A malignant cell growth in the esophagus is called esophageal cancer. In technical language, esophageal cancer is called esophageal carcinoma. Every year, approximately 11,000 people in Germany are newly diagnosed with esophageal cancer, mostly men and older people are affected.
Dangerous cancer
The esophagus is a muscular tube that transports ingested food from the mouth to the stomach. Because of its great extensibility, a patient with esophageal cancer does not feel the symptoms caused by the increasing narrowing until late in the disease, so the tumor is usually well advanced by the time it is diagnosed. Thus, if the diagnosis is made late, there is usually little chance of cure and the patient’s life expectancy is rather low. Esophageal cancer can be divided into two different types: Squamous cell carcinoma and adenocarcinoma. If the covering cells of the mucosa proliferate, it is called squamous cell carcinoma, which is the more common form of esophageal cancer. If the glandular cells proliferate, it is called adenocarcinoma.
Esophageal cancer: causes in squamous cell carcinoma.
The causes of esophageal cancer are very diverse, and many factors have not yet been determined with certainty. Nevertheless, some factors can be clearly linked to the development of esophageal cancer. Esophageal cancer of the squamous cell carcinoma type is usually found in the upper part of the esophagus. In particular, the following causes underlie squamous cell carcinoma:
- The most important risk factors are smoking and alcohol. They are causative for three quarters of all squamous cell carcinomas. Especially the simultaneous consumption of nicotine and alcohol multiply the risk of esophageal cancer.
- Too hot or too spicy food and drinks attack the mucosa of the esophagus and can thus lead to esophageal cancer.
- Certain additives in food also increase the risk of esophageal cancer. These include nitrosamines, which are present in high concentrations in cured meat, for example, or the substance aflatoxin from certain mushrooms. Ingredients of the betel nut, which is eaten in Southeast Asia heaped, also increase the risk of esophageal cancer.
- Caustic burns or irradiation can damage the mucosa and thus lead to esophageal cancer even after years.
- Furthermore, certain congenital malformations can be the cause of esophageal cancer.
Esophageal cancer: causes in adenocarcinoma.
The less common, but increasing in frequency, form of esophageal cancer is adenocarcinoma, which usually forms in the lower part of the esophagus. In adenocarcinoma, the main cause is reflux of gastric acid from the stomach into the esophagus, which is called reflux disease among medical professionals. As a symptom, the patient usually feels heartburn, but reflux is not always noticed by the patient. As the cause of reflux disease, these factors in particular can be considered:
- A very high-fat diet with little fruit and vegetables promotes the reflux of gastric acid. Therefore, especially overweight people often have an increased risk of esophageal cancer.
- Smoking is also a risk factor in adenocarcinoma.
- More rare cause of reflux are drugs that reduce the pressure of the sphincter between the esophagus and stomach.
- Frequent vomiting of food and stomach acid causes chronic irritation of the mucosa in bulimic patients and thus can also lead to esophageal cancer.
In reflux disease, the sensitive mucosa of the esophagus is subject to constant irritation by gastric acid and becomes inflamed. In the course, the mucosal cells transform into the more robust gastric mucosa, which is then called Barrett’s mucosa or Barrett’s disease. The altered mucosa is a possible precursor to esophageal cancer, but not all Barrett’s mucosa has to develop into cancer. Nevertheless, patients with Barrett’s disease should have regular checkups to detect a potentially developing tumor as soon as possible and increase their chances of recovery.
Esophageal cancer and its symptoms.
Because the esophagus is very ductile, incipient esophageal cancer can enlarge unnoticed for a long time before the first symptoms and discomfort appear.The first symptoms are usually difficulty swallowing, pain when swallowing or the feeling of having a “lump in the throat”. Often, the esophageal cancer is already far advanced at this point and the chances of recovery and thus the patient’s life expectancy are very limited. The first symptoms are usually subtle and non-specific, and they can quickly be misjudged as trivial complaints. Therefore, it is especially important to recognize signs of esophageal cancer early. In addition to difficulty swallowing as a leading symptom, there is also pain or a feeling of pressure behind the chest, which is occasionally perceived as back pain.
Difficulty swallowing as the first sign
Other symptoms may include gagging when swallowing, constant heartburn after eating, or frequent forceful belching. Later, cramps in the esophagus may also indicate esophageal cancer. These symptoms can have many causes and do not always have to mean esophageal cancer, but a doctor should be consulted in these cases. Due to the difficulty in swallowing food, patients with esophageal cancer suffer from severe weight loss. If the esophageal cancer has already spread beyond the esophagus and invaded the trachea, food can enter the airways and cause pneumonia. The growth of the tumor into the larynx can cause hoarseness. These symptoms signify outgrowth of the cancer beyond the organ boundaries and further worsen the life expectancy of esophageal cancer.