Diseases of esophagus & stomach

Diseases of esophagus and stomach

The esophagus is a long, hollow tube that runs from the throat to the stomach It helps move swallowed food from the mouth to stomach for digestion. Esophageal cancer usually begins in the cells that line the inside of the esophagus.

Esophageal cancer can occur anywhere along the esophagus. Although both genders can be affected, men are more commonly affected by esophageal cancer than women.

Types

Symptoms

• Difficulty and pain with swallowing, particularly meat, bread, or raw vegetables. At the start patient may have pain when swallowing solids. As the tumor grows, it can block the pathway to the stomach. Later on, even liquid may be painful to swallow. Advanced cases may be unable to swallow at all.
• Pressure or burning in the chest
• Pain in the chest or throat
• Indigestion or heartburn
• Vomiting
• Frequent choking on food
• Unexplained weight loss
• Coughing or hoarseness of voice

Risks

Common risk factors for esophageal cancer are:

• Gender – Men are three times as likely to develop esophageal disorders as women.
• Age – Risk of esophageal cancer is highest after 65.
• Tobacco – Any form of tobacco use, including cigars, cigarettes, and chewing tobacco, increases the risk of esophageal cancer.
• Alcohol – High intake of alcohol increases your risk. The risk is higher for people who smoke and drink regularly
• Diet – Eating a diet rich in fruits and vegetables lowers your risk, while eating a diet high in processed meats may increase your risk. Overeating is also associated with an increased risk.
• Obesity – Obese people are more likely to develop esophageal cancer.
• Gastroesophageal reflux disorder (GERD) – Apart from immediate effects such as discomfort, and relatively short-term effects such as oral problems, GERD is associated with a higher risk of esophageal cancer. The risk is higher the longer you have the condition and the more severe the symptoms are.
• Barrett’s Esophagus – People with chronic GERD can develop Barrett’s Esophagus, in which the squamous cells of the lower esophagus are replaced by gland cells more associated with the small intestine. This condition is associated with a significant increase in the risk of other esophageal disorders, like cancer
• Achalasia – If the sphincter between the esophagus and stomach doesn’t relax properly, it can’t stretch out all the time. Food then sits in the lower esophagus, causing irritation. Achalasia is a major risk factor for esophageal cancer

Diagnosis Tests

Once you consult an oncologist and tell him about your symptoms, he will guide you towards further diagnostic procedures. This might include some tests and procedures like:

Barium swallow/ esophagram

The patient swallows a liquid containing barium and then a series of x-rays are taken. Barium coats the surface of the esophagus, making a tumor easier to see on the x-ray.

Upper endoscopy, also called esophagus-gastric-duodenoscopy

Upper endoscopy allows the doctor to see the lining of the esophagus. A thin, flexible tube with a light and video camera on the end, called an endoscope, is passed down the throat and into the esophagus while the patient is sedated. If there is an abnormal looking area, a biopsy will be performed to find out if it is cancerous.

Endoscopic ultrasound

This procedure is often done at the same time as the upper endoscopy. During an endoscopic ultrasound, an endoscopic probe with an attached ultrasound that produces the sound waves is inserted into the esophagus through the mouth. The ultrasound is used to find out if the tumor has grown into the wall of the esophagus, how deep the tumor has grown, and whether cancer has spread to the lymph nodes or other nearby structures. An ultrasound can also be used to help get a tissue sample from the lymph nodes.

Biopsy

Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A biopsy is the removal of a small amount of tissue from the suspicious area for examination. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

Computed tomography (CT or CAT) scan

A CT scan creates takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Usually, a special dye called a contrast medium is given before the scan to provide better detail. This dye is generally injected into a patient’s vein.

Magnetic resonance imaging (MRI)

An MRI uses magnetic fields to produce detailed images of the body. MRI can be used to measure the tumor’s size. A contrast medium is usually injected into a patient’s vein to create a clearer picture.

Positron emission tomography (PET) scan

PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Stages

Stage 0 & I

At this stage, cancer is limited to the innermost layer i.e. mucosal lining. It has not yet reached the muscle layer. This is a very early stage and generally it is detected by chance without any symptom or signs. Additional tests are required to confirm the stage. Since it is an early stage results of cure are very good (90-95% survival).

Stage II

At this stage, cancer has reached the muscle layer. In many of these patients, surgery may be the initial treatment. Other option that is very often done is to give chemotherapy with radiation therapy to the tumor followed by surgery. This increases the chance of cure, but, increases the risk of complications during and after surgery. However, surgery is the only treatment that can cure this cancer. The surgeon takes the decision based on the case findings.

Stage III

Stage III includes locally advanced cancers where the treatment can be surgery when it is possible. However, if some important structures like major blood vessels or heart is involved, surgery would not be possible. In these cases a combination of chemotherapy and radiotherapy is preferred.

Stage IV

Stage IV is when the cancer is spread to other organs like liver and lung. At this stage disease is treated with chemotherapy or symptomatic and supportive care, as indicated. Cancers of esophagus in the region of neck and upper part of chest are usually treated with chemotherapy along with radiation.