13 Risk Factors, 5 Stages

13 most common risk factors for esophageal cancer

1. Chronic acid reflux (as seen in gastroesophageal reflux disease)
2. Smoking
3. Alcohol consumption
4. Obesity
5. Barrette’s esophagus (a precancerous condition in which there is damage to the cells in the lower portion of the esophagus due to chronic acid reflux)
6. Older age (esophageal cancer risk is higher in people older than 60 years)
7. Male gender
8. Diet rich in processed meats
9. Frequent consumption of very hot liquids (149°F)
10. Tylosis (a rare genetic condition characterized by thickening of the skin of palms and soles and may be associated with abnormal growths in the esophagus)
11. Drinking corrosive liquids (such as lye)
12. Human papillomavirus infection
13. Other genetic conditions, such as Plummer-Vinson syndrome, Bloom syndrome, Fanconi anemia

11 symptoms of esophageal cancer

Esophageal cancer generally does not cause any symptoms in its early stages. Symptoms usually appear by the time cancer is advanced and may include:

1. Dysphagia (difficulty swallowing – initially to solid foods but later progresses to dysphagia to liquids as well)
2. Loss of weight
3. Appetite loss
4. Pale complexion (due to anemia occurring as a result of bleeding from the esophagus)
5. Vomiting
6. Black, tarry stool (due to bleeding)
7. Pain under the lower end or behind the breastbone (sternum)
8. Hoarseness
9. Chronic cough
10. Frequent lung infection (pneumonia)
11. Bone pain (when the tumor spreads or metastasizes to the bones)

What are the stages of esophageal cancer?

Staging is a crucial determinant of various aspects related to cancer, including the expected survival rates and the best treatment approach. Staging helps the doctor know how much cancer has spread in the body. The staging is done from 0 to IV with 0 being the earliest and IV being the most advanced stage of esophageal cancer.

Staging is done based on three main factors:

1. The primary tumor (denoted as T)
2. Lymph node involvement (denoted as N)
3. The extent of spread or metastasis to other sites (M)

Staging considers the grade of cancer or how closely cancer cells resemble normal cells. Grade I (GI) means cancer cells appear quite similar to normal cells, and GIII means the cells look quite abnormal.

Staging of the most common type (about 80 percent of the cases) of esophageal cancer, adenocarcinoma, includes:

1. Stage 0 (high-grade dysplasia)

   • Cancer is localized to the epithelium (the top layer of cells lining the inside of the esophagus) and has not spread to the deeper layers.

2. Stage I

   • IA: Cancer is growing in the deeper layers (lamina propria or muscularis mucosa layer) of the esophagus but has not spread to any lymph nodes or distant organs. Cancer can be grade I or unknown grade.
   • IB: Cancer is growing into the lamina propria, muscularis mucosa, or the submucosa but has not spread to nearby lymph nodes or distant organs. Cancer can be grade I or II or an unknown grade.
   • IC: Cancer is growing into the lamina propria, muscularis mucosa, submucosa, or muscularis propria (the thick muscle layer) but has not spread to nearby lymph nodes or distant organs. Cancer can be grade I, II, or III.

3. Stage II

   • IIA: Cancer is growing into the muscularis propria but has not spread to nearby lymph nodes or distant organs. Cancer can be grade III or unknown.
   • IIB: Cancer is growing into the lamina propria, muscularis mucosa, or the submucosa and has spread to one or two nearby lymph nodes but has not spread to distant organs. Cancer can be any grade, or cancer is growing into the outer layer of the esophagus (the adventitia) but has not spread to nearby lymph nodes.

4. Stage III

   • IIIA: Cancer is growing into the lamina propria, muscularis mucosa, submucosa, or muscularis propria but has spread to no more than six nearby lymph nodes and has not spread to distant organs. Cancer can be any grade.
   • IIIB: It has not spread to distant organs. Cancer can be any grade and is growing into one of the following:
     • The muscularis propria and spread to no more than six nearby lymph nodes
     • The adventitia and spread to no more than six nearby lymph nodes
     • The pleura (the thin tissue layer over the lungs), pericardium (the thin sac covering the heart), or diaphragm (the muscular partition under the lungs that separates the chest from the abdomen) and spread to no more than two nearby lymph nodes

5. Stage IV

   • IVA: It has not spread to distant organs. Cancer can be any grade and is growing into any one of the following:
     • The pleura, pericardium, or diaphragm and spread to no more than six nearby lymph nodes
     • The trachea, aorta (the large blood vessel coming from the heart), spine, or other crucial structures and no more than six nearby lymph nodes
     • Any layers of the esophagus and spread to six or more nearby lymph nodes
   • IVB: Cancer has spread to distant lymph nodes and other organs, such as the liver and lungs. Cancer can be any grade.

What is the treatment of esophageal cancer?

The treatment of esophageal cancer mainly depends on:

• The stage of cancer
• The patient’s general health
• The location of the cancer
• The patient’s preferences for treatment

Treatment may consist of any or a combination of the following:

• Surgery (may be conventional or endoscopic surgery)
• Radiation therapy (uses high energy radiation, such as X-rays or gamma rays to destroy cancer cells)
• Chemotherapy (uses medications that destroy cancer cells)
• Laser therapy (uses laser light to destroy cancer cells)
• Immunotherapy (uses medications that help the immune system destroy cancer cells)
• Electrocoagulation (heat from electric current is used to destroy cancer cells)
• Targeted therapy (targets specific characteristics of cancer cells to destroy them without harming normal cells)