include the following.
- In the current era, for esophageal dysplasia (precancer), after establishing an early, timely diagnosis, immediate, appropriate treatment can be given for cure.
- The treatment will usually combine intervention methods that either act locally (surgery or radiotherapy) or that act on cancer cells all over the body by systemic therapy such as chemotherapy.
- It is recommended to get to know from your oncologists about the expected benefits and risks of every treatment in order to be aware of all the possible consequences.
- When a tumor is yet confined and the patient is fit enough, surgery is the treatment of choice. This is in case of localized disease. Surgery is then the preferred option. However, surgery of the esophagus can carry high risks, therefore not all patients can be operated on.
- So it is the tumor stage, its location, its histopathological variants (adenocarcinoma or squamous cell carcinoma) and the patient’s fitness that dictate if surgery can be done or not. In case of tumour spread to rest of the body (extensive disease), surgery is not considered.
What is the care to be taken after the removal of an esophageal cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans. Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
How to find and reach cancer specialists for esophageal cancer treatment ?
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
