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Oesophagus Cancer


Gastroesphageal reflux disease or GERD is considered as one of the most common predisposing factors for oesophagus cancer. Located behind the trachea, the oesophagus is a muscular and hollow tube that connects the stomach and the throat. The lumen of the oesophagus helps food to travel into the stomach. It is about 10 13 inches long. The oesophagus has many layers.

  • The first layer is the mucosa. This lines the inner surface of the oesophagus and has three parts the epithelium, the lamina propria and muscularis mucosa.
  • The second layer is the submucosa containing blood vessels and nerves.
  • The third layer is the muscularis propria is a thick layer of muscles, which contracts with rhythm and coordination in order to push food.
  • The outermost layer is adventitia formed by the connective tissue.

Cancer starting in the mucosa and growing into the submucosa and muscle layer is known as oesophageal cancer.

Types

There are two main types of oesophagus cancer:

  • Squamous cell carcinoma squamous cells are thin, flat and form at the mid-portion of the oesophagus. They usually develop in the middle-third of the oesophagus.
  • Adenocarcinoma formed from glandular cells, adenocarcinoma usually affects the lower third of the oesophagus.
  • Rare forms other rare types of oesophagus cancer are lymphoma, malignant melanoma, sarcoma, small cell cancer and choriocarcinoma.

Causes and risk factors

  • Harmful changes in the DNA cells lining the oesophagus are the cause of oesophageal cancer though the exact reason for the mutation is not known.
  • Tobacco and alcohol use of tobacco and alcohol can cause cancer
  • GERD gastroesophageal reflux disease an important predisposing factor for adenocarcinoma
  • Oesophageal injury ingestion of harmful materials, accidentally or intentionally
  • Achalasia when the oesophagus contracts a motility disease
  • Chromosome and gene abnormalities

Signs and symptoms

  • Dysphagia difficulty in swallowing
  • Epigastric pain
  • Bone pain
  • Hoarseness
  • Persistent cough
  • Bleeding
  • Weight loss

Tests and diagnosis

  • Physical examination may not show any abnormality.
  • Diagnostic tests and Imaging studies.
  • Oesophagogastroduodenoscopy to visualize a tumour and to take biopsies to confirm the type of tumor.
  • EUS endoscopic ultrasonography sensitive for T and N staging.
  • PET Positron Emission Tomography is a test for scanning and staging cancer.
  • CT Scan of the chest and abdomen – to know the extent of the local disease as well as the potential for removal by surgery.
  • Laparoscopy and thoracoscopy to stage regional nodes.

Treatment

Surgical treatment will include oesophagectomy with or without preoperative administration of chemotherapy and radiotherapy as a treatment modality for cancer. Surgery entails removal of the entire oesophagus and replacing it with tubularised stomach. This can be done through minimally invasive methods (key-hole surgery) with minimal postoperative morbidity. The treatment of oesophagal cancer needs a multidisciplinary team, as treatment involves chemotherapy, radiotherapy etc.

We have extensive experience in managing oesophagal cancer patients and has performed many key-hole surgeries to remove oesophagal cancer.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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