Esophagus is the part of the gastro intestinal tract connecting pharynx of the mouth with the stomach. The lower end of the esophagus which connects with the stomach normally remains partially closed so as not to allow the acid contents of the stomach to come and injure the esophagus.
In India, esophagus is the commonest site of gastrointestinal cancer after the oral cancer.
Causes
Cancer of the esophagus is common in Kashmir. Amongst the food habits of Kashmiris which differ from the people in other parts of the country, are consumption of large quantities of very hot saltish tea (noon chai), high intake of spices such as chillies, animal fats and smoking. These factors, along with attendant vitamin deficiency, may combine to produce injury of the oesophageal lining, leading to the high incidence of oesophageal inflammation seen in the Kashmiri population.
Symptoms
· Difficulty in swallowing solid or semi-solid food and in later stages even liquid food.
· Pain in the middle of the chest and also in the back.
· Loss of weight.
· Vomiting of food that has been taken lately, sometimes mixed with blood.
Diagnosis
Routine: Blood: Hb, and RBC may be lowered. TLC and DLC may be normal. ESR is raised.
Stool: Evidence of altered (occult) blood may be seen in the stool examination.
Special:
· Barium swallow may reveal a cancer or an ulceration.
· Endoscopy (oesophagoscopy) may show the lesion directly.
· Biopsy examination taken through endoscopic forceps, would clinch the diagnosis.
Additional: Liver scan may reveal if the cancer has spread in the liver.
Treatment
The cancer is usually not detected early enough.
Surgery: Surgical removal of the cancer in the upper two-thirds of the esophagus is more difficult technically than in the lower one-third. Both the thorax and the abdomen have to be opened, so as to remove the cancer tissue and to rejoin the normal esophagus with stomach. Healing from the operation takes a long time.
Radiation: It is only done to give some relief for sometime from the symptoms, such as pain or difficulty in eating. It is given for 4 or 5 days each week for a total of about 5 weeks.
Side-effects include nausea, diminished appetite and initially an increase in the difficulty in swallowing.
Surgery and radiation may be given together.
Chemotherapy: No useful drug is available to treat the cancer of the esophagus or its secondaries if they have spread in the liver, lungs and bones.
Prognosis
Oesophageal cancer has a grim prognosis, as it does not produce clear symptoms early enough. Vague discomfort during swallowing and heaviness or uneasiness underneath the sternum are usually ignored by the patient so that the cancer is not detected early.
Early Detection
Signs & Symptoms
· History of living in a region of the country where this cancer is common.
· Difficulty in swallowing solid or semi-solid food.
· Discomfort or pain in the middle of the chest and also in the back.
· Vomiting of food that has been taken lately, sometimes mixed with blood
Investigations
· Barium swallow.
· Endoscopy (oesophagoscopy) which shows the lesion directly.
· Biopsy examination of the tissue taken through the endoscope.