Cardiovascular and Thoracic Surgery

ALERT BAR

Diseases of the Esophagus

gastro2The esophagus is a muscular tube that extends from the neck to the abdomen and connects the mouth to the stomach. The lining of the esophagus is the most common region for cancers of the esophagus to begin. Most of the length of the esophagus is lined with squamous cells, which, if they degenerate into a malignant tumor, give rise to a type of cancer called squamous cell cancer. The very bottom portion of the esophagus and the region where the esophagus and stomach join are lined with columnar cells that can give rise to malignant tumors called adenocarcinomas. Other rare forms of esophageal cancer include sarcoma and small cell cancer. Esophageal cancer is not nearly as common as cancers of the breast, lung, prostate, or colon.

Most people who develop esophageal cancer are in their 50's to 70's. In the U.S. squamous cell cancers develop more often in men than they do in women, and are more common among African-Americans than among Caucasians. This is likely due to the higher incidence of specific risk factors in this population than to any increased risk based on race. Adenocarcinomas are more common among men than women and are much more likely to occur in Caucasions than in minorities.

Symptoms

The most common symptom of esophageal cancer is difficulty swallowing, or the sticking of food before it gets into the stomach. This is usually a progressive problem which begins initially when large pieces of poorly chewed food are swallowed, but can worsen to the point that thin liquids won't go down easily. Esophageal cancer may also cause weight loss, pain with swallowing, regurgitation of undigested food, and bleeding manifested by vomiting blood or passing old blood with bowel movements.

If you experience these symptoms, you should promptly visit your physician. There is no simple way to determine whether you have esophageal cancer. Tests are usually necessary to determine whether there is a growth (or tumor) in the esophagus that is creating problems with swallowing. If such a problem is identified, a biopsy is necessary to confirm the diagnosis.

Tests

An endoscopy is usually the first step in evaluation. This is an outpatient test performed under sedation in which a flexible telescope is passed through your mouth and down your esophagus into your stomach. The telescope permits the physician performing the test to look at the lining of the esophagus and take a small bite of tissue, or biopsy, of any areas that look suspicious. The tissue is looked at under a microscope to determine whether there is cancer present. Other common tests include an x-ray of the esophagus and stomach or a computed tomography, or a CT scan, of the chest and abdomen to get a picture of the lungs, liver, and other organs surrounding the esophagus.

Treatment

Minimally Invasive Esophagectomy procedure does not require large incisions; wounds therefore heal extremely wellThe treatment of any cancer depends in part on the stage of cancer at the time it is diagnosed. Other considerations include the overall condition of the patient and specific symptoms the patient is having. Most cancers of the esophagus are diagnosed at a relatively late stage because symptoms of swallowing difficulty don't begin until many months after the cancer begins to grow.

For patients in whom the cancer has not spread to other organs, and thus is potentially curable, surgery to remove the majority of the esophagus is the main form of therapy. Minimally invasive procedures involving laparoscopic surgery, thoracoscopic surgery, or both are the mainstay surgical approach for a variety of benign esophageal disorders and are associated with equivalent functional results compared with open procedures. These techniques offer the potential advantages of enhanced recovery, a reduction in pain, and a quicker return to normal function. Many patients also receive chemotherapy (intravenous drug therapy) and radiotherapy (X-ray treatments) after surgery.

For patients who are found to have cancer spread to other organs or who, for some other reason, can't have surgery, combined chemotherapy and radiotherapy is the most common treatment.