Esophageal cancer is malignancy of the esophagus. There are two types of esophageal cancer: adenocarcinoma and squamous cell carcinoma.
The clinical features commonly seen in the patients of esophageal carcinoma include the following:
Esophageal carcinoma frequently spreads by the following routes:
The following investigations are required when esophageal carcinoma is suspected.
The survival of the patient depends upon the stage of the tumor. The five year survival rate for the patients with stage 1 tumor is 80% whereas for stage 2 patients, it is as low as 30%. The 5 year survival rates for patients with stage 3 and 4 tumor are 18% and 4% respectively.
There is no single cause for the development of esophageal carcinoma; however, certain risk factors have been recognized. The risk factors differ for squamous cell carcinoma and adenocarcinoma of the esophagus.
Squamous cell carcinoma
The most notable risk factors that lead to the development of squamous cell carcinoma of the esophagus are listed below.
It should be noted that the risk for the development of squamous cell carcinoma of the esophagus in the people who are both smokers and alcoholics is exponentially higher.
The risk factors that are associated with the development of adenocarcinoma of the esophagus include the following:
n the United States, esophageal carcinoma is the seventh most common fatal cancer in males. Two kinds of esophageal carcinomas are commonly seen.
Squamous cell carcinoma is by far the more common of the two. It has a peak incidence over the age of 50 years. It is much more prevalent in males as compared to females - the male to female ratio being 3:1. It is most common in China and Iran.
Various risk factors can cause esophageal carcinoma individually or in association with each other. Chronic irritation of the esophagus is the underlying mechanism by which esophageal carcinoma develops.
Tobacco smoking has a highly irritating effect on the esophageal epithelium and so does heavy alcohol intake. The repeated cycles of damage and repair of the esophagus ultimately progress to cancer development.
Similarly, in achalasia, the food stays in contact with the esophageal mucosa for an extended period of time. This causes chronic inflammation and irritation, ultimately leading to the development of squamous cell carcinoma.
The reflux of the acid contents from the stomach has a highly damaging and irritating effect on the esophagus. Barrett’s esophagus which results from long standing reflux disease is a metaplasia characterized by the replacement of the normal squamous epithelium of the esophagus by columnar epithelium of the intestinal type.
All metaplasias have a tendency to progress to cancer development. Further damage by the reflux of the stomach contents accelerates the development of adenocarcinoma in these patients .
Furthermore, mutations in the oncosuppressor gene TP53 also occur which are associated with adenocarcinoma  .
There are no guidelines for prevention of esophageal carcinoma.
Two types of carcinomas can occur in the esophagus; squamous cell carcinoma and adenocarcinoma. Tobacco smoking and alcohol intake are the commonest causes of the former whereas gastroesophageal reflux disease is the commonest cause of the latter.
Esophageal carcinoma is characterized by progressive difficulty in swallowing along with discomfort in the chest and weight loss. If detected early and treated properly, the survival rate is very high.