The disease more often affects the elderly, the peak incidence falls on the age of 60 to 80 years. In recent years, however, alarming data have been provided on the increase in the frequency of occurrence of the disease in the middle age group (30-50 years). Modern methods of treating esophageal cancer today in the article.
Geography of the disease
The largest prevalence of esophageal cancer among countries in Europe and North America is observed in France. In some regions of the world, namely in the northern part of China, in Transkei (southern Africa), as well as in northeastern Iran, the disease can be considered endemic, since in them the incidence is 20-30 times higher than in the West.
The risk factors for esophageal cancer include:
• tobacco - smoking and chewing tobacco;
• Alcohol abuse - in some regions of the world, local alcoholic beverages, because of their composition or mode of treatment, favor the development of a tumor;
• malnutrition - insufficient intake of certain vitamins and trace elements, as well as fruits and vegetables, reduces the level of protective factors;
• physical factors - thermal burns with very hot food and drinks; adherence to spicy food and pickles, which explains the geographical features of morbidity.
Diseases of the esophagus
Various pathological conditions of the esophagus are considered as risk factors, including:
• Achalasia - a violation of the motor activity of the esophagus due to the destruction of nerve elements in the wall of the esophagus;
• reflux-esophagitis-chronic inflammation of the esophagus mucosa due to back-casting of acidic gastric contents;
• Barrett's esophagus - transformation of normal cells of the lower part of the esophagus into cells of the gastric type; the disease increases the risk of esophageal cancer by 40 times;
• Plummer-Vinson syndrome - the condition is associated
Two main forms of esophageal cancer are known:
• squamous cell carcinoma is the most common form (more than 90% of cases);
• Adenocarcinoma - has recently been encountered more often (up to 8%).
Clinical manifestations
The tumor can grow into the lumen of the esophagus in the form of a fungus (polypous cancer - approximately 60% of cases), can have the appearance of ulcers (25%) or sprout esophageal walls (invasive cancer). Esophageal cancer is characterized by aggressive growth and early metastasis (spread) within the thoracic cavity and into distant organs through the blood and lymph vessels. The most common foci of tumor elimination appear in the liver and lungs. Approximately 75% of patients at the time of diagnosis of esophageal cancer have metastases.
Forecast
For the prognosis of the disease, the presence or absence of metastases is critical. The boundary of five years is experienced by less than 3% of patients with secondary tumor foci, although in the absence of metastases - more than 40%.
Symptoms
The main complaint of patients is progressive dysphagia (violation of swallowing). At first, the sensation of "sticking" food when ingested can only periodically appear. Gradually there is difficulty in passing first solid food, and then liquid, until finally the patient can not swallow even saliva. Other symptoms:
• weight loss;
• pain in the chest;
• dysphagia (pain when swallowing);
• vomiting with an admixture of blood (a fairly rare symptom).
Because of the elderly patients with esophageal cancer, chest pain can be mistaken for cardiac. Sometimes patients who are examined for cardiac disease are diagnosed with esophageal disease. The purpose of the examination is to determine the degree of tumor growth and the possibility of its surgical removal. The following studies are carried out.
• Contrast radiography. The patient takes inside a contrast agent (usually barium) visible on X-rays. Esophageal cancer usually has a very characteristic form on radiographs.
• Esophagoscopy. Examination of the internal surface of the esophagus with the help of an optical fiber endoscope plays a crucial role in diagnosis, since it allows taking material from a suspicious area to a biopsy. Pathohistological study of the material determines the nature of the neoplasm and, in case of its malignancy, identifies the type of tumor. Esophagoscopy also allows to establish the exact localization of the tumor - in the upper, middle or lower third of the esophagus.
• CT scan of the thoracic and abdominal cavities. The purpose of this study is to determine the presence of metastases, for example, in the liver or in the lungs, as well as secondary damage to the lymph nodes. The presence of metastases, as a rule, indicates an inoperable tumor.
• Bronchoscopy. Endoscopic examination of the respiratory tract is carried out with suspicion of the spread of the tumor to the lungs. In the early stages of tumor development the optimal method of treatment is a resection of the esophagus. But in most cases, unfortunately, we have to limit ourselves to palliative therapy. The spread of the tumor beyond the esophagus in most patients excludes the possibility of a cure. If the disease is not caught at an early stage, surgical treatment is advisable, only in a small number of patients.
Palliative Therapy
Palliative therapy of esophageal cancer aims to alleviate the symptoms and aims to restore the ability to swallow. Most often for this purpose intubation of the esophagus is carried out, that is, the institution of a special tube (stent) keeping its lumen open, which ensures the passage of food and water. The stent is started under the radiological control at local anesthesia or operative by anesthesia. An operation known as esophagectomy or esophagogastrectomy involves:
• removal of the entire esophagus, except for the uppermost part, together with the initial section of the stomach in conjunction with surrounding tissues and lymph nodes;
• Restoring the integrity of the digestive tube by connecting the remain of the stomach with the proximal (upper) portion of the esophagus - usually performed at the level of the lower third of the neck.
Surgical access is provided through a cut in the left side of the chest (left-sided thoracotomy), in the right half (right-sided thoracotomy), by opening the abdominal cavity (laparotomy) or by combining all three options. Often there is a need to create an additional incision on the left side of the neck. Other options for surgical treatment are essentially palliative. Most of the cancer-affected esophagus are elderly patients who are in serious condition according to the genus of the underlying disease.
Forecast
The prognosis for the majority of patients is unfavorable. 80% of patients with inoperable cancer die within a year after its detection, regardless of the type of palliative measures. Among the patients undergoing surgery, the outcome is determined by the size and spread of the tumor, the histological type and the degree of involvement of the lymph nodes. In the early stage of esophageal cancer, the five-year survival rate is about 30-40%. With late detection, the mortality is comparable to that in patients with an inoperable tumor. When asked, it became clear that this feeling had been bothering the patient for two months already. At first she tried to overcome the discomfort by changing the nature of food with a predominance of liquid and semi-liquid dishes.